Postpartum depression (PPD) is a mood disorder that typically occurs within the first few weeks after childbirth and can last up to a year if untreated, affecting about 10% of new mothers. It is characterized by symptoms such as depression, anxiety, and intrusive thoughts, with risk factors including a history of depression, stressful events during pregnancy, and complications during birth. Treatment options include antidepressants, cognitive behavioral therapy, and support resources for both mothers and fathers, as PPD can also affect men, especially when correlated with partners' mental health.

1. Postpartum Depression
UYANGA BAYANDALAI
SPRING 2016

2. Postpartum depression
 Postpartum Depression is a mood disorder that commences after giving birth.
 The DSM does not consider Postpartum Depression as a separate disorder, but
rather a type of mood disorder categorized by a major depressive episode.
 It can occur anytime within the first year after childbirth; however, it
usually occurs within the first couple weeks.
 Many suffer for up to 6 months and about ¼ of sufferers still experience
symptoms after a year if left untreated.

3. Etiology
 Biology:
 Sudden change in hormone levels
 Poor diet
 Lack of efficient sleep
 Pain
 Stress:
 Sudden change in life style
 Change in level of marital support
 Societal expectations of the “Happy Mother”

4. Risk factors
 Women with a previous history of depression or anxiety
 Stressful event during pregnancy
 Premature or complicated birth
 Women with previous history of PPD (55%)
 Illnesses
 Diabetes (50% more likely)
 Thyroiditis (33% more likely)

5. Postpartum Psychiatric disorders
Disorder Incidence Time Course Clinical Features
Postpartum Blues
(A.K.A. Baby Blues) 70 - 80% Within first week to 14 days
Tearfulness, anxiety, insomnia, and
mood instability
Postpartum Depression 10% Within first month
Depression, guilt, anxiety, fear of
harm to baby, and obsession.
Postpartum Psychosis 0.1 - 0.2% Within first month
Disorientation, Confusion,
Delusions, Hallucinations, and
Rapid mood cycling

6. Symptoms of Postpartum Depression
 Depression
 Inability to sleep when the baby sleeps
 Intrusive thoughts
 Thoughts of hurting the baby
 Thoughts of hurting self
 Suicidal thoughts
 Loss of appetite
 Lack of interest in the baby
 Anxiety and panic attacks

7. Detection of Postpartum depression
 Edinburgh Postnatal Depression Scale
 Can be used during pregnancy and postpartum
 10 item, self-administered
 Easy to score
 Validated in at least 12 languages
 PHQ-9
 Clinical interviews with Patient or Family/Significant other
 Ask about appetite, sleep, daily self-care, mood, SI/HI thoughts lasting more than
two weeks.

8. Treatments
 Antidepressants (SSRI’s)
 Low levels in breastmilk
 Paroxetine (Paxil)
 Sertraline (Zoloft)
 Citalopram (Celexa)

9. Treatments continued..
 Cognitive Behavioral Therapy
 Effective in targeting negative thoughts
 Teaches about:
 Automatic thoughts
 Common cognitive distortions
 Assumptions and beliefs.
 Skills:
 Examining and challenging cognitive distortions
 Thought records
 Cost-benefit analysis
 Asking for things that are important to me

10. Treatments continued..
 Self Help Support
 Depression after delivery: National foundation that provides support and information for PPD.
http://www.depressionafterdelivery.com
 Postpartum Progress: the most widely read US based blog. http://postpartumprogress.typepad.com/weblog/
 Marce Society: http://www.marcesociety.com

11. Postpartum depression in fathers
 More common than you would think
 10.4% overall from 1st trimester to 1 year after delivery
 25.6% at 3-6 months
 The biggest correlation is with depression in the partner
 But also associated with marriage problems.
 Life style change
 Role with partner and child. Sharing attention
 Stress at work
 Feeling physically separated

12. Postpartum depression affects children
 Behavioral problems: sleep problems, aggression and hyperactivity
 Cognitive delays: walk and talk later, problems in school
 Social problems: difficulty developing relationships, socially withdrawn,
aggressively act out
 Emotional problems: lower self-esteem, higher levels of anxiety
 Psychological problems: high risk of developing depression.

13. Major issues in PPD
 Loss of Autonomy (Personal Freedom) and Time
 Loss of Loss of Loss of Sexuality, Femininity, Appearance
 Loss of Occupational identity
 Debate whether or not to go back to work or to stay at home with the child. Many have
feelings of guilt.
 The women have feelings of loss concerning:
 Loss of power
 Loss of opportunity
 Loss of relationship with partners, friends
 Loss of Finances.

14. References
 US Department of Health and Human Services:
http://www.womenshealth.gov/faq/depression-pregnancy.cfm
 American Academy of Family Medicine:
http://familydoctor.org/online/famdocen/home/women/pregnancy/ppd/general/
379.html
 National Institute of Mental Health:
http://newsinhealth.nih.gov/2005/December2005/docs/01features_02.htm
 International Lactation Consultant Association: http://www.ilca.org
 Postpartum Support International: http://postpartum.net/resources/