Postpartum depression is a mood disorder that can occur within the first year after giving birth. Hippocrates first described depression, which he called melancholia. Postpartum depression is triggered by hormonal and psychological changes following childbirth. Symptoms include sadness, anxiety, irritability and reduced concentration. Left untreated, postpartum depression can negatively impact both mother and child. Proper screening and treatment with SSRIs like sertraline can effectively treat postpartum depression while allowing for breastfeeding.

2. DARK DEPRESSION
Hippocrates provided the first description of
depression he called it melancholia and believed it was
caused by excess black bile in the brain.
Depression has many type but we concern with most severe one
many new moms feel happy one minute and sad the next if she
feels better after a week is just baby blue but if takes longer
she may have postpartum depression
postpartum depression :- The birth of a baby can
trigger a jumble of powerful emotions, from excitement and joy
to fear and anxiety. But it can also result in something you
might not expect — depression. It is mood disorder that
commences after giving birth. It can occur any time within the
first year after birth

3. HOW DO I KNOW??
Symptoms :-
Anxiety , Sadness , irritability , Feeling overwhelmed
Crying , Reduced concentration , Appetite problems
,Trouble sleeping
Six Loss :- 1-autonomy 2-time
3-appearance 4-femininty
5-sexuality 6-occuptional
identity

5. Causes
1)Biological
changes:
2)Psychosocial
factors:
3)Genetic
factors:

6. • Although there is considerable evidence for a preeminent role for three
monoamine systems, serotonin (5HT), norepinephrine (NE), and
dopamine (DA), in the pathogenesis of depression, depression clearly
involves other circuits including neuropeptide systems such as
corticotropin-releasing factor (CRF) and glutamate and GABA circuits

7. MECHANISM FOR POSTPARTUM
DEPRESSION FOUND IN MICE
JULY 30, 2008
• Researchers have pinpointed a mechanism in the
brains of mice that could explain why some human
mothers become depressed following childbirth
• the study used genetically engineered mice lacking a
protein critical for adapting to the sex hormone
fluctuations of pregnancy and the postpartum
period.
• "After giving birth, female mice deficient in the
suspect protein showed depression-like behaviors

8. • Evidence suggested that the hormones exert their effects on mood through
the brain's major inhibitory chemical messenger system, called GABA,
which dampens neural activity, helping to regulate when a neuron fires.
• Mody and Maguire discovered that a GABA receptor component, called
the delta subunit, fluctuated conspicuously during pregnancy and
postpartum in the brains of female mice, hinting that it might have
pivotal behavioral effects. To find out, they used mice lacking the gene for
this subunit and studied them in situations that can elicit responses
similar to human depression and anxiety.
This abnormal maternal behavior was reversed and pup
survival increased after the researchers gave the animals a
drug called THIP that acts on the receptor in a way that
specifically restores its function in spite of the reduced number
of subunits.

9.  RISK FACTORS:
• You have a history of depression, either
during pregnancy or at other timeshare
20 times more likely to experience PPD
than their counterparts without a
depression history
• You've experienced stressful events
during the past year, such as pregnancy
complications, illness or job loss
• Your baby has health problems or other
special needs
• You have difficulty breast-feeding
Multiple Birth =43% greater risk

10. • Feeling of loss of her appearance or her occupational identity
• Gestational diabetes appears to be an independent risk factor for
postpartum depression (PPD) in first-time mothers, new research shows.
• Results of a large, population-based study showed that even in the
absence of a history of depression, gestational diabetes significantly
increased the risk for PPD
• for those women who have had a past depressive episode, having diabetes
during pregnancy makes it 70% more

11. - diagnosis of major depressive disorder requires the presence of
-at least- five key symptoms that last at least two weeks and
impair normal function.
1. Depressed
mood
2. (anhedonia)
3. Suicidal
ideation
(active or
passive)
1. Decreased energy*
2. Changes in sleep pattern
3. Weight change (gain or loss)
4. Decreased concentration
5. Feelings of guilt or
worthlessness
6. Psychomotor retardation or
agitation

12. • The diagnosis of postpartum
major depression should also
include asking patients about past
manic episodes or Bipolar
disorder is also associated with a
higher risk of mood episode
postpartum.
• thyroid-stimulating hormone
levels in women with suspected
ppd as About 8 % develop
postpartum autoimmune
thyroiditis, which can mimic many
symptoms of postpartum major
depression .
• Patients with identified
risk factors may be
selected for screening
by the Edinburgh
Postnatal Depression
Scale .
• The scale has 10
questions, including a
question on suicidal
ideation. Each
question is scored on a
scale from 0 to 3.
• In women without a
history of PPD , a score
< 12 has a sensitivity of
86% – 78 % for PPD.
• In 80% of women with a
history of PPD who
relapsed within one
year scored <9 at 4
weeks postpartum

13. TREATMENT

14. PHARMACOLOGIC TREATMENT
• Selective serotonin reuptake inhibitors have become the mainstay
of treatment for moderate to severe postpartum major depression
because of their favorable adverse effect profiles and relative
safety in overdose compared with tricyclic antidepressants
MOA
SSRIs ease depression by increasing levels of serotonin in the brain.
Serotonin is one of the chemical messengers (neurotransmitters)
that carry signals between brain cells. SSRIs block the reabsorption
(reuptake) of serotonin in the brain, making more serotonin
available.

16. • The risks of exposure to antidepressant therapy in
the postpartum period are primarily focused on
the exposure of the infant to the antidepressant in
breast milk.
Most of the literature examining the safety of
lactation with antidepressant use has found low
rates of adverse events in infants exposed to
antidepressants.
most studies show few adverse events and low or
undetectable plasma levels with sertraline,
paroxetine, and fluvoxamine.

17.  ADVERSE EFFECT
 Some adverse events in infants exposed to antidepressants via breast milk
have been reported, mostly in case reports and case series. They include
symptoms such as
• Irritability.
• decreased feeding.
• sleep problems.
 which are subtle, nonspecific, and not necessarily caused by the
antidepressants.
 These suspected adverse events were more often reported after exposure to
fluoxetine and citalopram.
 Thus, many authors recommend sertraline and paroxetine be used post
partum owing to their lower infant plasma ratios and lack of reported
adverse effects.
 It should be emphasized that if a mother was successfully treated for
depression during her pregnancy, the same medication should usually be
used in the postpartum period.

18. sertraline
Because of the low levels of sertraline in breast milk, amounts ingested by the
infant are small and is usually not detected in the serum of the infant.
although the weakly active metabolite norsertraline (desmethylsertraline) is often
detectable in low levels in infant serum.
 Rarely, preterm infants with impaired metabolic activity might accumulate the drug
and demonstrate symptoms similar to neonatal abstinence.
Occasional mild side effects have ben reported in breastfed infants.
such as :
1. insomnia,
2. restlessness
3. increased crying
Most authoritative reviewers consider sertraline one of the preferred antidepressants
during breastfeeding.
Sertarline effect is similar to paroxetine

19. fluoxetine
The average amount of drug in breast milk is higher with fluoxetine than with most other
SSRIs
the long-acting, active metabolite, norfluoxetine, is detectable in the serum of most
breastfed infants during the first 2 months postpartum and in a few thereafter.
 Adverse effects have been reported in some breastfed infants.
such as:
1. colic
2. fussiness
3. drowsiness
4. Decreased infant weight gain was found in one study, but not in others.
No adverse effects on development have been found in a few infants followed for up to a
year.
If fluoxetine is required by the mother, it is not a reason to discontinue breastfeeding.
If the mother was taking fluoxetine during pregnancy or if other antidepressants have been
ineffective, most experts recommend against changing medications during breastfeeding.
Otherwise, agents with lower excretion into breast milk may be preferred, especially while
nursing a newborn or preterm infant.

20. Sertraline, in particular, appears to
have the lowest concentration of
transmission into breast milk and
should be strongly considered as
first line use for lactation
The long half-life of fluoxetine and
the potentially high breast milk
concentrations of citalopram make
these SSRIs less desirable choices.
Overall, the degree of infant exposure to medication in breast milk is
affected by the rate of absorption into maternal circulation, diffusion from
maternal circulation to breast milk, and absorption of the agent by the
infant. Therefore, as a general recommendation, taking medication
immediately after breast-feeding minimizes the amount present in milk
and maximizes clearance before the next feeding.

21. MIRTAZAPINE
• Mirtazapine is an Atypical Antidepressant . Limited
information indicates that maternal doses of up to 120
mg daily produce low levels in milk and would not be
expected to cause any adverse effects in breastfed
infants, especially if the infant is older than 2 months.
If mirtazapine is required by the mother, it is not a
reason to discontinue breastfeeding.

22. Estrogen therapy has been studied as a treatment for postpartum major
depression. Three studies have reported positive results, but each has had
notable limitations.
Although estrogen therapy is not currently recommended for postpartum
major depression, further research is needed.
Take Care!
• while PPD is the most common mood disorder in new mothers, it is
important to rule out or diagnose and treat other possible sources of
depression (which treatment would not effect the baby, but may rather
provide benefits), such as thyroiditis or vitamin B12 deficiency.

23.  Conclusion
At present, there is little evidence that exposure to
antidepressants through breast milk has any serious adverse
effects in infants; however, long-term neurodevelopmental
effects have not been adequately studied.
There are many benefits of treating postpartum depression
and advantages of breastfeeding, for both the mother and
the infant.
Therefore, if maternal depression necessitates treatment
with pharmacotherapy, then breast-feeding need not be
avoided, and the antidepressant that would be most effective
for the mother should be considered.

24. POSTPARTUM DEPRESSION IN MALES !
DADS CRY TOO..

26. HOW DOES IT AFFECT THE CHILD ?

27. Prenatal Inadequate prenatal care, poor nutrition, higher preterm
birth, low birth weight, pre-eclampsia and spontaneous abortion
Infant
Behavioral : Anger and protective style of coping, passivity, withdrawal,
self-regulatory behavior, and dysregulated attention and arousal
Cognitive : Lower cognitive performance
Toddler
Behavioral : Passive noncompliance, less mature expression of
autonomy, internalizing and externalizing problems, and lower interaction
Cognitive : Less creative play and lower cognitive performance
School age
Behavioral : Impaired adaptive functioning, internalizing and
externalizing problems, affective disorders, anxiety disorders and conduct
disorders
Academic : Attention deficit/hyperactivity disorder and lower IQ scores
Adolescent
Behavioral : Affective disorders (depression), anxiety disorders, phobias,
panic disorders, conduct disorders, substance abuse and alcohol dependence
Academic : Attention deficit/hyperactivity disorder and learning
disorders