Postpartum Depression Overview of Postpartum Mood Disorders

Author: Saju Joy, MD, MS; Chief Editor: David Chelmow, MD

Postpartum depression is due to increase of hormones. Lack of family support can also be a factor. Despite multiple contacts with medical professionals during the postpartum period, patients and their caregivers often overlook postpartum affective illness. Too often, postpartum depression is dismissed as a normal or natural consequence of childbirth. Other risk factors include inadequate social supports, marital dissatisfaction or discord, and recent negative life events such as a death in the family, financial difficulties. Rapidly fluctuating mood, tearfulness, irritability, and anxiety are common symptoms. Postpartum blues is typically mild in severity and resolves spontaneously. No specific treatment is required, other than support and reassurance. The postpartum period is the most vulnerable time for a woman to develop psychiatric illness. Postpartum depression is no different from depression that can occur any other time in a woman's life. In addition to a history of depression, recent stressful life events, daily stressors such as childcare, lack of social support (especially from the partner), unintended pregnancy, and insurance status have been validated as risk factors. Signs and symptoms of postpartum depression are clinically indistinguishable from major depression that occurs in women at other times. Postpartum depression is more persistent and debilitating than postpartum blues, often interfering with the mother's ability to care for herself or her child. Untreated depression is associated with poor maternal health and intrauterine growth restriction. Major depression may include depressed mood, tearfulness, anhedonia, insomnia, fatigue, appetite disturbance, suicidal thoughts, and recurrent thoughts of death. In the postpartum period, depression is characterized as intense sadness, anxiety, or despair. These interfere with the mother s ability to function with risk of harm to mother or infant. The mother may have ambivalent or negative feelings toward the infant. She may also have intrusive and unpleasant fears or thoughts about harming the infant. Antidepressants remain the first line of treatment. However, there are preliminary data to suggest that estrogen, alone or in combination with an antidepressant, may be beneficial. A large body of literature suggests that a mother's attitude and behaviour toward her infant significantly affects mother-infant bonding and infant well-being and development. Postpartum depression may negatively affect these mother-infant interactions. Mothers with postpartum depression are more likely to express negative attitudes about their infant and to view their infant as more demanding or difficult. Depressed mothers exhibit difficulties engaging the infant, either being more withdrawn or inappropriately intrusive, and more commonly exhibit negative facial interactions. Children of mothers with postpartum depression are more likely than children of non-depressed mothers to exhibit behavioural problems (e.g., sleep and eating difficulties, temper tantrums, hyperactivity), delays in cognitive development, emotional and social dysregulation, and early onset of depressive illness.
Ref: http://emedicine.medscape.com/article/271662-overview#aw2aab6b2