Postpartum Psychiatric Illnesses

Postpartum "Blues"

-occurs in 50-80%
-onset usually between day 3 and day 14 postpartum
-symptoms may persist from several days to a few weeks

Symptoms:

• mood instability
• weepiness
• sadness
• anxiety
• lack of concentration/inability to carry out activities of daily living
• feelings of dependency

Etiology:

• rapid hormonal changes
• physical and emotional stress of birthing
• physical discomforts
• emotional letdown after pregnancy and birth
• awareness and anxiety about increased responsibility
• fatigue and sleep deprivation
• disappointments-about the birth, spousal support, nursing, the baby, etc.

Postpartum Depression
-occurs in 8-15%, 20% of those with postpartum blues develop depression
-onset is usually insidious although it can be rapid, and can occur any time in the first year
-may last from 3 to 14 months, most recover within 1 year

Symptoms:

• excessive worry or fatigue
• sad mood, feelings of guilt, loss of interest, phobias
• sleep problems (often can't sleep)
• physical symptoms or complaints in excess of or without physical cause
• marked fear of criticism of mothering skills
• excessive concern about baby's health or well-being
• infant's failure to thrive
• loss of focus and concentration (may miss appointments)
• loss of interest or pleasure
• appetite changes-poor appetite or weight gain

Risk factors:

• 50-80% risk if previous postpartum depression
• depression or anxiety during pregnancy
• past psychiatric disorder (especially depression) or family history of depression
• presence of anti-thyroid antibodies
• marital conflict, single parenthood, irritable infant

Postpartum Obsessive-Compulsive Disorder
-3%-5% of new mothers may develop obsessive symptoms

Symptoms:

• intrusive repetitive and persistent thoughts or mental pictures
• thoughts often are about hurting or killing the baby
• tremendous sense of horror and disgust about these thoughts (ego alien)
• thoughts may be accompanied by behaviors to reduce the anxiety (hiding knives)

Risk factors:

• history of Obsessive-Compulsive Disorder
• negative feelings resulting from unrealistic expectations

Postpartum Panic Disorder
-may occur in up to 10% of postpartum women

Symptoms:

• episodes of extreme anxiety
• shortness of breath, chest pain, sensations of choking or smothering, dizziness
• hot or cold flashes, trembling, palpitations
• may experience restlessness, agitation, or irritability
• during attack may fear she is going crazy, dying, or losing control
• panic attack may awaken from sleep
• often no identifiable trigger for panic
• excessive or obsessive worry or fears

Risk factors:

• previous history of anxiety or panic disorder
• thyroid dysfunction

Postpartum Psychosis
-occurs in 1-2/1000, this disorder has a 5% suicide and 4% infanticide rate
REQUIRES IMMEDIATE HOSPITALIZATION

Symptoms:

• begins about 3 days postpartum
• fatigue
• tearfulness
• mood instability
• confusion, suspiciousness, and obsessive concern about baby
• delusional thinking (infant death, denial of birth, need to kill baby)

Risk factors:

• history of psychosis or bipolar disorder
• family history of mental illness
• difficult labor
• possible other factors include: first child, perinatal death, advanced maternal age, premature delivery, low birth weight, unmarried mother

References:

REFERENCES

Dunnewold, Ann, Evaluation and Treatment of Postpartum Emotional Disorders

Professional Resource Press, Sarasota, Florida, 1997

Knops, GG. Postpartum mood disorders: a startling contrast to the joy of birth. Postgraduate Medicine 1983;93(3):103-116.

Stowe ZN, Nemeroff CB. Women at risk for postpartum-onset major depression.

Am J Obstet Gynecol 1995;173(2):639-644.