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.