Postpartum Mood Disorders

Postpartum Mood Disorders

·        Screen at post-natal check up (6 weeks) using Edinburgh Postnatal Depression Scale (EPDS), but still needs careful clinical assessment

·        Differential: hypothyroidism (more common post-partum), recurrence of previous psychiatric illness, initial presentation of a psychiatric illness (eg schizophrenia or anxiety disorders – postpartum period increases risk), adjustment disorder with depressed mood

·        Possible aetiological factors:

o   Stress of delivery, difficult pregnancy

o   Lack of sleep

o   Hormonal

o   Isolation, lack of support 

o   Internal conflicts about role as mother: motherhood idealised or devalued, very difficult adjustment in role, powerless, dependent, alone, may have had unrealistic expectations, etc

o   May not have wanted to be pregnant, may now feel trapped in unhappy situation (eg relationship) 

o   Cultural factors: cultures vary in support offered (eg by extended family) to new mother, in pressures to return to work (variable maternity leave policies), differing attitudes to female children, etc.

·        Considerable overlap in the risk factors for major depression, post-partum depression, inadequate parenting and child abuse

·        Treatment:

o   Check whether drugs enter breast milk.

o   Indications for antidepressants similar for those for other mood disorders 

o   If agitated or anxious, more sedating antidepressants are appropriate (eg imipramine) or even small doses of antipsychotics

·        Long term effect of postnatal depression on child development: disturbances in mother-infant relationships (eg attachment), impaired cognitive and emotional development in later infancy, and ­ risk of longer-term behavioural and social development of the child. These factors compounded by indices of socio-economic adversity, which are risk factors for these outcomes and for depression. So good initial diagnosis and treatment important