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 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
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