PU Postpartum Depression Discussion

Reply to Discussion :

Approximately 1 in 7 women experience postpartum depression (PPD), this is different from baby blues. Baby blues are a mild form of depression, which the mother may feel sad, weepy or anxious and it usually goes away on its own within 10-14 days. PPD last longer and is more severe and effects a women’s ability to return to normal functions and it affects the mother’s relationship with her infant (Mughal, Azhar, & Siddiqui, 2022).

           PPD is depression that a mother develops after childbirth usually within 6 weeks of delivery but can happen up to one year after. The mother may experience a depressed mood lasting most of the time, little interest or a loss of interest in doing things, problems with sleeping, feelings of worthlessness or guilt, weight change, loss of concentration, fatigue, low energy and/or suicidal thoughts/attempts (Mughal, Azhar, & Siddiqui, 2022).

           The exact cause of PPD is unknown but it is thought to be due to rapid fluctuations in hormones, genetics, psychological and new social life stressors. There can be risk factors for postpartum depression such as: previous history of depression, history of PPD, prenatal depression, lack of social support, prenatal anxiety, and stressful life events (Saftner & Friedrich, 2020). After delivery women should be screened on the first postnatal visit for PPD using the Edinburgh Postnatal Depression Scale (EPDS) or a similar screening tool. The EPDS is used to help diagnosis depression, assess suicide and homicide risk, and to rule out other psychiatric illness (Mughal, Azhar, & Siddiqui, 2022).

           Firstline treatment for mild to moderate PPD is CBT or IPT, as well as peer support and nondirective counseling. With moderate to severe PDD a combination of medication and therapy is recommended. Medication should be tailored for each patient, and if the mother is breastfeeding the SSRI sertraline and paroxetine are preferred. Other options include TCAs, SNRIs, and the newest drug specifically for PDD brexanolone. For those who have severe PDD and do not respond to psychotherapy or pharmacology may need ECT (Stewart & Vigod, 2019). 

           If medication is started follow up should be in 1-2 weeks for assessment of symptoms, and are they starting to improve, then again at 4-6 weeks. If a referral to another provider was made for therapy, a follow up phone call can be made to see when her appointment might be.

           The WHO’s comprehensive mental health action plan 2013-2020, has a goal to promote mental health wellbeing, prevent mental health disorders, provide care, improve recovery, advocate for human rights, and to reduce the morbidity, mortality and disabilities for those with a mental health disorder (WHO, 2013). One strategy for change that the WHO lists that can be applied to PPD is objective 3-mental health promotion and prevention. In this strategy options for implementation include informing the public about the mental health disorder to decrease stigmatization and discrimination and to promote human rights.

           Another implementation options is to include emotional and mental health as part of home and health facility based antenatal and postnatal care of new mothers and babies, to include parenting behaviors (WHO, 2013). When a women has her first prenatal visit she should be informed of the signs and symptoms of depression. A history of depression in pregnancy can lead to depression in the postpartum period. Women should be monitored for signs and symptoms of depression during pregnancy and after delivery.

           The USPSTF as of 2019 recommends that women who are at an increased risk for depression during pregnancy and in the postpartum period be referred for counseling interventions to help with prevention of depression. The pregnant woman is monitored during pregnancy and if risk factors become apparent a referral should be made usually during the second trimester or after delivery (US Preventive Services Task Force, 2019). 

           PPD can have repercussions on the mother-infant bond, causing emotional and behavioral problems in children of untreated mothers with PPD. For mothers PPD can lead to other chronic medical conditions and can be a risk factor for future major depression episodes. Prevention of PPD is the goal and with screening during pregnancy and after childbirth women with depression can hopefully be identified and treated as needed.

References

Mughal, S., Azhar, Y., & Siddiqui, W. (2022). Postpartum depression. In Stat Pearls. Stat Pearls

           Publishing  https://www.ncbi.nlm.nih.gov/books/NBK519070/

Saftner, M., & Friedrich, C. (2020). Chapter 22: Postpartum and lactation. In D. M. Schadewald,

           U. A. Pritham, E. Q. Youngkin, M. S. Davis, C. Juve (ed), Women’s Health: A Primary Care

Clinical Guide (5th ed., pp. 581-637) Pearson

Stewart. D. E., & Vigod, S. N. (2019). Postpartum depression: Pathophysiology, treatment, and

           emerging therapeutics. Annual Reviews of Medicine, 70, 183-196.

https://doi.org/doi.org/10.1146/annurev-med-041217-011106

US Preventive Services Task Force (2019). Interventions to prevent perinatal depression: US

           Preventive Services Task Force recommendation statement. JAMA, 321(6), 580-587.

https://doi.org/10.1001/jama.2019.0007

World Health Organization (2013). Sixty-sixth world health assembly: Comprehensive mental

           health action plan 2013-2020. Retrieved from

https://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R8-en.pdf