Puerperal
Depression (PD) is a severe from of depression or elation occurring
in the first few weeks after the baby is born. The term `puerperal'
refers to the six week period immediately following childbirth.
This disorder however, is a relatively rare, affecting at most
1 woman in every 500 who have given birth. Postpartum illness
was initially conceptualized as a group of disorders specifically
linked to pregnancy and childbirth and thus was considered diagnostically
distinct from other types of psychiatric illness. More recent
evidence suggests that postpartum psychiatric illness is virtually
indistinguishable from psychiatric disorders that occur at other
times during a woman's life. Puerperal Depression is also known
as Post Partum Psychosis, Postpartum and Puerperal Psychosis.
The disorders main characteristics follow very closely Major Depression
and are listed as:
The symptoms are usually an acute state of confusion, fluctuating
mood, disordered thinking and behavior and 'psychotic' symptoms
of hallucinations and delusions.
In most cases, the onset is in the first few weeks after childbirth.
In the same 2 weeks, the patient has had 5 or more of the following
symptoms, which are a definite change from usual functioning.
Either depressed mood or decreased interest or pleasure must be
one of the five:
Mood. For
most of nearly every day, the patient reports depressed mood
or appears depressed to others.
Interests. For most of nearly every day, interest or pleasure
is markedly decreased in nearly all activities (noted by the
patient or by others).
Eating and weight. Although not dieting, there is a marked loss
or gain of weight (such as five percent in one month) or appetite
is markedly decreased or increased nearly every day.
Sleep. Nearly every day the patient sleeps excessively or not
enough.
Motor activity. Nearly every day others can see that the patient's
activity is agitated or retarded.
Fatigue. Nearly every day there is fatigue or loss of energy.
Self-worth. Nearly every day the patient feels worthless or
inappropriately guilty. These feelings are not just about being
sick; they may be delusional.
Concentration. Noted by the patient or by others, nearly every
day the patient is indecisive or has trouble thinking or concentrating.
Death. The patient has had repeated thoughts about death (other
than the fear of dying), suicide (with or without a plan)
or has made a suicide attempt.
These symptoms cause clinically important distress or impair work,
social or personal functioning.
The disturbance
is not due to the direct physiological effects of a substance
(e.g., a drug of abuse, a medication) or a general medical condition.
Associated
Features:
Sufferers
may have a family history of psychotic illness, or have had a
psychotic illness themselves in the past. Irrational preoccupations
concerning the newborn baby. General features include:
Anxiety
Panic Attacks
Sleeplessness even when baby is asleep
Aches and Pains or generally feeling unwell
Memory loss and/or unable to concentrate
Tearfulness or unexplained crying
Hopelessness and isolation
Loss of interest in the baby
Feeling of unreality
Obsessional or suicidal thoughts fear of being alone
Hostility
Overactivity
Anger and/or aggression
Hallucinations
Delusions
Paranoia
Differential
Diagnosis:
Some disorders have similar symptoms. The clinician, therefore,
in his diagnostic attempt, has to differentiate against the following
disorders which need to be ruled out to establish a precise diagnosis.
Baby Blues -Sometime around the third day, or so, the happy
period ends abruptly and, for 60% of women, or more, the `Baby
Blues' are experienced.
Pinks - For the first three days or so after giving birth most
women, although tired, experience a `high', that is they feel
happy, excited, thrilled with the baby and themselves, and they
may experience difficulties sleeping.
Postnatal Depression - whose symptoms generally start some weeks
after the baby is born. Women affected commonly describe feelings
of tiredness, irritability and anxiety. Many women assume that
what they are experiencing is due to being tired from coping
with the new baby and perhaps other children, or having interrupted
sleep due to the baby crying.
Cause:
The cause
of Puerperal Depression is
unclear. It is a biological, including the hormonal changes that
occur following childbirth or chemical, form of mood disorder
like other depressive illness or manic depression. Woman with
a history of manic-depression run the greatest risk of developing
puerperal depression after giving birth. Psychological and social
factors such as the demands, obligations and responsibilities
of motherhood are other causal factor. Fear that the mother may
be inadequate and not able to live up to her own and/or other
people's expectations. Women which have caesarean section or a
stillbirth also have a slightly increased risk of experiencing
this condition. Biological factors may also play a role.
Treatment:
Treatment of puerperal depression
is usually with medication however in the past electroconvulsive
therapy (E.C.T.} was frequently used as a treatment.
Psychotherapy, for those that do not wish to use any form
of medication, and support group participation have also be found
helpful.
Counseling
and Psychotherapy [ See
Therapy Section ]:
Interpersonal therapy, a form of psychotherapy that may be particularly
suitable for use in postpartum women because it focuses on the
patient's interpersonal relationships and changing roles. Individual
and group therapy may also be considered. Spouses and significant
family members should also be counseled about the nature and treatment
of PD and what they can do to assist in the mothers support structure.
Women with severe marital discord should be referred for couples
therapy.
Pharmacotherapy
[ See
Psychopharmacology Section ] :
The
medication is generally continued over a six to twelve month period
after the initial upset. Drugs used include:
Amitriptyline
(Elavil)
Desipramine (Norpramin)
Imipramine pamoate (Tofranil-PM)
Nortriptyline (Pamelor)
Clomipramine (Anafranil)
Fluoxetine (Prozac)
Sertraline (Zoloft)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Bupropion (Wellbutrin)
Venlafaxine (Effexor)
Nefazodone (Serzone)
Mirtazapine (Remeron)
If a woman
decides to take drugs to alleviate the symptoms of PD and wishes
to breast feed whilst receiving treatment she should consider
evaluating the extent of the infants exposed to any antidepressant
through breast milk.
