Baby Blues, Postnatal Depression & Puerperal Psychosis Flashcards
Up to when can postpartum depression develop?
It can develop up to 1 year after the birth of a baby
baby blues vs postpartum depression vs puerperal psychosis:
Unlike “baby blues”, which present in the first two weeks after birth and resolve spontaneously, postpartum depression rarely resolves spontaneously and should be treated to prevent long-term depressive disorder.
A 28 year old woman presents to her GP 4 months after giving birth to her baby girl. She reports feeling low in mood since the birth. She has low energy levels, limited appetite and poor sleep. She has not experienced any hallucinations and there is no evidence of formal thought disorder. She has no past psychiatric history. Although she still feels able to care for her baby, she is anxious that they will not bond properly while she feels this low. The baby appears well cared for and the mother is attentive to her needs. The woman adamantly denies any thoughts of harming herself or her baby. From the following options, which is the most appropriate management of her presentation?
A. Psychological therapy
B. Admission to mother and baby inpatient mental health unit
C. Reassure symptoms will resolve spontaneously
D. Antidepressants
E. Antipsychotics
A. Psychological therapy:
This woman is suffering from postpartum, or postnatal, depression. In keeping with any depressive disorder, postpartum depression presents with a lowering of mood, reduced enjoyment in activities and lowering of energy levels. Biological symptoms of depression such as poor appetite and poor sleep may also be present, but it is important to distinguish between sleep that is disrupted because of the baby waking and sleep that is poor for other reasons. In postpartum depression there may also be associated concerns from the mother about bonding with her baby, caring for her baby, or even harming herself or her baby in extreme circumstances. This woman presents with mild postpartum depression, which should be treated either with self-help materials or psychological therapies such as Cognitive Behavioural Therapy or Interpersonal Therapy
Not: D. Antidepressants
As this woman’s postpartum depression is currently mild in severity and she is functioning well and caring for her baby, with low risk of harm to either her or the baby, it would be more appropriate to explore psychological therapies before offering pharmacological therapy. There may also be the added complexity of breastfeeding, which makes many antidepressants unsuitable
what is the incidence of baby blues?
50-75%
-typically occuring between 3-7 days after birth
what is the SSRI of choice in postpartum depression? what should be avoided?
*paroxetine is recommended because of the low milk/plasma ratio
**fluoxetine is best avoided due to a long half-life
what is the incidence of postpartum depression?
10-15%
screening questionnaire for postpartum depression:
EPDS (Edinburgh Postnatal Depression Scale): important at 6 week postnatal check (& health visitor followup on regular basis)
Incidence of postpartum psychosis:
0.1-0.5%
minimum stay in secondary care for pts with suspected postpartum psychosis
4 hours
baby blues vs postpartum depression
baby blues usually resolve after 2 weeks (can last up to 12 months postpartum)
