Postpartum Mood Disorders

Postpartum Mood Disorders can be divided into 3 categories-

1. Baby blues

2. Postnatal depression

3. Postpartum (or puerperal) psychosis

Baby blues– affects 30 to 80% of women .

Time period – usually day 3 to 10 after delivery. Usually peaks at day 5 .

Signs and symptoms- variable- tearfulness, anxiety, irritability. Symptoms usually last 2 days. Care of the baby is not compromised. Feelings of hopelessness or worthlessness are not there.

Treatment- reassurance. Monitoring for changes in symptoms.

Postnatal Depression- affects about 10 to 15% of deliveries.

Pregnancy is a major psychological event and 50% of women with postnatal depression develop their symptoms during pregnancy.

Time of onset- Gradual onset within the first 2 weeks. Two peak times of occurrence- 2 to 4 weeks and 10 to 14 weeks post delivery.

Symptoms- Persistent sadness or low mood. Loss of interest. Fatigue or low energy.

Signs- Sleep Disturbance, Poor concentration Poor or increased appetite, Suicidal thoughts or acts, Guilt or self-blame, Impaired functioning.

Risk factors– history of major depression ; family history of postnatal depression

Prognosis is good.

Recurrence risk 1 : 3 to 1: 2 in future pregnancies.

Treatment– Mild depression- Psychological therapy

Moderate to severe depression- Antidepressants.

Severe episodes- May need mood stabilizers or Electroconvulsive therapy .

Postpartum Psychosis- Incidence- 1 to 2 per 1000 deliveries.

Risk factors- Personal history of bipolar disorder( 1 in 2 risk)

Family history of postpartum psychosis( 1 in 4 risk)

If both of the above- about 75% risk.

Personal history of postpartum psychosis( 1 in 2 risk).

Time of Presentation- 50% in first week, 75% by day 16.

Signs- Initially- Insomnia, agitation and odd behaviour. Progression is often rapid. Rapidly changing mental state( Kaleidoscopic presentation) . About 78% have delusional ideas about the infant.

Treatment– Postpartum Psychosis is a Medical emergency.

Patient may have suicidal or infanticidal ideas.

Prompt psychiatric assessment.

Admit to mother baby unit. Do not leave her unattended.

Most will need treatment with antipsychotics.

Implications for future health- Upto 65% will develop Bipolar Disorder.

References- 1. Management of Women with Mental Health Issues during

Pregnancy and the Postnatal Period Good Practice No.14 June 2011.

2. Perinatal mental health: how to ask and how to help. The Obstetrician &

Gynaecologist. 2017;19:147–53. DOI: 10.1111/tog.12376

3. Strat OG TUtorials

3. Postpartum psychosis. The Obstetrician & Gynaecologist 2013;15:145–50.

NICE guideline – Antenatal and postnatal mental health: clinical management and service guidance Clinical guideline [CG192]