Condition characterized by persistent low mood developing during the puerperium period, usually 1 or 2 weeks following delivery. It needs specialized assessment and treatment.
Mild depressive symptoms (sadness, tearfulness, irritability, anxiety) develop commonly during the first week after
the delivery but resolve within 2 weeks (“baby blues”): it usually needs ONLY counseling and support.
Risk factors
- Previous psychiatric history
- Recent stressful events
- Young age, first baby (primigravida) and associated fear of the responsibility for the new baby
- Poor marital relationship, poor social support
Clinical features
- Starts soon after delivery and may continue for a year or more
- Feelings of sadness with episodes of crying, anxiety, marked irritability, tension, confusion
- Guilty feeling of not loving baby enough
- Loss of positive feeling towards loved ones
- Refusal to breast feed baby
- Ideas to harm the baby
Postpartum psychosis
- Distortions of thinking and perception, as well as inappropriate or narrowed range of emotions
MANAGEMENT
- Routine assessment for depressive symptoms during post natal visits or at least once at 6 weeks
- Counselling and reassurance at first contact and review after 2 weeks
- If persisting, refer for specialized treatment
- Psychotherapy
- Antidepressant
- If suicidal thoghts, or any risk for mother and/or baby, refer urgently to hospital
Prevention
- Postpartum counselling, support, and follow up
- Identification of patients at risk
- Male involvement and support