POSTNATAL DEPRESSION

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