Postpartum depression ( PPD ), also called postnatal depression , is a type of mood disorder associated with labor, which can affect both sexes. Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleep or eating patterns. Onset is usually between one week and one month after delivery. PPD can also have a negative impact on newborns.
While the exact cause of PPD is unclear, the cause is believed to be a combination of physical and emotional factors. This may include factors such as hormonal changes and sleep deprivation. Risk factors include previous episodes of postpartum depression, bipolar disorder, family history of depression, psychological distress, labor complications, lack of support, or drug use disorders. The diagnosis is based on a person's symptoms. While most women experience a brief period of worry or unhappiness after childbirth, postpartum depression should be suspected when the symptoms are severe and last for more than two weeks.
Among those at risk, providing psychosocial support can protect in preventing PPD. Treatment for PPD may include counseling or medication. The types of counseling that have been found to be effective include interpersonal psychotherapy (IPT), cognitive behavioral therapy (CBT), and psychodynamic therapy. The provisional evidence supports the use of selective serotonin reuptake inhibitors (SSRIs).
Postpartum depression affects about 15% of women around labor. In addition, this mood disorder is thought to affect 1% to 26% of new fathers. Postpartum psychosis, a more severe form of postpartum mood disorder, occurs in about 1 to 2 per 1,000 women after delivery. Postpartum psychosis is one of the leading causes of childhood killings of less than one year, which occurs in about 8 per 100,000 births in the United States.
Video Postpartum depression
Signs and symptoms
Symptoms of PPD can occur any time in the first year of postpartum. Usually, the diagnosis of postpartum depression is considered after signs and symptoms persist for at least two weeks. These symptoms include, but are not limited to:
Emotional
- Ongoing sadness, anxiety, or "empty" mood
- Severe mood swings
- Frustrated, irritable, anxious, angry
- Feelings of hopelessness or helplessness
- Guilt, shame, worthless
- Low self-esteem
- Numbness, emptiness
- Fatigue
- Inability to be entertained
- Difficulty binding with baby
- Feeling unable to care for baby
Behavior
- Lack of interest or pleasure in regular activities
- Low or no energy
- Low Libido
- Changes of appetite
- Fatigue, decreased energy and motivation
- poor self-care
- Social withdrawal
- Insomnia or excessive sleep
Cognition
- Inability to make decisions and think clearly
- Poor concentration and poor memory
- Fear that you can not care for a baby or be afraid of a baby
- Worry about hurting yourself, baby, or spouse
Onset and duration
The onset of postpartum depression usually begins between two weeks to one month after delivery. A study conducted in mental health clinics in the city has shown that 50% of episodes of postpartum depression there start before delivery. Therefore, in postpartum depression DSM-5 was diagnosed under "depressive disorder with peripartum onset", in which "peripartum onset" was defined as when either during pregnancy or within four weeks after delivery. PPD can take several months or even a year. Postpartum depression may also occur in women who have had a miscarriage. For fathers, several studies have shown that men experience the highest postpartum depression rate between 3-6 months postpartum.
Parent-baby relationship
Postpartum depression can disrupt normal maternal-infant bonding and affect the development of acute and long-term children. Postpartum depression may cause the mother to be inconsistent with childcare. This inconsistency of childcare can include eating routines, sleep routines, and health care.
In rare cases, or about 1 to 2 per 1,000, postpartum depression appears as a postpartum psychosis. In this case, or among women with a previous history of psychiatric hospitalization, infanticide may occur. In the United States, postpartum depression is one of the leading causes of an annual infanticide incidence rate of approximately 8 per 100,000 births.
Maps Postpartum depression
Cause
The cause of PPD is not well understood. Hormonal changes, genetics, and major life events have been hypothesized as potential causes.
Evidence suggests that hormonal changes can play a role. Hormones that have been studied include estrogen, progesterone, thyroid hormone, testosterone, hormone releasing corticotropin, and cortisol.
Fathers, who do not undergo profound hormonal changes, can also experience postpartum depression. The cause may differ in men.
Lifestyle changes caused by infant care are often hypothesized to cause PPD. However, little evidence supports this hypothesis. Mothers who have had several children before without suffering from PPD can still suffer with their newest child. Despite the biological and psychosocial changes that may accompany pregnancy and the postpartum period, most women are not diagnosed with PPD.
Risk factors
Although the cause of PPD is not understood, a number of factors have been suggested to increase the risk:
- Prenatal depression or anxiety
- Personal or family depression history
- Symptoms of moderate to severe premenstruation
- Maternity blues
- psychological trauma associated with birth
- Physical trauma associated with birth
- Prior to stillbirth or miscarriage
- formula feeding rather than breastfeeding
- Smoking cigars
- Low self-esteem
- Child care or life stress
- Low social support
- Bad marital relationship or single marital status
- Low socioeconomic status
- Baby/colic temperament problem
- Unplanned/undesirable pregnancy
- Increased prolactin levels
- Oxytocin depletion
Of these risk factors, formula feeding, history of depression, and smoking have been shown to have additive effects.
The above factors are known to correlate with PPD. This correlation does not mean these factors are causal. On the contrary, both may be caused by some third factor. By contrast, several factors are almost certainly the cause of postpartum depression, such as the lack of social support.
Not surprisingly, women with fewer resources exhibit higher levels of depression and postpartum stress than women who have more resources, such as finance. The level of PPD has been shown to decrease with increasing revenue. Women with fewer resources may be more likely to have unwanted or unwanted pregnancies, increasing the risk of PPD. Women with fewer resources may also include single-income single mothers. Single income mothers may have more limited access to resources when transitioning into mothers.
Studies also show a correlation between maternal race and postpartum depression. African American mothers have been shown to have the highest risk of PPD at 25%, while Asian mothers have the lowest at 11.5%, after controlling for social factors such as age, income, education, marital status, and infant health. The rate for First Women, Caucasian and Hispanic WPs falls between them.
One of the strongest predictors of PPD paternal is having couples with PPD, with fathers developing PPD 50% of the time when their female partner has PPD.
Sexual orientation has also been studied as a risk factor for PPD. In a 2007 study conducted by Ross and colleagues, lesbian and bisexual mothers were tested for PPD and then compared with heterosexual sample groups. It was found that lesbian and bisexual biological mothers had a significantly higher scores of the Edinburgh Postnatal Depression Scale compared with heterosexual women in the sample. Higher PPD rates in lesbian/bisexual women may reflect poor social support, especially from their home family and additional stress due to homophobic discrimination in the community.
The correlation between postpartum thyroiditis and postpartum depression has been proposed but remains controversial. There may also be an association between postpartum depression and anti-thyroid antibodies.
Violence
A meta-analysis study reviewing the relationship between postpartum violence and depression suggests that violence against women increases the incidence of postpartum depression. About a third of women worldwide will experience physical or sexual abuse at some point in their lives. Violence against women occurs in conflict, post-conflict, and non-conflict areas. It is important to note that the reviewed study only looked at the violence experienced by women from male perpetrators, but did not consider the violence perpetrated against men or women by women. Furthermore, violence against women is defined as "any act of gender-based violence that results, or may result, physical, sexual, or psychological harm or suffering to women". Psychological and cultural factors associated with increased incidence of postpartum depression include a family history of depression, stressful life events during early puberty or pregnancy, anxiety or depression during pregnancy, and low social support. Violence against women is a chronic stress trigger, so depression can occur when a person is no longer able to respond to violence.
Diagnosis
Criteria
Postpartum depression in DSM-5 is known as "depressive disorder with peripartum onset". The onset of peripartum is defined as starting anytime during pregnancy or within four weeks after delivery. No more difference is made between depressive episodes that occur during pregnancy or that occur after childbirth. Nevertheless, the majority of experts continue to diagnose postpartum depression as depression with onset anytime within the first year after delivery.
The criteria required for the diagnosis of postpartum depression are the same as those required to make a diagnosis of major depression that is not associated with birth or mild depression. Criteria include at least five of the following nine symptoms, within a two-week period:
- Feeling sad, hollow, or desperate, almost daily, for most of the day or observations of distressed mood created by others
- Loss of interest or fun in activities
- Weight loss or decreased appetite
- Changes in sleep patterns
- Feeling uneasy
- Loss of energy
- Feelings of worthlessness or guilt
- Loss of concentration or increased doubts
- Recurrent thoughts about death, with or without a suicide plan
Differential diagnosis
Postpartum blues
Postpartum blues, commonly known as "baby blues," is a transient postpartum mood disorder characterized by mild depression symptoms rather than postpartum depression. This type of depression can occur up to 80% of all mothers who attend labor. Symptoms usually improve within two weeks. Symptoms lasting more than two weeks are a sign of a more serious type of depression. Women who experience "baby blues" may have a higher risk of experiencing a more serious episode of depression later in life.
Psychosis
Postpartum psychosis is not a formal diagnosis, but is widely used to describe a psychiatric emergency that appears to occur in about 1 in 1000 pregnancies, where high mood symptoms and racing thinking (mania), depression, severe confusion, loss of inhibition, paranoia, hallucinations and delusions start suddenly in the first two weeks after giving birth; symptoms vary and may change rapidly. It differs from postpartum depression and from maternal blues. This may be a form of bipolar disorder. It is important not to confuse psychosis with other symptoms that may occur after childbirth, such as delirium. Delirium usually includes loss of consciousness or inability to pay attention.
About half of women with postpartum psychosis have no risk factors; but a history of mental illness, particularly bipolar disorder, previous episode history of postpartum psychosis, or family history puts some at higher risk.
Postpartum psychosis often requires hospitalization, where treatment is an antipsychotic drug, a mood stabilizer, and in cases of a strong suicide risk, electroconvulsive therapy.
The most severe symptoms last from 2 to 12 weeks, and recovery takes 6 months to a year. Women who have been hospitalized for psychiatric conditions shortly after delivery are at a much higher risk of suicide during the first year after childbirth.
Screening
In the US, the American College of Obstetricians and Gynecologists recommend that healthcare providers consider depression screening for perinatal women. In addition, the American Academy of Pediatrics recommends pediatricians examine mothers for PPD at 1 month, 2 month and 4 month visits. However, many service providers do not consistently provide proper screening and follow-up. For example, in Canada, Alberta is the only province with universal PPD screening. This screening is performed by a Public Health nurse with an infant immunization schedule.
The Edinburgh Postnatal Depression Scale, self-reported standard questionnaire, can be used to identify women with postpartum depression. If the new mom gets a score of 13 or more, she may have PPD and further assessments should follow.
Prevention
The 2013 Cochrane review found evidence that psychosocial or psychological interventions after delivery help reduce the risk of postnatal depression. These interventions include home visits, peer-based peer support, and interpersonal psychotherapy. Support is an important aspect of prevention, since depressed mothers generally state that their depressive feelings are caused by "lack of support" and "feel isolated."
In couples, according to systematic review and meta-analysis 2015, emotional attachment and global support by partners protect against perinatal depression and anxiety. Further factors such as communication between couples and relationship satisfaction have only anxiety protection effect.
The main part of prevention is informed about risk factors. The medical community can play a key role in identifying and treating postpartum depression. Women should be examined by their doctor to determine their risk for getting postpartum depression. In addition, exercise and proper nutrition seem to play a role in preventing postpartum depression and general depression mood.
Treatment
Treatment for mild to moderate PPD includes psychological or antidepressant interventions. Women with moderate to severe PPD are likely to experience greater benefits with a combination of psychological and medical interventions. Exercise has been found to be useful for mild and moderate cases.
Therapy
Both individual social and psychological interventions appear to be equally effective in the treatment of PPD. Social interventions include individual counseling and peer support, while psychological interventions include cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). Other forms of therapy, such as group therapy and home visits, are also effective treatments.
Internet-based cognitive behavioral therapy (iCBT) has shown promising results with lower negative parenting behavior scores and lower levels of anxiety, stress, and depression. iCBT can be beneficial for mothers with limited access to CBT directly. However, long-term benefits have not yet been determined.
Medication
There are several drug studies to treat PPD, but the sample size is small, so the evidence is generally weak. Some evidence suggests that mothers with PPD will respond similarly to people with major depressive disorder. There is evidence to suggest that selective serotonin reuptake inhibitors (SSRIs) are an effective treatment for PPD. However, recent research has found that adding sertraline, SSRIs, to psychotherapy does not seem to provide any additional benefit. Therefore, it is not entirely clear which antidepressants, if any, are most effective for the treatment of PPD, and for whom antidepressants would be a better choice than non-pharmacotherapy.
Several studies have shown that hormone therapy may be effective in women with PPD, supported by the idea that decreased levels of estrogen and progesterone postpartum contribute to depressive symptoms. However, there is some controversy with this form of treatment because estrogen should not be given to people at high risk for blood clots, which include women up to 12 weeks after delivery. In addition, there were no studies that included women who breastfed.
Breastfeeding
There are currently no FDA-approved antidepressants to be used during lactation. Most antidepressants are excreted in breast milk. However, there are limited studies that show the effects and safety of these antidepressants in breast-fed infants.
More
Electroconvulsive therapy (ECT) has demonstrated efficacy in women with severe PPD who have failed several drug-based treatment trials or can not tolerate available antidepressants.
In 2013 it is unclear whether acupuncture, massage, bright lights, or consuming omega-3 fatty acids is beneficial.
Epidemiology
Postpartum depression is found worldwide, with rates varying from 11% to 42%. About 3% to 6% of women will develop depression during pregnancy or shortly after delivery. About 1 in 750 mothers will experience postpartum depression with psychosis and the risks are higher if they have a postpartum episode in the past.
Society and culture
Malay culture has belief in Ghost Meroyan; spirits that are in the placenta and amniotic fluid. When this spirit is dissatisfied and vengeful, it causes the mother to experience frequent crying, loss of appetite, and difficulty falling asleep, known collectively as "pain ripping." The mother can be cured with the help of a shaman, who takes action to force the spirit to leave. Some cultures believe that postpartum depressive symptoms or similar diseases can be avoided through protective rituals in the period after birth. Chinese women participate in rituals known as "doing months" (cages) where they spend the first 30 days after giving birth resting in bed, while mother or mother-in-law takes care of domestic chores and childcare. In addition, the new mother is not allowed to bathe or bathe, wash her hair, clean her teeth, leave the house, or be blowing in the wind.
Patient Protection and Affordable Care Act include a section that focuses on research into postpartum conditions including postpartum depression. Some argue that more resources in the form of health policies, programs, and goals need to be directed to their care with PPD.
Mental health stigma with or without support from family members and health professionals often prevents women seeking help for their PPD. When medical help is achieved, some women find helpful diagnoses and encourage higher profiles for PPD among the healthcare professional community.
See also
- Antenatal Depression
- Psychiatric disorders during childbirth
- Sex after pregnancy
References
External links
- Postnatal depression in Curlie (based on DMOZ)
- "Depression during and after pregnancy fact sheet". Womenshealth.gov. 6 Mar 2009. Archive from original on March 1, 2012
- Postnatal Depression, information from the mental health agency The Royal College of Psychiatrists
- Choice of NHS Health A-Z: Postnatal Depression
Source of the article : Wikipedia
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