Beruflich Dokumente
Kultur Dokumente
POSTPARTUM
DEPRESSION
BY:
DEPARTMENT OF PSYCHIATRY
FACULTY OF MEDICINE
UNIVERSITY OF NORTH SUMATERA
MEDAN
2009
CONTENTS
2
ACKNOWLEDGEMENT…………………………………...4
Chapter 1
1.1 Introduction ………………………………………...5
1.2 Prevalence…………………………...……………....5
Chapter 2
2.1 Definition
2.1.1 Definition of Depression……………………………6
2.1.2 Definition of Postpartum Depression….……………7-8
2.2 Epidemiology ……………………………………….9
2.3 Etiology ……………………………………………..9
Factors that causes depression :
2.3.1 During Pregnancy……………………………………11
2.3.2 After Pregnancy……………………………………...11-12
2.4 Diagnosis …………………………………………….13
2.5 Clinical features ……………………………………..14
2.6 Differential diagnosis………………………………...15
2.7 Prognosis:…………………………..……………..…..16
2.8 Treatment ………………………………….................16
2.8.1 Psychological Treatment………………………………17-18
2.8.2 Medical Treatment……………………………………..18-20
2.9 Complication ………………………………………….20
2.10 Summary………………………………………………21
References …………………………………………………..22
POSTPARTUM DEPRESSION
3
Instructor :
Dr. Hj Abdul Rasyid bin Hj. Said Ssp, AMP, M. Med Psyc (HTF)
Year : 2009
Acknowledgement
First and foremost I would like to thank the god for setting me up in this
SpKJ, Co-ordinator Dr. Elmeida Effendy SpKJ and our evaluator Prof
Thanks also to my friends and other contributors for both material and
moral supports.
Hopefully this journal will benefits all those who would like to
Chapter One
Postpartum Depression
1.1 Introduction:
True postnatal depression can be a severe mental illness. However, the massive
hormonal, physical, and emotional effects from childbirth and a new baby are well
5
blues", and particularly common is some level of crying or distress on the third day
after birth. It's not easy being a mother and first-time mothers often feel
overwhelmed. A new mother feeling down, moody, or a bit "depressed" does not
1.2 Prevalence:
The prevalence of Postpartum depression in the general population is 10% among
pregnancies. While the estimation of its occurrence range from 3% to 20% of births.
10 - 17 percent of women.
Chapter Two
Discussion
2.1 Definition:
dumps. Most of us feel this way at one time or another for short periods. But true
frustration interfere with everyday life for an extended time. Depression can be mild,
6
moderate, or severe. The degree of depression, which your doctor can determine,
For every woman, having a baby is a challenging time, both physically and
emotionally. It is natural for many new mothers to have mood swings after delivery,
feeling joyful one minute and depressed the next. These feelings are sometimes
known as the "baby blues", and often go away within 10 days of delivery. However,
some women may experience a deep and ongoing depression which lasts much
References to postpartum depression date back as far as the 4th century BC. Despite
this early awareness, it has not always been recognized as an illness. As a result,
effectively treated. The sooner the condition is diagnosed, the more effective the
depression in yourself or another as soon as possible. This can be difficult, since the
depressive feelings often involve intense and irrational feelings of fear. The mother
may fear she is losing her mind or fear that others may feel she is unfit to be a
mother.
depression, and can also include fluctuations in mood, preoccupation with infant
well-being, as well as at times just the opposite, complete disinterest in the infant
A woman with PPD may also have feelings similar to the baby blues -- sadness,
despair, anxiety, irritability -- but she feels them much more strongly than she would
with the baby blues. PPD often keeps her from doing the things she needs to do every
7
day. When a woman's ability to function is affected, this is a sure sign that she needs
treatment. If a woman does not get treatment for PPD, it can get worse and last for as
long as a year.
Postpartum Psychosis
The baby blues can happen in the days right after childbirth and normally go away
within a few days to a week. A new mother can have sudden mood swings, sadness,
crying spells, loss of appetite, sleeping problems, and feel irritable, restless, anxious,
and lonely. Symptoms are not severe and treatment isn't needed. But there are things
Postpartum depression can happen anytime within the first year after childbirth. A
woman may have a number of symptoms such as sadness, lack of energy, trouble
between postpartum depression and the baby blues is that postpartum depression
often affects a woman's well-being and keeps her from functioning well for a longer
Postpartum psychosis is rare. It occurs in 1 or 2 out of every 1000 births and usually
begins in the first 6 weeks postpartum. Women who have bipolar disorder or another
psychiatric problem called schizoaffective disorder have a higher risk for developing
8
disturbances, and obsessive thoughts about the baby. A woman may have rapid mood
2.2 Epidemiology:
In developed countries, PPD occurs in about 12% to 13% of postpartum women.
More recently, the rates in the United States have been reported as 10% to20%.
Transculturally, the rates are estimated at 10% to 15%, with a higher rate in
childbirth, such as lack of sleep, appetite changes, fatigue, decreased libido, and
mood lability. The exact number of women with depression during this time is
unknown. But researchers believe that depression is one of the most common
complications during and after pregnancy. Often, the depression is not recognized or
treated, because some normal pregnancy changes cause similar symptoms and are
reactions, and changes in body weight may occur during pregnancy and after
2.3 Etiology:
The exact cause of postpartum depression is not known. One factor may be the
changes in hormone levels that occur during pregnancy and immediately after
childbirth. Also, when the experience of having a child does not match the mother's
expectations, the resultant stress can trigger depression. Studies have also considered
and the level of social support for the new mother.There may be a number of reasons
9
why a woman gets depressed. Hormone changes or a stressful life event, such as a
death in the family, can cause chemical changes in the brain that lead to depression.
Depression is also an illness that runs in some families. Other times, it's not clear
One certain fact is that women who have experienced depression before becoming
pregnant are at higher risk for postpartum depression. Women in this situation should
discuss it with their doctor so that they may receive appropriate treatment, if
The amount of sick leave taken during pregnancy and the frequency of medical
consultation may also be warning signs. Women who have the most doctor visits
during their pregnancy and who also took the most sick-leave days have been found
who have experienced 2 or more abortions, or women who have a history of obstetric
complications.
Other factors which increase the risk of postpartum depression are severe
estrogen and progesterone, in a woman's body increases greatly. In the first 24 hours
after childbirth, the amount of these hormones rapidly drops back down to their
normal non-pregnant levels. Researchers think the fast change in hormone levels
may lead to depression, just as smaller changes in hormones can affect a woman's
Occasionally, levels of thyroid hormones may also drop after giving birth. The
thyroid is a small gland in the neck that helps to regulate your metabolism (how your
body uses and stores energy from food). Low thyroid levels can cause symptoms of
fatigue, difficulty concentrating, sleep problems, and weight gain. A simple blood
11
test can tell if this condition is causing a woman's depression. If so, thyroid medicine
• Feeling tired after delivery, broken sleep patterns, and not enough rest often
keeps a new mother from regaining her full strength for weeks.
• Feeling stress from changes in work and home routines. Sometimes, women
think they have to be "super mom" or perfect, which is not realistic and can
add stress.
having the baby, loss of control, loss of your pre-pregnancy figure, and
• Having less free time and less control over time. Having to stay home indoors
for longer periods of time and having less time to spend with the your partner
2.4 Diagnosis:
The criteria used to diagnose depression is the same in postpartum states. In addition
to these criteria, other symptoms may include fear or feelings of guilt about being a
"bad" mother, or possibly extreme fear that some harm will come to the baby. These
postpartum major depressive episodes may also have severe anxiety, panic attacks,
spontaneous crying long after the usual duration of "baby blues" (ie, 3-7 days
12
falling asleep).
exhaustion or irritability may be quite normal when her infant is 2 weeks old and
nursing frequently, but may not be normal when her baby is 4 months old and
sleeping soundly through the night. Sleep deprivation can cause fatigue and poor
• Crying a lot
• Having headaches, chest pains, heart palpitations (the heart beating fast and
breathing)
After pregnancy, signs of depression may also include being afraid of hurting the
2.7 Prognosis:
Postpartum depression usually goes away during the months after delivery. Some
If untreated, the illness can cause prolonged misery for the mother and her family.
herself.
2.8 Treatment:
There are two common types of treatment for depression.
worker to learn to change how depression makes you think, feel, and act.
help you. These medicines can help relieve the symptoms of depression.
15
therapy with a mental health professional. If depression is severe, the experts urge
finding someone to stay with and assist the mother at all times, such as a relative,
friend, or paid helper. Family and friends can offer non-judgmental support,
reassurance, hope, and validation of the new mother’s abilities. Common issues in
responsibilities and guilt over becoming depressed at such a crucial time. Two
include the spouse or other main caretaker in therapy to help him or her understand
the symptoms of depression and cope with the increased stress on the family.
Here are some other helpful tips that can be suggested to the patients:
• Try to get as much rest as you can. Try to nap when the baby naps.
• Ask for help with household chores and nighttime feedings. Ask your
husband or partner to bring the baby to you so you can breastfeed. If you can,
have a friend, family member, or professional support person help you in the
• Talk to your husband, partner, family, and friends about how you are feeling.
• Do not spend a lot of time alone. Get dressed and leave the house. Run an
• Talk with other mothers, so you can learn from their experiences.
• Join a support group for women with depression. Call a local hotline or look
• Don't make any major life changes during pregnancy. Major changes can
cause unneeded stress. Sometimes big changes cannot be avoided. When that
happens, try to arrange support and help in your new situation ahead of time.
advantages and risks of taking antidepressant medicines. Some women are concerned
that taking these medicines may harm the baby. A mother's depression can affect her
baby's development, so getting treatment is important for both mother and baby. The
decision that women need to discuss carefully with their doctors. Women who decide
Antidepressant medications
Many different kinds of antidepressants are available with different chemical actions
and side effects. All of them treat depressive symptoms and may be helpful for
about the safety of antidepressant medication for her infant. For postpartum
serotonin.Their top choice among these is Zoloft (sertraline), the most widely studied
antidepressant in breast-feeding mothers and their infants. While small amounts enter
breast milk, little or no medication can be detected in infants, and there appear to be
detectable in breast milk or nursing infants.Two other widely used SSRIs, fluoxetine
(Prozac) and citalopram(Celexa), enter breast milk in small amounts but are viewed
pregnancy and needs to stay on medication after delivery, experts do not think it is
Tricyclics usually cause more side effects in the mother than SSRIs but are
sometimes more effective. If the baby has health problems, the pediatrician can
For an extremely severe type of depression in which the mother has psychotic
are preferred otherwise, but have not been tested enough in breast-feeding mothers
If a woman has very severe symptoms, such as suicidal or psychotic thoughts, the
doctor may need to put her in the hospital to ensure her safety and that of the baby
avoid medication.
18
2.9 Complication:
Postpartum depression,if left untreated, postpartum depression can interfere with
mother-child bonding and cause family distress. Children of mothers who have
untreated postpartum depression are more likely to have behavioral problems, such
levels, sleep problems, and distress. It helps if the father or another caregiver can
assist in meeting the needs of the baby and other children in the family while mom is
2.10 Summary :
Like all forms of depression, postpartum depression creates a cloud of negative
feelings and thoughts over a woman's view of herself, those around her, her situation,
and the future. Under the cloud of depression, a woman might see herself as helpless
might seem disappointing, uninteresting, or without meaning. Keep in mind that the
With the right treatment and support, the cloud can be lifted. This can free a woman
to feel like herself again, to regain her perspective and sense of her own strength, her
energy, her joy, and her hope. With those things in place, it's easier to work with
changes, to see solutions to life's challenges, and to enjoy life's pleasures again.
19
REFERENCES
http://www.medicinenet.com/postpartum_depression/article.htm#tocb
http://family.jrank.org/pages/1293/Postpartum-Depression-Epidemiology-
Course.html
http://www.freemd.com/postpartum-depression/outlook.htm
20
http://www.mayoclinic.com/health/postpartumdepression/