Baby Blues

dr. Rohmania Setairini

Post partum affective disorder

Postpartum blues (Baby blues/maternity blues)

Highly sensitive period up to 2 weeks after birth. About 50-85% of women experience this. Major depression that lasts for at least 2 weeks About 10-15% of women develop this. Severe form of postpartum depression 1/1,000 women develop this.

Postpartum depression

Postpartum Psychosis

Baby Blues
Characteristics:
mood

lability, irritability, tearfulness, generalized anxiety, sleep and appetite disturbance

Baby Blues

Occur within 2-3 days of delivery

Symptoms peak on 4th or 5th postpartum day Symptoms resolve within 2 weeks

Postpartum Depression

Same DSM IV criteria as for non-pregnancy related depression Symptoms usually begin in initial 12 months after delivery Symptoms often seen as normal for new mothers caring for a newborn

Symptom PPD
Hopelessness Helplessness Persistent sadness Irritability Low self-esteem Loss of pleasure in activities Mood changes Inability to adjust to role of motherhood Inability to concentrate Sleep /appetite disturbances

Risk Factors for PPB

History of depression or premenstrual mood changes Depressive symptoms during pregnancy Family history of depression Concern about child care Psychosocial impairment Poor relationship with own mother Not breastfeeding

PPD Risk Factors

Personal history of depression Family psychiatric history Marital conflict Lack of perceived social support Lack of emotional & financial support from partner Living without a partner Unplanned pregnancy

PPD Risk Factors

Unemployment in the mother Lifetime history of depression in partner Stressful life events in previous 12 months

Etiology

No clear etiology
Possibly due to combination of:
Genetic

susceptibility Hormonal changes Major life events

Screening - Tools
Becks Depression Inventory (PDI) Postpartum Depression Screening Scale (PDSS) Edinburgh Postnatal Depression Scale (EPDS)

Postpartum Depression Screening Scale

94% sensitive and 96% specific in initial trials

35 item self-administered questionnaire Uses 5 point scale

Edinburgh Postnatal Depression Scale

10 item questionnaire
Each response scored 0 3, with total score of 30 possible

Scores > 12 or 13 identify most women with postpartum depression

EPDS

Score > 12 reported as 100% sensitive and 95% specific in detecting major depression

Treatment

Psychosocial therapies
First

choice for those with mild to moderate symptoms of PPD therapy

Cognitive-behavioral Interpersonal

psychotherapy- focuses on patients interpersonal relationship and changing roles

Psychosocial Therapies

Group therapy
Helps

to increase support network

Family and marital therapy

More

rapid recovery More appreciative of partners contribution

Peer-support groups

Pharmacologic Therapy

No antidepressants are approved by the FDA for use during pregnancy All psychotropic drugs are transferred through the placenta and breast milk Consider prior history SSRIs and TCAs have low detection in breastfed infant serum

Antidepressant Choice

TCAs
Desipramine

and Nortryptiline are preferred Least anti-cholinergic affects Minimize postural hypotension

SSRIs
Fluoxetine

is the best studied

summary