POSTPARTUM DEPRESSION

Volume-1 Issue-1 July, 2011

CONSULTATION LIAISON PSYCHIATRY: FOCUS> OBSTETRICS & GYNECOLOGY

Postpartum Depression (PPD) is a form of clinical depression which can affect women after childbirth. Though the incidence of PPD is 15-20% in our country, it is not considered seriously in the rural population & it may not be noticed till it becomes serious. Instead, the parturient mother is blamed for not properly taking care of future heir of the family.
The cause of PPD could be due to hormonal fluctuation especially thyroid hormones, estrogen, and progesterone. The other major factors of aetiological importance are largely of psychosocial nature. The affected person may manifest with mood swings, loss of interest, fatigue, eating disorders, lack of joy of the motherhood and persistent sadness. They may become irritable and prefer loneliness. Some women may feel guilty and blame themselves for all the misery. Their food intake reduces & there may be sleep disturbances. Severely depressed women may even think of ending their life.

These symptoms are seen within 4 weeks post partum or as late as after 3-6 months. The associated risk factors at the level of family are unplanned pregnancy, illegitimate child, family discord, single parentage, young child at home, etc. Obstetric factors responsible are operative intervention, PIH & other pregnancy complications. At a personal level, substance abuse, smoking and contributory factors from the baby like temperament of the baby, sleep, feeding problems & abrupt weaning of the baby play a role. If PPD is not recognized, it may lead to dysfunction in the family & the mother may harm or kill the newborn. On the other side, there may be delay in cognitive, emotional and social development of the baby. However PPD needs to be differentiated from ‘Postpartum blues’, a self remitting milder condition considered as normal part of motherhood; and ‘Postpartum Psychosis’, a severe form of illness wherein the person loses touch with the reality and develops symptoms like hallucinations, paranoid or grandiose beliefs, poor self hygiene & aggressiveness.

There are few scales used in the screening of PPD like the Edinburgh Postnatal Depression Scale (EPDS) and the NIMHANS scale which can be used by obstetricians or the primary health care givers to recognize the cases early. Post Partum Depression can be managed by judicious use of antidepressants like SSRIs (Selective Serotonin Reuptake Inhibitors) and supportive psychotherapy. The latter includes support from the family & community; teaching skills to cope up with the new responsibility and psychoeducation in the prenatal period. Early recognition & prompt treatment brings happiness in the family, increases the joy of motherhood and ensures good health of the newborn.