Disease: Postpartum Depression

    Postpartum depression facts

    • Postpartum depression (PPD) is the most common problem associated with childbirth.
    • PPD is characterized by depression that a woman experiences within four weeks of childbirth.
    • PPD can affect as many as 10% of fathers as well.
    • Biological, psychological, and social factors play roles in predisposing women to develop postpartum depression.
    • There is no one test that definitively indicates that someone has PPD.
    • Treatment options for PPD include illness education, support groups, psychotherapy, and/or medication. Particular care is taken when considering medication given the potential risks of exposing an infant to the medications through breastfeeding.
    • Women who have suffered from postpartum depression are much more likely to have depression again sometime in the future. Children of a mother or father with PPD are at risk for emotional challenges.
    • Intensive nursing intervention can help prevent the development of postpartum depression.

    What is postpartum depression? Are there different types of postpartum depression?

    Postpartum depression is the most common problem associated with childbirth. It has been described as afflicting prominent historical figures like author/suffragist Charlotte Perkins Gilman in the 19th century. This illness is characterized by depression that a woman experiences within four weeks of childbirth, affecting about 13% of women who give birth. Postpartum depression occurs after one out of every eight deliveries in the United States, affecting about half a million women every year. Postpartum depression is also called major depression with postpartum onset. Delusional thinking after childbirth, called postpartum psychosis, affects about one in every thousand women.

    Notably, postpartum depression is not an illness that is exclusive to mothers. Fathers can experience it as well. In fact, it can affect as many as 10% of new fathers. As with women, symptoms in men can result in fathers having difficulty caring for themselves and for their children when suffering from postpartum depression.

    Unfortunately, up to 50% of individuals with postpartum depression or postpartum psychosis are never detected. That can result in devastating outcomes for the patient and family. For example, postpartum psychosis is thought to have been a potential factor in Andrea Yates drowning her five children in 2001 and was explored as a factor in Susan Smith drowning her two sons.

    What are causes and risk factors for postpartum depression?

    Similar to many other mental health conditions, there is thought to be a genetic vulnerability to developing postpartum depression. Rapid changes in the levels of reproductive hormones that occur after delivery are thought to be biological factors in the development of postpartum depression. Interestingly, men are also known to experience changes in a number of hormones during the postpartum period that can contribute to the development of PPD. Also, the stress inherent in caring for a newborn is a considerable factor.

    Further risk factors for developing postpartum depression include marital problems, low self-esteem, and a lack of having social support before and after the birth of the child.

    What are postpartum depression symptoms and signs?

    Symptoms of postpartum depression begin within four weeks after having a baby and include the following:

    • Feelings of severe sadness, emptiness, emotional numbness, or frequent crying
    • Feelings of irritability or anger
    • A tendency to withdraw from relationships with family, friends, or from activities that are usually pleasurable for the PPD sufferer
    • Constant tiredness, trouble sleeping, overeating, or loss of appetite
    • A strong sense of failure or inadequacy
    • Intense concern and anxiety about the baby or a lack of interest in the baby
    • Thoughts about suicide or fears of harming the baby

    Postpartum psychosis occurs much more rarely and is thought to be a severe form of postpartum depression. Symptoms of that disorder include the following:

    • Delusions (false beliefs)
    • Hallucinations (for example, hearing voices or seeing things that are not real)
    • Thoughts of harming the baby
    • Severe depressive symptoms

    How is postpartum depression diagnosed?

    There is no one test that definitively indicates that someone has PPD. Therefore, health care professionals diagnose this disorder by gathering comprehensive medical, family, and mental health history. Patients tend to benefit when the professional takes into account their client's entire life and background. This includes, but is not limited to, the person's gender, sexual orientation, cultural, religious, ethnic background, and socioeconomic status. The health care professional will also either perform a physical examination or request that the individual's primary care doctor perform one. The medical examination will usually include lab tests to evaluate the person's general health and as part of screening the individual for medical conditions that might have mental health symptoms.

    Postpartum depression must be distinguished from what is commonly called the "baby blues," which tend to happen in most new mothers. In the brief mood problem of baby blues, symptoms like crying, feeling sad, irritability, anxiety, and confusion can occur. In contrast to the symptoms of PPD, the symptoms of the baby blues tend to peak around the fourth day after delivery, resolve by the 10th day after giving birth and do not tend to affect the parent's ability to function.

    Postpartum psychosis is a psychiatric emergency that requires immediate intervention because of the danger that the sufferer might kill their infant or themselves. Postpartum psychosis usually begins within the first two weeks after delivery. Symptoms of this condition tend to involve extremely disorganized thinking, bizarre behavior, unusual hallucinations, and delusions. Postpartum psychosis is often a symptom of bipolar disorder, also called manic depression. While seasonal affective disorder (SAD) features depression, it takes place at a particular time of year, typically in the darker winter months.

    What are the treatments for postpartum depression?

    Educational programs and support groups

    Treatment of postpartum depression in men and women is similar. Both mothers and fathers with this condition have been found to greatly benefit from being educated about the illness, as well as from the support of other parents who have been in this position.

    Psychotherapies

    Psychotherapy ("talk therapy") involves working with a trained therapist to figure out ways to solve problems and cope with all forms of depression, including postpartum depression. It can be a powerful intervention, even producing positive biochemical changes in the brain. This is particularly important as an alternative to medication treatment while women are breastfeeding. In general, these therapies take weeks to months to complete. More intense psychotherapy may be needed for longer when treating very severe depression or for depression with other psychiatric symptoms.

    Interpersonal therapy (IPT): This helps to alleviate depressive symptoms and helps the person with PPD develop more effective skills for coping with social and interpersonal relationships. IPT employs two strategies to achieve these goals.

    • The first is education about the nature of depression. The therapist will emphasize that depression is a common illness and that most people can expect to get better with treatment.
    • The second is defining specific problems (such as child care pressures or interpersonal conflicts). After the problems are defined, the therapist is able to help set realistic goals for solving these problems. Together, the individual with PPD and his or her therapist will use various treatment techniques to reach these goals.

    Cognitive behavioral therapy (CBT): This helps to alleviate depression and reduce the likelihood it will come back by helping the PPD sufferer change his or her way of thinking. In CBT, the therapist uses three techniques to accomplish these goals.

    • Didactic component: This phase helps to set up positive expectations for therapy and promote cooperation.
    • Cognitive component: This helps to identify the thoughts and assumptions that influence behaviors, particularly those that may predispose the person with PPD to being depressed.
    • Behavioral component: This employs behavior-modification techniques to teach the individual with PPD more effective strategies for dealing with problems.
    Medications

    Medication therapy for postpartum depression usually involves the use of antidepressant medication. The major types of antidepressant medication are the selective serotonin reuptake inhibitors (SSRIs), seritonin/norepinephrine/dopamine reuptake inhibitors (NSRIs), the tricyclic antidepressants (TCAs), and the monoamine oxidase inhibitors (MAOIs). SSRI medications affect levels of serotonin in the brain. For many prescribing doctors, these medications are the first choice because of the high level of effectiveness and general safety of this group of medicines. Examples of antidepressants are listed here. The generic name is first, with the brand name in parentheses.

    Learn more about: dopamine

    • Fluoxetine (Prozac)
    • Sertraline (Zoloft)
    • Paroxetine (Paxil)
    • Fluvoxamine (Luvox)
    • Citalopram (Celexa)
    • Escitalopram (Lexapro)

    Learn more about: Prozac | Zoloft | Paxil | Luvox | Celexa | Lexapro

    SNRIs and NDRs:

    • Bupropion (Wellbutrin)
    • Mirtazapine (Remeron)
    • Venlafaxine (Effexor)
    • Duloxetine (Cymbalta)
    • Desvenlafaxine (Pristiq)

    Learn more about: Wellbutrin | Remeron | Effexor | Cymbalta | Pristiq

    TCAs are sometimes prescribed in severe cases of depression or when SSRIs or SNRIs don't work. These medications affect a number of brain chemicals (neurotransmitters), especially epinephrine and norepinephrine (also called adrenaline and noradrenaline, respectively). Examples include

    • amitriptyline (Elavil),
    • clomipramine (Anafranil),
    • desipramine (Norpramin),
    • doxepin (Adapin),
    • imipramine (Tofranil),
    • nortriptyline (Pamelor).

    Learn more about: Elavil | Anafranil | Norpramin | Tofranil | Pamelor

    Approximately two-thirds of people who take antidepressant medications get better. It may take anywhere from one to six weeks of taking medication at its effective dose to start feeling better. It is, therefore, important not to give up taking the medication because benefits are not felt right away. The MAOIs are not used as often since the introduction of the SSRIs. Because of interactions with some antidepressants and other medications and specific foods, the MAOIs may not be taken with many other types of medication, and some types of foods that are high in tyramine (like aged cheeses, wines, and cured meats) must be avoided as well. Examples of MAOIs include phenelzine (Nardil) and tranylcypromine (Parnate). Atypical neuroleptic medications are often prescribed in addition to a mood-stabilizer medication in people with postpartum psychosis. Examples of atypical neuroleptics include

    Learn more about: Nardil | Parnate

    • aripiprazole (Abilify),
    • olanzapine (Zyprexa),
    • paliperidone (Invega),
    • quetiapine (Seroquel),
    • risperidone (Risperdal),
    • ziprasidone (Geodon),
    • asenapine (Saphris),
    • iloperidone (Fanapt).

    Learn more about: Abilify | Zyprexa | Invega | Seroquel | Risperdal | Geodon | Saphris | Fanapt

    Non-neuroleptic mood-stabilizer medications are also sometimes used with a neuroleptic medication to treat people with postpartum psychosis because bipolar disorder may be underlying in some patients. Examples of non-neuroleptic mood stabilizers include

    • lithium (Lithium Carbonate, Lithium Citrate),
    • divalproex sodium (Depakote),
    • carbamazepine (Tegretol),
    • lamotrigine (Lamictal).

    Learn more about: Depakote | Tegretol | Lamictal

    What is the prognosis of postpartum depression?

    Women who have suffered from postpartum depression are much more likely to have depression again sometime in the future. Children of mothers with PPD are at risk for emotional challenges as a result of problematic relationships with their mother.

    Can postpartum depression be prevented?

    Intensive nursing intervention in the form of visits to new mothers by a nurse can help prevent the development of postpartum depression.

    Where can people get more information about postpartum depression?

    Depression After Delivery
    http://www.depressionafterdelivery.com

    Jennifer Mudd Houghtaling Postpartum Depression Foundation
    200 E. Delaware Apt. 3D
    Chicago, IL 60611
    Phone: 312-867-7239
    Email: [email protected]

    Kids Health -- Postpartum Depression and Caring for Your Baby
    http://kidshealth.org/parent/emotions/feelings/ppd.html

    Postpartum Education for Parents
    http://www.sbpep.org

    Postpartum Progress
    http://postpartumprogress.com

    Womenshealth.gov helpline (English and Spanish)
    Phone: 800-994-9662
    TDD: 888-220-5446
    Hours: Monday through Friday, 9 a.m. to 6 p.m., EST. (closed on federal holidays)

    Office on Women's Health
    Phone: 202-690-7650
    Fax: 202-205-2631

    Pregnancy Info.net
    http://www.pregnancy-info.net

    What are causes and risk factors for postpartum depression?

    Similar to many other mental health conditions, there is thought to be a genetic vulnerability to developing postpartum depression. Rapid changes in the levels of reproductive hormones that occur after delivery are thought to be biological factors in the development of postpartum depression. Interestingly, men are also known to experience changes in a number of hormones during the postpartum period that can contribute to the development of PPD. Also, the stress inherent in caring for a newborn is a considerable factor.

    Further risk factors for developing postpartum depression include marital problems, low self-esteem, and a lack of having social support before and after the birth of the child.

    What are postpartum depression symptoms and signs?

    Symptoms of postpartum depression begin within four weeks after having a baby and include the following:

    • Feelings of severe sadness, emptiness, emotional numbness, or frequent crying
    • Feelings of irritability or anger
    • A tendency to withdraw from relationships with family, friends, or from activities that are usually pleasurable for the PPD sufferer
    • Constant tiredness, trouble sleeping, overeating, or loss of appetite
    • A strong sense of failure or inadequacy
    • Intense concern and anxiety about the baby or a lack of interest in the baby
    • Thoughts about suicide or fears of harming the baby

    Postpartum psychosis occurs much more rarely and is thought to be a severe form of postpartum depression. Symptoms of that disorder include the following:

    • Delusions (false beliefs)
    • Hallucinations (for example, hearing voices or seeing things that are not real)
    • Thoughts of harming the baby
    • Severe depressive symptoms

    How is postpartum depression diagnosed?

    There is no one test that definitively indicates that someone has PPD. Therefore, health care professionals diagnose this disorder by gathering comprehensive medical, family, and mental health history. Patients tend to benefit when the professional takes into account their client's entire life and background. This includes, but is not limited to, the person's gender, sexual orientation, cultural, religious, ethnic background, and socioeconomic status. The health care professional will also either perform a physical examination or request that the individual's primary care doctor perform one. The medical examination will usually include lab tests to evaluate the person's general health and as part of screening the individual for medical conditions that might have mental health symptoms.

    Postpartum depression must be distinguished from what is commonly called the "baby blues," which tend to happen in most new mothers. In the brief mood problem of baby blues, symptoms like crying, feeling sad, irritability, anxiety, and confusion can occur. In contrast to the symptoms of PPD, the symptoms of the baby blues tend to peak around the fourth day after delivery, resolve by the 10th day after giving birth and do not tend to affect the parent's ability to function.

    Postpartum psychosis is a psychiatric emergency that requires immediate intervention because of the danger that the sufferer might kill their infant or themselves. Postpartum psychosis usually begins within the first two weeks after delivery. Symptoms of this condition tend to involve extremely disorganized thinking, bizarre behavior, unusual hallucinations, and delusions. Postpartum psychosis is often a symptom of bipolar disorder, also called manic depression. While seasonal affective disorder (SAD) features depression, it takes place at a particular time of year, typically in the darker winter months.

    What are the treatments for postpartum depression?

    Educational programs and support groups

    Treatment of postpartum depression in men and women is similar. Both mothers and fathers with this condition have been found to greatly benefit from being educated about the illness, as well as from the support of other parents who have been in this position.

    Psychotherapies

    Psychotherapy ("talk therapy") involves working with a trained therapist to figure out ways to solve problems and cope with all forms of depression, including postpartum depression. It can be a powerful intervention, even producing positive biochemical changes in the brain. This is particularly important as an alternative to medication treatment while women are breastfeeding. In general, these therapies take weeks to months to complete. More intense psychotherapy may be needed for longer when treating very severe depression or for depression with other psychiatric symptoms.

    Interpersonal therapy (IPT): This helps to alleviate depressive symptoms and helps the person with PPD develop more effective skills for coping with social and interpersonal relationships. IPT employs two strategies to achieve these goals.

    • The first is education about the nature of depression. The therapist will emphasize that depression is a common illness and that most people can expect to get better with treatment.
    • The second is defining specific problems (such as child care pressures or interpersonal conflicts). After the problems are defined, the therapist is able to help set realistic goals for solving these problems. Together, the individual with PPD and his or her therapist will use various treatment techniques to reach these goals.

    Cognitive behavioral therapy (CBT): This helps to alleviate depression and reduce the likelihood it will come back by helping the PPD sufferer change his or her way of thinking. In CBT, the therapist uses three techniques to accomplish these goals.

    • Didactic component: This phase helps to set up positive expectations for therapy and promote cooperation.
    • Cognitive component: This helps to identify the thoughts and assumptions that influence behaviors, particularly those that may predispose the person with PPD to being depressed.
    • Behavioral component: This employs behavior-modification techniques to teach the individual with PPD more effective strategies for dealing with problems.
    Medications

    Medication therapy for postpartum depression usually involves the use of antidepressant medication. The major types of antidepressant medication are the selective serotonin reuptake inhibitors (SSRIs), seritonin/norepinephrine/dopamine reuptake inhibitors (NSRIs), the tricyclic antidepressants (TCAs), and the monoamine oxidase inhibitors (MAOIs). SSRI medications affect levels of serotonin in the brain. For many prescribing doctors, these medications are the first choice because of the high level of effectiveness and general safety of this group of medicines. Examples of antidepressants are listed here. The generic name is first, with the brand name in parentheses.

    Learn more about: dopamine

    • Fluoxetine (Prozac)
    • Sertraline (Zoloft)
    • Paroxetine (Paxil)
    • Fluvoxamine (Luvox)
    • Citalopram (Celexa)
    • Escitalopram (Lexapro)

    Learn more about: Prozac | Zoloft | Paxil | Luvox | Celexa | Lexapro

    SNRIs and NDRs:

    • Bupropion (Wellbutrin)
    • Mirtazapine (Remeron)
    • Venlafaxine (Effexor)
    • Duloxetine (Cymbalta)
    • Desvenlafaxine (Pristiq)

    Learn more about: Wellbutrin | Remeron | Effexor | Cymbalta | Pristiq

    TCAs are sometimes prescribed in severe cases of depression or when SSRIs or SNRIs don't work. These medications affect a number of brain chemicals (neurotransmitters), especially epinephrine and norepinephrine (also called adrenaline and noradrenaline, respectively). Examples include

    • amitriptyline (Elavil),
    • clomipramine (Anafranil),
    • desipramine (Norpramin),
    • doxepin (Adapin),
    • imipramine (Tofranil),
    • nortriptyline (Pamelor).

    Learn more about: Elavil | Anafranil | Norpramin | Tofranil | Pamelor

    Approximately two-thirds of people who take antidepressant medications get better. It may take anywhere from one to six weeks of taking medication at its effective dose to start feeling better. It is, therefore, important not to give up taking the medication because benefits are not felt right away. The MAOIs are not used as often since the introduction of the SSRIs. Because of interactions with some antidepressants and other medications and specific foods, the MAOIs may not be taken with many other types of medication, and some types of foods that are high in tyramine (like aged cheeses, wines, and cured meats) must be avoided as well. Examples of MAOIs include phenelzine (Nardil) and tranylcypromine (Parnate). Atypical neuroleptic medications are often prescribed in addition to a mood-stabilizer medication in people with postpartum psychosis. Examples of atypical neuroleptics include

    Learn more about: Nardil | Parnate

    • aripiprazole (Abilify),
    • olanzapine (Zyprexa),
    • paliperidone (Invega),
    • quetiapine (Seroquel),
    • risperidone (Risperdal),
    • ziprasidone (Geodon),
    • asenapine (Saphris),
    • iloperidone (Fanapt).

    Learn more about: Abilify | Zyprexa | Invega | Seroquel | Risperdal | Geodon | Saphris | Fanapt

    Non-neuroleptic mood-stabilizer medications are also sometimes used with a neuroleptic medication to treat people with postpartum psychosis because bipolar disorder may be underlying in some patients. Examples of non-neuroleptic mood stabilizers include

    • lithium (Lithium Carbonate, Lithium Citrate),
    • divalproex sodium (Depakote),
    • carbamazepine (Tegretol),
    • lamotrigine (Lamictal).

    Learn more about: Depakote | Tegretol | Lamictal

    What is the prognosis of postpartum depression?

    Women who have suffered from postpartum depression are much more likely to have depression again sometime in the future. Children of mothers with PPD are at risk for emotional challenges as a result of problematic relationships with their mother.

    Can postpartum depression be prevented?

    Intensive nursing intervention in the form of visits to new mothers by a nurse can help prevent the development of postpartum depression.

    Where can people get more information about postpartum depression?

    Depression After Delivery
    http://www.depressionafterdelivery.com

    Jennifer Mudd Houghtaling Postpartum Depression Foundation
    200 E. Delaware Apt. 3D
    Chicago, IL 60611
    Phone: 312-867-7239
    Email: [email protected]

    Kids Health -- Postpartum Depression and Caring for Your Baby
    http://kidshealth.org/parent/emotions/feelings/ppd.html

    Postpartum Education for Parents
    http://www.sbpep.org

    Postpartum Progress
    http://postpartumprogress.com

    Womenshealth.gov helpline (English and Spanish)
    Phone: 800-994-9662
    TDD: 888-220-5446
    Hours: Monday through Friday, 9 a.m. to 6 p.m., EST. (closed on federal holidays)

    Office on Women's Health
    Phone: 202-690-7650
    Fax: 202-205-2631

    Pregnancy Info.net
    http://www.pregnancy-info.net

    Source: http://www.rxlist.com

    Treatment of postpartum depression in men and women is similar. Both mothers and fathers with this condition have been found to greatly benefit from being educated about the illness, as well as from the support of other parents who have been in this position.

    Psychotherapies

    Psychotherapy ("talk therapy") involves working with a trained therapist to figure out ways to solve problems and cope with all forms of depression, including postpartum depression. It can be a powerful intervention, even producing positive biochemical changes in the brain. This is particularly important as an alternative to medication treatment while women are breastfeeding. In general, these therapies take weeks to months to complete. More intense psychotherapy may be needed for longer when treating very severe depression or for depression with other psychiatric symptoms.

    Interpersonal therapy (IPT): This helps to alleviate depressive symptoms and helps the person with PPD develop more effective skills for coping with social and interpersonal relationships. IPT employs two strategies to achieve these goals.

    • The first is education about the nature of depression. The therapist will emphasize that depression is a common illness and that most people can expect to get better with treatment.
    • The second is defining specific problems (such as child care pressures or interpersonal conflicts). After the problems are defined, the therapist is able to help set realistic goals for solving these problems. Together, the individual with PPD and his or her therapist will use various treatment techniques to reach these goals.

    Cognitive behavioral therapy (CBT): This helps to alleviate depression and reduce the likelihood it will come back by helping the PPD sufferer change his or her way of thinking. In CBT, the therapist uses three techniques to accomplish these goals.

    • Didactic component: This phase helps to set up positive expectations for therapy and promote cooperation.
    • Cognitive component: This helps to identify the thoughts and assumptions that influence behaviors, particularly those that may predispose the person with PPD to being depressed.
    • Behavioral component: This employs behavior-modification techniques to teach the individual with PPD more effective strategies for dealing with problems.

    Source: http://www.rxlist.com

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