Postpartum depression may be a common, disabling, and treatable problem that affects the lady, infant, and family.
In the least postpartum consultation, sensitive investigation into psychological problems should be carried out and thorough assessment should be carried out when key symptoms of depression such as low mood or lost interest exist.
- Symptoms that signify bipolar depression or postpartum psychosis should be known to physicians because they require a coping plan that is distinct from postpartum depression.
Postpartum depression treatment depends on the severity of symptoms and thus the degree of functional disability. Psychosocial interventions, including peer reinforcement and non-directive intervention, may also treat mild depression, and psychological therapy is recommended for moderate depression; pharmacotherapy (usually a first-line selective serotonin reuptake inhibitor [SSRI]) is suggested for extreme depression, for lack of reaction to non-drug therapy, or in compliance with patient preferences.
Symptoms
At least five symptoms present for a minimum of 2 weeks, for many of nearly a day
One symptom must include
• Depressed mood
• Significantly reduced desire or enjoyment or most things altogether
Other symptoms
Clinically significant loss of weight while not on a diet or clinically significant
Benefit or rise in weight or decrease in appetite
Hypersomnia or insomnia
Retardation or psychomotor agitation
Fatigue or Capacity Loss
Feelings of worthlessness or insufficient or unnecessary remorse
Decreased capacity to think or focus or to be indecisive
Recurrent thoughts of death or ideation of suicide (with or without a selected plan)
In social, occupational or other significant areas of function, symptoms cause clinically significant distress or impairment.
Symptoms are not better explained by schizoaffective disorder or other psychotic disorders due to direct physiological effects of a substance or another medical condition, and there has never been a manic or hypomanic episode.
Specifier: With onset of peripartum
This specification is also extended to the present or, if complete requirements for a severe depressive disorder are not currently met, the most recent episode of major depression if mood symptoms arise during pregnancy or within 4 week of delivery.
Treatment
Psychological treatment
Depending on the severity of the woman's symptoms and her functional condition, including her ability to worry about and relate to the infant, the successful treatment options for postpartum depression differ. In the first care environment, mild or moderate symptoms may also be controlled, but when symptoms do not respond to initial treatment, medical referral is required and is urgently suggested in cases of severe illness, particularly when there are thoughts of harm to oneself or others, mania, or psychosis. Methods that are recommended to improve treatment acceptance are the placement of psychological state programs in medical care or obstetric services, provider planning, and collaborative care networks. For women with moderate symptoms, first-line approaches are called psychosocial interventions that strengthen care, such as peer support and non-directive therapy by qualified health practitioners (e.g. in support groups or by nurses during home visits). Women treated with psychosocial therapies were less likely than women who received regular postpartum medical treatment from a health visitor, public health nurse, or medical care at 1 year postpartum to remain depressed practitioner. For women with moderate illness, and for those with mild illness who do not respond to psychosocial interventions alone, formal psychotherapy is recommended to resolve the difficulties of the adjustment to parenthood. Cognitive behavioral therapy focuses on modifying patterns of maladaptive thinking, habits, or both, to effect lasting spiritual change.
Drug therapy
Antidepressant medication is prescribed if the symptoms of postpartum depression are not overcome by psychiatric therapy alone, if the symptoms are severe and require rapid treatment, or if the patient prefers antidepressant medication. Additional drug treatment may also be suggested in cases of serious depression. For extreme anxiety, insomnia, or both, benzodiazepine agents may also be used temporarily before the antidepressant drug takes effect. For women who have depression with psychotic characteristics, adjunctive antipsychotic agents may also be needed. For extreme cases that are not receptive to drug therapy or where active suicidal intent or psychosis is present, hospitalization, a somatic intervention such as electroshock, or both may also be needed.
Other treatment
Because variations in hormone levels are thought to cause postpartum depression in some women, hormone prevention and treatment strategies are being studied. Treatment with transdermal estrogen may decrease symptoms of postpartum depression, but further study is needed. In another study, the risk of postpartum depression was raised by an artificial progestin.
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