Definition
Postpartum depression occurs in 8-15% of postpartum women, 3-6 months after
childbirth. Depressed mothers have less social interaction with children. It
is a condition similar to major and minor depression and necessitates medical
treatment.
Causes
- Biochemical changes due to childbirth.
- Strong association with previous psychological problems.
- History of depression: 30% recurrence rate.
Diagnosis
According to the American Psychiatric Association, a woman suffering from
postpartum depression demonstrates at least five of following symptoms:
- Depressed mood most of the day.
- Markedly diminished interest or pleasure in all, or almost all, activities.
- Significant weight loss or weight gain when not dieting, or decrease or
increase in appetite.
- Insomnia or hypersomnia.
- Psychomotor agitation or retardation.
- Fatigue or loss of energy.
- Feelings of worthlessness or excessive or inappropriate guilt.
- Diminished ability to think or concentrate.
- Recurrent thoughts of death, recurrent suicidal ideation without a
specific plan, or a suicide attempt
Treatment
Mild to moderate depression can be treated with psychotherapy. Severe, chronic
or recurrent depression can be treated with antidepressants and psychotherapy.
For patients with suicidal ideation or suicide attempts, hospitalization and
psychotherapy are needed.
1. Antidepressant Medications
Once medication is taken and is effective after a six-week trial period, it
must be taken regularly for 6 to 12 months. In cases of recurrent depression,
long-term maintenance of medication is the most effective way of treating and
preventing depression. When discontinuing antidepressants, dosage is gradually
decreased. Dosage of antidepressants is adjusted for each individual patient.
- Tricyclic antidepressants (TCAs)
TCAs are early antidepressants from the 1960s. They are as effective as the
newer antidepressants, but have less tolerable side effects. The action
mechanism of TCAs affects two brain chemicals: norepinephrine and serotonin.
TCAs, such as amitriptyline (Elavil), nortriptyline (Pamelor), desipramine
(Norpramin), and imipramine (Tofranil) are still commonly prescribed as a
second or third line of treatment for depression.
The most common side effects are dry mouth and constipation. Bladder problems,
change in sex drive, weight gain, blurred vision, dizziness, drowsiness, and
rapid
heard rate also may occur.
- Monoamine oxidase inhibitors (MAOIs)
MAOIs, such as Phenelzine (Nardil), Tranylcypromine (Parnate), and isocarboxazid
(Marplan) have been used for major depression, panic disorder and bipolar
disorder (manic depressive disorder) since the 1960s. MAOIs are used as the
last resort when other antidepressants are not effective.
Dietary restrictions are required because it may have interactions with
certain foods, including cheeses, pickles, beverages (wines), and with
medications, including decongestants and antidepressants, especially SSRIs.
This interaction can increase blood pressure sharply, which can lead to a
stroke. Interaction with SSRIs can cause serotonin syndrome.
- Selective serotonin reuptake inhibitors (SSRIs)
SSRIs have fewer side effects, less toxicity, and yield a lower suicide
risk than the older antidepressants (TCAs, MAOIs). SSRIs primarily
affect one neurotransmitter(serotonin), while old antidepressant TCAs
affect both serotonin and norepinephrine in the brain. Fluoxetine(Prozac),
sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil), and
citalopram (Celexa) are the most commonly used SSRIs. Side effects may
include sexual problems, headache, nausea, nervousness, insomnia and
agitation; however, they are usually temporary after a short period of
time. Sexual problems can be common in both men and women, but reversible.
When SSRIs are combined with other medications that affect serotonin, such
as an MAOI, it can lead to serotonin syndrome.
- Other antidepressants
Venlafaxine (Effexor), Nefazadone (Serzone), Mirtazepine (Remeron),
bupropion (Wellbutrin), are examples of other antidepressants that may be
used to treat postpartum depression.
2. Counseling and psychotherapy
Psychotherapy alone may be an effective treatment for postpartum depression;
but psychotherapy, accompanied by antidepressants, is a more effective in
treatment.
3. Electroconvulsive therapy (ECT)
ECT is effective for pregnant and postpartum women with depression,
especially psychotic depression, who have not responded to antidepressants
or who cannot take medications. ECT is relatively safe, not painful, but
recommended only when other treatments have failed.
4. Group therapy, light therapy, hormone therapy
Depression After Delivery, Inc. is a national, nonprofit organization that
provides support for women with ante and postpartum depression. Women and
families coping with mental health issues associated with childbearing,
both during pregnancy and post partum, should call 1-800-944-4773 for more
information, referral to support groups, telephone support, and more.
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