Psychological medicine

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Postpartum Mood Disorders

  • Screen at post-natal check up (6 weeks) using Edinburgh Postnatal Depression Scale (EPDS), but still needs careful clinical assessment
  • Differential: hypothyroidism (more common post-partum), recurrence of previous psychiatric illness, initial presentation of a psychiatric illness (eg schizophrenia or anxiety disorders – postpartum period increases risk), adjustment disorder with depressed mood
  • Possible aetiological factors:
    • Stress of delivery, difficult pregnancy
    • Lack of sleep
    • Hormonal
    • Isolation, lack of support 
    • Internal conflicts about role as mother: motherhood idealised or devalued, very difficult adjustment in role, powerless, dependent, alone, may have had unrealistic expectations, etc
    • May not have wanted to be pregnant, may now feel trapped in unhappy situation (eg relationship) 
    • Cultural factors: cultures vary in support offered (eg by extended family) to new mother, in pressures to return to work (variable maternity leave policies), differing attitudes to female children, etc.
  • Considerable overlap in the risk factors for major depression, post-partum depression, inadequate parenting and child abuse
  • Treatment:
    • Check whether drugs enter breast milk.
    • Indications for antidepressants similar for those for other mood disorders 
    • If agitated or anxious, more sedating antidepressants are appropriate (eg imipramine) or even small doses of antipsychotics
  • Long term effect of postnatal depression on child development: disturbances in mother-infant relationships (eg attachment), impaired cognitive and emotional development in later infancy, and ­ risk of longer-term behavioural and social development of the child. These factors compounded by indices of socio-economic adversity, which are risk factors for these outcomes and for depression. So good initial diagnosis and treatment important
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