1. By Abdulrhman Fahad AL-Mutairy

2. OBJECTIVES  Know the types of the Postpartum Mood Disorders  Know the Epidemiology  How they present to you  How to diagnose them  How to treat them

3. POSTPARTUM ?  We define the postpartum period as the first 12 months after birth

4. TYPES OF POSTPARTUM DISORDERS  Three types of postpartum Mood Disorders 1. Postpartum blues (“baby blues”) 2. Postpartum depression 3. Postpartum psychosis

5. DEFINITIONS  Postpartum depression: a major depressive episode that is temporally associated with childbirth  Postpartum blues: “baby blues”, heightened emotions, peaks in 3-5 days after delivery, may last up until 14 days  Postpartum psychosis: severe postpartum depression associated with delusions

6. “Baby Blues” vs. Post-Partum Depression

8. POSTPARTUM PSYCHOSIS  Rare: occurs in 0.1-0.2% of births  Usually occurs 3-6 weeks after delivery  Higher risk associated with bipolar disorder and schizoaffective disorder patients  Postpartum Psychosis, untreated, can lead to: Child Abuse Suicide Infanticide

9. RISK FACTORS OF POSTPARTUM DEPRESSION History of depression Depression in pregnancy Young age Stressful life events Marital dissatisfaction Child care stress Inadequate social supports Low self-esteem

10. ETIOLOGY OF POSTPARTUM DEPRESSION  Various theories based in physiological changes have been postulated: hormonal excesses or deficiencies of estrogen, progesterone, prolactin, thyroxine,

11. ETIOLOGY OF POSTPARTUM DEPRESSION  Other theories cite numerous psychosocial factors associated with PPD: marital conflict child-care difficulties (feeding, sleeping, health problems) perception by mother of an infant with a difficult temperament history of family or personal depression

12. SYMPTOMS OF POSTPARTUM DEPRESSION  depressed mood  tearfulness  anhedonia  insomnia  fatigue  appetite disturbance  suicidal thoughts, and recurrent thoughts of death

13. DIAGNOSIS OF POSTPARTUM DEPRESSION  History  The Edinburgh Postnatal Depression Scale (EPDS)  Important to rule out medical causes of depression, such as anemia or thyroid dysfunction

14. Edinburgh Postnatal Depression Scale (EPDS)  Screening tool for postpartum depression  Validated in diverse populations  10-item self-rated questionnaire  Score of > 12 suggestive of depression  Suicidal ideation requires further evaluation

15. SAMPLE EPDS QUESTIONS  1. I have been able to laugh & see the funny side of things As much as I always could Not quite so much now Definitely not so much not Not at all

16. TREATMENT OF POSTPARTUM DEPRESSION  Treatments can include: Counseling/psychotherapy Medication ECT Support groups Self-help

17. TREATMENT OF POSTPARTUM DEPRESSION For mild to moderate symptoms, focus less on pharmacological treatment and more on counseling and group therapy.

18. TREATMENT OF POSTPARTUM DEPRESSION  Medications: Antidepressants Transdermal estrogen

19. TREATMENT OF POSTPARTUM DEPRESSION  Medications: Antidepressants 1- SSRIs 2- SNRIs 3- TCAs

20. SUMMARY  Postpartum depression: is relatively common may have long-term consequences for mother, infant & family is easily missed should be screened for can be treated successfully

21. REFERENCES  Medscape  Uptodate  Our lectures in PSCH 534

22. THANKS