1. Postpartum Depression
Fall 2015

2. 3.“Some women may experience postpartum blues for several weeks.”
A nurse educator has provided an in-service session to nursing staff, and the topic of the discussion is postpartum blues. Which statement by a nursing staff member would indicate the need for further discussion?
1.“Postpartum blues are usually described as transient and mild mood disturbances.” 
2.“Postpartum blues usually start at approximately the third day postpartum and usually last 2 to 3 days.” 
3.“Some women may experience postpartum blues for several weeks.” 
4.“Postpartum blues are always due to a psychological alteration in the woman.” 

3. Postpartum Depression
Postpartum Depression Without Psychotic Features
PPD is an intense and pervasive sadness with severe and labile mood swings
Is more serious and persistent than postpartum blues
Intense fears, anger, anxiety, and despondency that persist past the baby’s first few weeks are not a part of postpartum blues
Symptoms rarely disappear without outside help

4. Postpartum Depression
Mother’s ruminations of guilt and inadequacy feed her worries about being and incompetent and inadequate parent
PPD, there may be odd food carvings (often sweet desserts) and binges with abnormal appetite and weight gain
A distinguishing feature of PPD is irritability
Episodes of irritability may flare up with little provocation, and they may sometimes escalate to violent outbursts or dissolve into uncontrollable sobbing
Outbursts are directed against significant others
“He never helps me”
“She cries all the time”
“I feel like hitting her”

5. Postpartum Depression
Women with postpartum major depressive episodes often have severe anxiety, panic attacks, and spontaneous crying long after the usual duration of baby blues
Prominent feature of PPD is rejection of the infant , often caused by abnormal jealousy
Mother may be obsessed by the notion that the offspring may take her place in her partner’s affection
Attitudes toward the infant may include disinterest, annoyance with care demands, and blaming because of her lack of maternal feeling
Obsessive thoughts of about harming the baby are very frightening to her
She does not share these thoughts because of embarrassment, but when she does, other family members become very frightened

6. Postpartum Depression
Medical Management
Natural course is one of gradual improvement over the 6 months after birth
Supportive treatment alone is not efficacious for major postpartum depression
Treatment options include antidepressants, anxiolytic agents, and electroconvulsive therapy
Psychotherapy focuses on her fears and concerns regarding her new responsibilities and roles
As well as monitoring for suicidal or homicidal thoughts
For some women hospitalization is necessary

7. Postpartum Depression
Postpartum Depression with Psychotic Features
Postpartum psychosis is a syndrome most often characterized by depression, delusions, and thoughts by the mother of harming either the infant or herself
May occur more often in primiparas
Mean time for the onset of symptoms is 2 to 3 weeks and almost always within 8 weeks after birth
Woman begins to complain of fatigue, insomnia, and restlessness and may have episodes of tearfulness and emotional lability
Complaints regarding the inability to move, stand, or work are common
Auditory hallucinations that command the mother to kill the infant can also occur in severe cases

8. Mental Health Disorders and Substance Abuse
Delusions are present, they are often related to the infant
Mother may think the infant is possessed by the devil, has special powers, or is destined for a terrible fate
Grossly disorganized behavior may be manifested as a disinterest in the infant or an inability to provide care

9. Postpartum Depression
Specific illness included in depression with psychotic features is bipolar disorder (formerly called manic depressive disorder)
Mood disorder os preceded or accompanied by manic episodes, characterized by elevated, expansive, or irritable moods
Clinical manifestations of a manic episode, include at least three of the following symptoms that have been significantly present for at least 1 week:
Grandiosity
Decreased need for sleep
Pressured speech
Flight of ideas
Distractibility
Psychomotor agitation
Excessive involvement in pleasurable activities without regard for negative consequences
Women are hyperactive, they may not take the time to eat or sleep, which leads to inadequate nutrition, dehydration, and sleep deprivation
In a manic state, mothers will need constant supervision when caring for their infant

10. Postpartum Depression
Medical Management
Mood disorders are usually espisodic, women may experience another episode of symptoms within a year or two of the birth
Postpartum psychosis is a psychiatric emergency, and the mother will probably need psychiatric hospitalization
Antipsychotics and mood stabilizers such as lithium are the treatments of choice
Antipsychotics and lithium should be avoided in breastfeeding mothers, but other mood stabilizers may be compatible with breastfeeding
Advantageous for the mother to have contact with her baby
Psychotherapy is indicated after the period of acute psychosis is past

11. Postpartum Depression
Assessment and Nursing Diagnosis
Nurse should be an active listener
Demonstrate a caring attitude
Nurse should observe for signs of depression and ask appropriate questions to determine moods, appetite, sleep, energy and fatigue levels, and ability to concentrate
Nurses can use screening tools in assessing whether the depressive symptoms have progressed from postpartum blues to PPD

12. Postpartum Depression
Plan of Care and Interventions
On the Postpartum Unit
Postpartum nurse must observe the new mother carefully for any signs of tearfulness and conduct further assessment as necessary
Nurses must discuss PPD to prepare for potential problems in the postpartum period
Family must be able to recognize the symptoms and know where to go for help
Written materials that explain what the woman can do to prevent depression could be used as part of the discharge planning
Mothers are often discharged from the hospital before the blues or depression occur
Postpartum nurse is concerned about the mother, a mental health consultant should be requested before the mother leaves the hospital
Routine instructions should be given to whoever comes to take the woman home

13. Mental Health Disorders and Substance Abuse
In the Home and Community
Postpartum home visits can reduce the incidence of or complications from depression
Brief home visit or phone call at least once a week until the new mother returns for her postpartum visit may save the life of a mother and her infant
Supervision of the mother with emotional complications may become a prime concern
Community resources may be beneficial

14. Mental Health Disorders and Substance Abuse
Psychotropic Medications
MAOIs, mood stabilizers, and antipsychotic medications may be prescribed for nonbreastfeeding mothers
Hypertensive crisis is the main reason that MAOIs are not prescribed more frequently
Woman should be taught to watch for signs of hypertensive crisis-throbbing: occipital headache, stiff neck, chills, nausea, flushing, retroorbital pain, apprehension, pallor, sweating, chest pain, and palpitations
Crisis is brought on by the client taking any large variety of over-the counter medications or eating food that contains tyramine,a sympathomimetic pressor amine, which normally is broken down by the enzyme monoamine oxidase
Women taking mood stabilizers must be taught about the many side effects, especially for those taking lithium
Need to have serum lithium levels every 6 months

15. Postpartum Depression
Postpartum Onset of Panic Disorder
Panic attacks are discrete periods in which there is sudden onset of intense apprehension, fearfulness, or terror
During these attacks, symptoms such as shortness of breath, palpitations, chest pain, choking, smothering sensations, and fear of losing control are present
Treatment is usually a combination of medications, education, psychotherapy, and cognitive behavioral interventions, along with an attempt to identify any medical or physiologic contributors
Zoloft and Paxil
Luvox for obsessions
Reassurance
Nurses can help women identify panic triggers that are particular in their own lives
Family support