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PostPartum Depression

Objectives
– Define postpartum depression
– Identify signs of postpartum psychosis
– Identify Risk factors of PPD
– Identify screening tools and protocols
– Discuss the impact of PPD on the mother, child and family
– Identify the cause of PPD
– Explore current biopsychosocial interventions for PPD
– Postpartum depression usually occurs in the first 4 to 6 weeks after giving birth, and it is unlikely to get better by itself.
– 50% of patients experienced depression for more than 1 year after childbirth.
– Women who were not receiving clinical treatment, 30% of women with postpartum depression were still depressed up to 3 years after giving birth

Define Postpartum Depression
– Perinatal mood disorders (20-weeks gestation to 4 weeks of age)
– According to the Centers for Disease Control and Prevention (CDC), up to 20 percent of new mothers experience symptoms of postpartum depression
– Postpartum blues is a relatively common emotional disturbance with crying, confusion, mood lability, anxiety and depressed mood.
– The symptoms appear during the first week postpartum, last for a few hours to a few days and have few negative sequelae.
– At the other end of the spectrum, postpartum psychosis refers to a severe disorder beginning within four weeks postpartum, with delusions, hallucinations and gross impairment in functioning
– Postpartum depression begins in or extends into the postpartum period and core features include dysphoric mood, fatigue, anorexia, sleep disturbances, anxiety, excessive guilt and suicidal thoughts for at least one month

Impact of PPD
– Prenatal
– Inadequate prenatal care, poor nutrition, higher preterm birth, low birth weight, pre-eclampsia and spontaneous abortion
– Infant
– Behavioral:
– Anger and distancing/averting gaze (protective of coping)
– Passivity, withdrawal
– Poor self-regulatory behavior
– Dysregulated attention and arousal/responsiveness
– Cognitive: Lower cognitive performance
– Infant
– Social:
– Mothers with postpartum depression exhibit fewer instances of maternal-child touch and positive engagement activities such as reading books, singing songs, and playing games
– Mothers with PPD also display less sensitive behaviors toward their children, and tend to respond to their children’s needs in a less responsive, attentive, and nurturing manner
– These withdrawn behaviors inhibit the formation of a caring and attentive primary attachment (mother-child relationship)
– The attachment relationship also suffers from a lack of physical touch which is crucial to the development of children’s regulatory skills and the ability to cope with stress
– Toddler
– Behavioral
– Passive noncompliance
– Less mature expression of autonomy
– Internalizing and externalizing problems
– Lower interaction
– Cognitive:
– Less creative play and problem solving
– Lower cognitive performance
– School age
– Behavioral:
– Impaired adaptive functioning
– Internalizing and externalizing problems
– Affective disorders
– Conduct disorders
– Academic:
– Attention deficit/hyperactivity disorder
– Lower IQ scores

Infanticide
– Many women who commit infanticide have no diagnosable mental illness that precludes them from being aware of the wrongfulness of their actions
– The exception is post-partum psychosis

Summary
– Postpartum depression affects about 20% of women
– Both the mother and partner should be screened for depressive symptoms
– While PPD can begin anytime between 20 weeks gestation and 4 weeks postpartum, untreated it can last years
– Scary thoughts are often part of PPD and should be normalized with parents
– Postpartum psychosis is ego-syntonic and will not produce “scary thoughts”
– PPD prevention involves NEST-S for both parents
– Treatments involve psychoeducation, cognitive behavioral and/or parent-child psychotherapy
– Certain SSRIs have been found to be safe when breastfeeding
– There are many triggers for PPD
– Women at risk for PPD should engage in early intervention and planning while still pregnant

Video by Dr. Dawn Elise Snipes on integrative behavioral health approaches including counseling techniques and skills for improving mental health and reducing mental illness.

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