Click here to view next page of this article


New Treatments for Postpartum Depression

Features which distinguish postpartum disorders

Symptoms of organicity

Changeability of symptoms

Timing and progression of symptoms blues, psychosis

Increase in incidence with previous episode

Excellent prognosis

Epidemiological studies

12 months after delivery is the greatest risk of psychiatric illness in a woman's life for postpartum depression

25-fold increase in the risk of a psychotic illness in the 30 days

Biological changes

Estrogen and progesterone reach highest during pregnancy

Precipitous fall after parturition

Unsubstantiated studies have shown decreased incidence with estrogen or post partum progesterone treatment

1. No major mood disturbances

2. More mood disturbances in primiparas

3. Significant correlations:

Increased irritability with higher postpartum blues estrogen levels

Increased depressive symptoms with greater drop

Increased sleep disturbance with lower estrogen

Depressive symptoms

1. Stressful life events during pregnancy

2. Depressive symptoms during pregnancy

3. Total breast feeding

4. Lower levels of stress during delivery

depression related to:

1. Previous depressive episodes

2. 1st degree relative with depression

3. Perception of support

4. Marital problems

Number of child care-related stressors

C. Other psychosocial aspects

1. Changes in body image

2. View of role as a woman and a mother

3. Fear of losing her identity

4. Financial and housing issues Older primiparas

6. Impaired parental relationships


A. Post-partum psychosis

B. Post partum depression

C. blues

V. Psychosis

A. Incidence and course

1. 1-2 per 1,000

2. 1st 6 weeks

3. 3-20 days is highest risk period

4. Lasts for a few days to months

5. 80% recover in 1 year

6. 30-50% recurrence

7. High incidence of future affective diagnosis

B. Risk factors

1. Previous history of affective disorder

2. Family history of affective disorders

3. Previous psychosis

4. 1st pregnancy

5. C-section

6. Perinatal death

C. Characteristics

1. Agitation

2. Confusion

3. Extremes of mood

4. Hallucinations

5. Delusions

6. Bizarre behavior

7. Violence

D. Hazards

1. Signs and symptoms subject rapid change

2. Impulsivity

3. Violence to self or others

4. Infanticide

5. Misinterpret remission as real improvement E. Suspect organic etiology

F. Management