Depression related to pregnancy

Depression related to pregnancy is a common and potentially serious concern for both mom and the baby. It is therefore important to understand the various conditions and when it is important to have a clinical intervention.

Postpartum Blues: Symptoms of mood lability, irritable mood, interpersonal hypersensitivity and tearfulness are common in the postpartum period and are commonly known as the postpartum “blues”. The incidence is up to 75% and the symptoms typically arise and resolve within 7-14 days after the delivery.

The following conditions are of more concern: depression during pregnancy (known as antepartum depression), postpartum depression (PPD) and postpartum psychosis.

Antepartum depression: The prevalence of depression during pregnancy ranges from 10-15% and it may persist into the first postpartum year. Depression during pregnancy is linked to birth complications like pre-eclampsia, low birth weight, premature delivery, and small for gestational age infants.

Postpartum depression: The prevalence of PPD is 10-15%. The postpartum year is one of the highest risk periods for first-onset depression for women with approximately 50% of women experiencing their first episode of depression during that time. In addition 25% of women with a history of Major Depressive Disorder will experience PPD and 50% of women who have had PPD will have a recurrence. The Edinburgh Postnatal Depression Scale and Postpartum Depression Screening Scale are useful screening tools. In addition to depressive symptoms, women with PPD typically also present with prominent anxiety symptoms that involve distressing and intrusive thoughts about infant safety and feelings of guilt and inadequacy about mothering. Infants of depressed mothers have been found to be less responsive and more irritable than infants of non-depressed mothers. Infants of depressed mothers are also more likely to develop an insecure attachment because of (unintentional) maternal rejection of the baby. If one suspects PPD it is important to rule out medical conditions, like thyroid dysfunction and iron-deficiency anemia, as these are more common during pregnancy and in the postpartum period.

Postpartum psychosis: Postpartum psychosis is rare and occurs in 1-2 women per 1000. The onset is typically within 2 weeks of delivery. The psychotic symptoms typically accompany affective symptoms of depression and anxiety, rather than represent a psychotic first break. Postpartum psychosis is more common in women who have a history of bipolar disorder. In addition to auditory and visual hallucinations, patients may present with cognitive impairment, confusion, and olfactory and tactile hallucinations. Many mothers are distressed because they experience command hallucinations to harm their infants. If postpartum psychosis is suspected, it is important to seek immediate psychiatric attention and to consider psychiatric hospitalization for the mother for her safety and for the infant’s safety. Antipsychotic medications are helpful for treating postpartum psychosis but it is more appropriate for the treatment to take place in a psychiatric hospital.

Treatment considerations for depression related to pregnancy will be discussed in the next e-Weekly.

Attached are a JAMA article about the timing of symptoms and the  Edinburgh Postnatal Depression Scale (EPDS) screening tool.

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