The adjustments required for a new baby mean that most parents experience some stress and certainly experience many common features of depression, including sleep deprivation, low energy and social withdrawal. The increased stress will certainly lead to a higher level of anxiety in most parents. The boundary between ‘normal’ adjustment functioning and the less severe post-natal disorders can be somewhat blurred.
As with the depressive disorders, there is no single condition of ‘post-natal depression’. Instead, there is a range of conditions, the principal ones briefly summarised below.
✰ Maternity blues
Most women experience normal mood changes but following the birth of a child these usually settle within the second week. So-called ‘maternity blues’ are therefore relatively normal, and are likely to be caused by an extreme reduction in hormone levels (of both oestrogen and progesterone) immediately postpartum, showing a rather similar mechanism to premenstrual mood shifts. Only a minority of women, even those with severe ‘maternity blues’, go on to develop a formal post-natal depressive disorder.
✰ Post-natal depression
Post-natal depression refers to a clinical depressive disorder occurring within the first six months after the birth of a baby. The overall incidence is held to be about 1 in 10, but this 10 per cent may be somewhat inflated by inclusion of conditions other than clinical depression (especially anxiety disorders). The chance of clinical depression occurring during this period is approximately three times the overall new episode rate for depression in women over their lifetime. Most post-natal depressive states are non-melancholic in type, but show depressive features akin to that condition. They commonly involve a focus of fears, depressive ruminations and obsessions about the wellbeing of the baby, as well as the woman’s perceived inadequacy as a mother. A significant number of women have fears of harming their baby.
For those who are genetically or otherwise biologically predisposed to develop melancholic depression, the post-natal period is a high-risk time for developing the condition, whether as an initial episode or as a recurrence. It is uncommon for a new episode of melancholic depression to commence during pregnancy.
✰ Puerperal psychosis
Puerperal psychosis is an all-encompassing term used to describe any psychotic condition occurring in the first month post-partum. The psychotic features of depression (delusions and hallucinations) are usually extremely florid and therefore very disturbing to the woman and to family members. In addition, the woman may appear quite cognitively affected— that is, in terms of being aware of what is happening to her. A small percentage of women may have a first onset or a recurrence of a schizophrenic episode but, over the last few decades, we have come to realise that the majority of such episodes are primary mood disorders. Thus, the post-partum period provides a distinctly increased risk for those women who are genetically disposed to develop bipolar disorder or melancholic depression. The main features of the depression are manic episodes, psychotic depressive episodes and, quite commonly, mixed states where both manic and depressive features are experienced. Onset is usually sudden, within the first two or three weeks after the birth of the baby. While the episodes are florid and disturbing at the time, the outcome is usually good with most women responding well to treatment. There is, however, an increased suicide risk for women during the first year of treatment.
Treatment options for the clinical condition are considered in more detail later, but there are some specific features to take into account when dealing with a diagnosis of post-natal depression. A family history of depression or previous episodes of depression increase the chance of a woman developing a post-natal mood disorder, as do a number of psychosocial factors including low self-esteem, exposure to poor parenting practices, or difficulties with a spouse.
Management of post-natal depression should involve assessment by trained primary health care staff such as early childhood or mothercraft nurses, or antenatal midwives, all of whom have the experience to know when to provide management themselves and when to refer women for medical or psychiatric assessment.
Drug treatment during pregnancy and while breastfeeding is clearly an extremely important issue in terms of the health of the baby. General principles suggest that if a woman is on antidepressant or mood stabilising medication, consultation with an expert should be undertaken and drug-free conception attempted. In the first three months of pregnancy certain medications should be avoided but this cannot always be done. In such cases, the mother, her partner and her doctor have to work together to address cost-benefit issues.
(extracted from) Dealing with Depression: A Commonsense Approach to Mood Disorders y Gordon Parker, published by Allen & Unwin