The Recognition &
Treatment of Postpartum
Johna M Bott
Eileen Van Dyke
Characterized by despair, sadness, anxiety,
fears, compulsive thoughts, feelings of
inadequacy, loss of libido, fatigue, &
 Affects upwards of 20% of women after
 Major health problem that threatens the
family unit as a whole
Postpartum psychosis
Emergency that requires immediate
 Presents with mania, psychotic thoughts,
severe depression
 Rare occurring in 1-2 deliveries out of a
Why do we care?
Affects entire family unit, not just the mother
One mother described PPD as being buried
alive with no chance of clawing to the surface
While mom is debilitated, child’s cognitive and
social development suffers then & potentially
later on in life with the development of conduct
& attention disorders
Fathers also affected by stress put on marriage
PPD screening
is not being
Approximately 50% of PPD cases go
Although family physicians believe PPD is
serious, identifiable, and treatable, screening is
still not standard clinical practice in the US
Clinical signs are often not apparent unless
screened for
Screening tools are out there & some are even
specific for PPD
OB screens for that
 Pediatricians screen for that at well baby
 There are too many tools out there, I don’t
know which one to use
 The tools are too complex
 Is that my job?
Risk Factors
 Prenatal
 Totally
independent of time
 Any depression during pregnancy was
discovered to be a significant predictor
Risk Factors
 Child care stress
 Childbirth itself is a traumatic stressful event
that makes the mother more vulnerable to
other stressors
 Any stressful event involving the care of the
newborn, including the temperament of the
baby which may be fussy, irritable, and
difficult to console
 Unhealthy infants
Risk Factors
 Support
 Social,
or lack there of
emotional, and instrumental
support is very important for new
mothers and either perceiving a lack of it
or actually having a lack of it can be very
Risk Factors
 Life
 The
number of both positive and
negative stressful life events that occur
during pregnancy and the postpartum
Risk Factors
 Prenatal
 Marital dissatisfaction
 History of previous depression
 Affective
illness or previous PPD
Medical Problems with Related Sx
Transient hypothyroidism
 Anemia
 Diabetes
 Other endocrine disorders
 Abuse situations
 Infection
Treatment Options
Individual psychotherapy
 Personalized
 Scheduling flexibility
Group therapy
 Not
for everyone
 Compliance issue with scheduling conflicts
 Need adequate # to participate
Treatment Options
Pharmacologic treatment
Selective serotonin reuptake inhibitors (SSRIs)
 All antidepressants are secreted in breast milk
 Continued at least six months to ensure complete
Complementary or alternative treatments
Bright-light therapy, exercise, massage therapy, &
chronobiological therapies, such as wake therapy
Treatment Options
Controversial therapies
 Progesterone
or estrogen injections
 Risk
of suicide or infanticide
 Antipsychotics
 Electroconvulsive therapy
Available Screening Tools
The Beck Depression Inventory
The Bromley Postnatal Depression Scale
The Center for Epidemiological Studies Depression
The General Health Questionnaire
The Inventory of Depressive Symptomatology
The Zung Self-Rating Depression Scale
The Edinburgh Postnatal Depression Scale
The Postpartum Depression Screening Scale
The Edinburgh Postnatal
Depression Scale
One of the best known screening scales for
Measures emotional and cognitive symptoms of
Ten items scored from 0 to 3
Only somatic sx taken into account is sleeping
Available in multiple languages
The Postpartum Depression
Screening Scale
Measures 7 dimensions of PPD including
sleeping/eating disturbances, anxiety/insecurity,
emotional liability, cognitive impairment, loss of
self, guilt/shame, & contemplating harming
35 items
Excellent sensitivity & specificity
The general consensus is that both the
EPDS & the PDSS are good screening
scales for PPD
 Practitioners may form personal
preferences due to length or detail of
 Most important thing is that a screening
method is used
PPD is real & very serious
Talking about PPD openly might make it less
scary, educate the patient & their family
Screening at every visit is the key to the difficult
recognition that is due to drastic differences in
symptoms from patient to patient
Prompt treatment with effective follow-up
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The Recognition & Treatment of Postpartum Depression