Postpartum depression is a mood disorder that affects new mothers approximately 3 months after the birth of the baby. Individuals with postpartum depression may experience identical complaints as those with major depression, such as sadness, crying, lack of pleasure, difficulty sleeping, poor appetite, and impulses to kill themselves or harm their child.
Postpartum depression differs from the "baby blues," a condition in which the mother has a total lack of interest in the baby, or has a pervasive terror of spending one-on-one time with the baby. The baby blues occurs in as many as 70% of new mothers (DSM-IV-TR 423).The baby blues may be present for the first 1 to 2 weeks after the baby is born, when hormonal fluctuations are most severe.
Medically-related risk factors for developing postpartum depression include fluctuations in hormone levels, an episode of major depression prior to the birth of the baby, or relatives with depression. Many complaints of postpartum depressive symptoms may be missed, ignored, or dismissed by doctors, and the disease often goes undetected.Risk: Factors that may put a woman at risk include a poor marriage, poor psychological support system, traumatic incident, money problems, and unemployment. Incidence and Prevalence: Postpartum depression is present in 10% to 15% of females who have given birth (Nonacs). Twenty-five percent to thirty percent of females with a previous episode of major depression prior to their pregnancy will develop postpartum depression (Gold). |
Source: Medical Disability Advisor
History: The symptoms of postpartum depression usually start 3 months after the birth of the baby, or as late as 6 months. Individuals may feel anxious and/or obsessive, and may have intrusive thoughts about hurting the baby. Individuals may experience similar symptoms as those with major depression such as despair, crying, lack of pleasure, difficulty sleeping, poor appetite, decreased sex drive, diminished energy, and impulses to kill themselves or harm their child. Physical exam: Nonspecific signs can be detected on physical exam such as tearfulness and flat affect. A complete physical exam should be performed to rule out medical conditions such as hypothyroidism that may be causing the depressive symptoms. Tests: Obstetricians or pediatricians can screen individuals for postpartum depression to aid in the early identification of the disorder. Neuropsychological testing such as the Edinburgh Postnatal Depression Scale (EPDS) can help establish the diagnosis. A complete blood count and testing to determine thyroid hormone levels may be performed. Other laboratory tests may be necessary to rule out a medical etiology for the disorder. |
Source: Medical Disability Advisor
Individuals may initially be treated with selective serotonin reuptake inhibitors (SSRIs). Benzodiazepine can be beneficial to reduce anxiety in some individuals. If insomnia is a problem, tricyclic antidepressants (TCA) may also be helpful. Some studies have shown the efficacy of antidepressant medication combined with estrogen hormone therapy. If the individual has had no previous depressive episodes, 6 months to 1 year of antidepressant therapy is a common duration for treatment. If the individual has a recurrence of the disorder, they may need a longer maintenance period of using antidepressants. Individuals who are breastfeeding while receiving antidepressant medications should discuss if weaning is appropriate with their physician, since these medications may be excreted in breast milk. Individuals with recurrent postpartum depression may benefit from prophylactic antidepressants administered following the birth of each baby.
Individual or group psychotherapy may also be helpful; however, individuals may need to be hospitalized if their symptoms do not subside or if they continue to express thoughts or plans involving harming themselves or the baby. If the individual is unresponsive to antidepressant therapy and psychotherapy, electroconvulsive therapy (ECT) may be considered. |
Source: Medical Disability Advisor
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| ACOEM's Practice Guidelines, the gold standard in effective medical treatment of occupational injuries and illnesses, are provided in this section to complement the disability duration guidelines.* |
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| * The relationship between the MDGuidelines (MDA) content and ACOEM's guidelines is approximate and does not always link identical diagnoses. The user should consult the diagnostic codes in both guidelines, as well as the clinical descriptions, before assuming an equivalence. |
Source: ACOEM Practice Guidelines
| Most individuals who respond to antidepressant and/or psychotherapy may show improvement in 2 weeks to 1 month after treatment has begun. Complete resolution of symptoms may occur after a period of many months. A better outcome is expected for those individuals who were treated quickly. An individual who has been diagnosed with postpartum depression once has a 90% chance of having the disorder occur with future pregnancies (Nonacs). |
Source: Medical Disability Advisor
| Prompt recognition and treatment of postpartum depression is essential for the well-being of both the mother and baby. Due to the possibility of inconsistent or inadequate care by a depressed mother, the baby runs the risk of developing acute as well as long-term problems. One study showed that 80% of 14-month-old babies developed poor attachment to the mother due to negative experiences with the depressed mother. Individuals may develop suicidal or homicidal ideation as a result of the condition, as well as delusions about the baby or themselves. |
Source: Medical Disability Advisor
| Individuals with postpartum depression can attend their work activities as soon as their symptoms allow. Return to work is facilitated by compliance of the individual with treatment, and the discussion of appropriate accommodations by the therapist and the employer. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Was individual evaluated by a psychiatrist who obtained a complete psychiatric history?
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Does individual have any relatives who have committed suicide or have a history of depression?
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Does individual have any medical conditions that could explain the problem such as hypothyroidism?
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Has individual experienced similar depressive episodes or any comorbid psychiatric conditions such as anxiety disorder that may need treatment?
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Does individual abuse drugs or alcohol?
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Has individual had similar symptoms during a previous pregnancy?
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What is the duration of individual's symptoms?
Regarding treatment:
- Has individual been treated with an effective antidepressant? Have alternate antidepressants been attempted?
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Has individual participated in group or individual psychotherapy?
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Does individual require inpatient hospitalization because they have failed to respond to treatment?
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Does individual have suicidal ideation or homicidal ideation towards the baby?
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Has ECT been considered?
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Has individual experienced any negative side effects from prescribed medication?
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Has combining antidepressant therapy with estrogen been considered?
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Has adding a benzodiazepine to help decrease anxiety been considered?
Regarding prognosis:
- Is individual compliant with current treatment regimen including medication, doctor and therapist appointments?
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Has individual seen improvement of symptoms on current antidepressant medicine?
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Does individual have adequate support systems?
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Has individual been advised of the increased risk of developing postpartum depression in future pregnancies?
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If individual is breastfeeding, could fears that medication might harm the infant be causing noncompliance with treatment?
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Source: Medical Disability Advisor
| CitedFrances, Allen, ed. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000.Gold, L. H. "Postpartum Disorders in Primary Care: Diagnosis and Treatment." Primary Care: Clinics in Office Practice 29 1 (2002): 27-41. MD Consult. 1 Mar. 2002. Elsevier, Inc. 16 Oct. 2004 <http://home.mdconsult.com/das/journal/view/41664397-2/N/12265210?sid=307582173&source=MI>. Nonacs, Ruta M. "Postpartum Depression." eMedicine. Ed. Suzanne R. Trupin. 8 Aug. 2004. Medscape. 16 Oct. 2004 <http://emedicine.com/med/topic3408.htm>. |
Source: Medical Disability Advisor