Postpartum depression: what is it, how to cure it and what are the differential diagnosis

Postpartum depression is a form of depression that may happen immediately after childbirth and that may adversely affect the health and daily functioning of new mothers. According to clinical studies, in fact, this form of depression could compromise the mother-child attachment, exercising a negative influence on the marriage and family relationship serenity. Postpartum depression is often confused with a physiological condition, called maternity blues and with a serious psychopathological condition, known as postpartum psychosis.

The maternity blues (also known as postpartum blues, or baby blues) is a physiological condition, very common, reported by 80% of new mothers within the first 5 days after birth. The symptoms reported by mothers suffering from maternity blues (including anxiety, emotional lability, fatigue, irritability, memory lapses) usually resolve within 10 days of birth.

Postpartum psychosis, however, is a serious psychopathological condition generally characterized by confusion, agitation, insomnia, delusions and hallucinations for which it’s important to go to the psychiatrist immediately as it could damage the health or jeopardize the life of mother and newborn.

Postpartum depression is defined by three characteristics:

  • depressive symptoms begin four to six weeks after birth and continue for at least two weeks;
  • there are usually more than 5 depressive symptoms among the following: depressed mood, poor appetite, loss of pleasure and interest, emotional lability, irritability, insomnia, psychomotor slowing or agitation, disorientation or confusion;
  • postpartum depression affects daily functioning of mothers markedly making complex for them to take care of babies and focus on daily activities (Lee et al., 2015).

The story of Alessia, a case report of postpartum depression. Video uploaded to Youtube by Centro Psiche Donna:

Among the possible causes of postpartum depression endocrine abnormalities during pregnancy that in the postpartum period would result in an increased risk of occurrence of depressive episodes are reported. Some studies have identified in new mothers neurobiological alterations, responsible for a deficit in emotional regulation (increased reactivity of the insula, the median frontal gyrus and the inferior frontal gyrus in the first days after birth). The insula reactivity seems positively correlated with the presence of anxiety in the early period of the postpartum and with the presence of depressive symptoms in the late period of the postpartum. The increased reactivity of brain areas such as the insula, the middle frontal gyrus and inferior frontal gyrus would be the result of a normal adaptation after childbirth, but if associated with the presence of depression or anxiety, may let women in the postpartum susceptible with an increased risk of depression (Gingnell et al., 2015).

One study evaluated the association between unwanted pregnancies and the onset of post-partum depression. The study found that women with unwanted pregnancies were more at risk to suffer from depressive symptoms in postpartum (Brito et al., 2015).

The treatment of postpartum depression is preferably psychotherapeutic. It is preferred, in fact, limit the use of prescriptions to severe cases allowing mothers to continue breastfeeding.

The group interpersonal psychotherapy in pregnant women seem useful in the prevention of postpartum depression because of the importance of social support and of the construction of interpersonal skills during maternity period (Kao et al., 2015).

References:

Brito CN et al (2015). Postpartum depression among women with unintended pregnancy.Rev Saude Publica. 49:1-9.

Gingnell et al (2015). Emotion Reactivity Is Increased 4-6 Weeks Postpartum in Healthy Women: A Longitudinal fMRI Study. PLoS One. 10(6). eCollection 2015.

Kao JC et al (2015).The Positive Effect of a Group Intervention to Reduce Postpartum Depression on Breastfeeding Outcomes in Low-Income Women. Int J Group Psychother. 65(3):445-58.

Lee PJ et al (2015).[Concept Analysis of Postpartum Depression]. Hu Li Za Zhi. 62(3): 66-71.

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