Many women while pregnant or in the period that follows the delivery of a baby may be more emotionally stressed without meeting the criteria for any mental illness. Some of the normal psychological changes include anxiety, mood lability, and concerns about bodily changes and well-being of the fetus. Women are more likely to suffer mood and behavioral changes during this time than at any other part of the life cycle. Following are some of the most prevalent conditions:
- The blues, often referred to as postpartum blues, postnatal blues, or 3-day blues, happen to as many as 70% of women, occur within 48 hours of delivery, last 2-3 days to 2 weeks, and are experienced by women cross-culturally. The most common symptoms are emotional lability, elation or tearfulness, sadness, anxiety, irritability, insomnia, and fatigue. These feelings come as a surprise to many women who are so pleased to have a baby, but are not expecting those feelings. Often, rest is helpful but no other special treatments are needed.
- Postpartum depression (PPD) is defined as a major depressive disorder that occurs during or after pregnancy or a pregnancy loss. It has similar symptoms to depressive illnesses occurring at other times, except for more feelings of guilt and possible obsessional thoughts of harming the baby after it is born. Postpartum depression may occur up to 9 months after birth, usually within the first 3 months, affects 10-15% of women giving birth to healthy babies with a higher incidence with babies who are ill or have congenital malformations. Adolescent mothers have a higher incidence of PPD. Risk factors for having PPD are past history, family history, inadequate social supports such as family and friends, perinatal loss, and birth of multiple babies (twins, triplets, or more). Milder forms of depressive illnesses are called adjustment reactions with depressed mood. Evaluation by health care staff should always include a careful physical exam plus laboratory tests for thyroid function. Alcohol and drug use may complicate these disorders.
Treatment of postpartum depression includes psychotherapy, usually interpersonal or cognitive behavioral, group therapy, self-help groups such as Depression After Delivery (DAD), and medications. Light therapy has been helpful. At this time there are no conclusive data about the use of ovarian hormones such as estrogen and progesterone. Since these hormones drop precipitously after delivery, their role is being studied. It is important to weigh the risk benefits of use of medications in the pregnant and postpartum woman who is nursing. Some medications can be used safely and should be carefully considered. Untreated depressive illnesses may last as long as 9 months or longer. About 50% of women with PPD may have a recurrence in subsequent pregnancies or within 4 years. Recent studies have shown the effectiveness of preventive treatment by giving medications during pregnancy or right after delivery.
Peripartum psychosis is the most severe mental illness associated with pregnancy and afterward and occurs in about 1 per 1,000 deliveries. More than half of these women have depressive illnesses, while others may have schizophrenic or other causes. The symptoms, in addition to those already mentioned, include hallucinations, delusions, a loss of reality, confusion, distractibility, and inability to focus attention. There is often danger of suicide or harming the baby. Usually, hospitalization is indicated plus treatment with antipsychotic medications as well as psychotherapy. Such individuals should not be left alone until they show marked improvement. Electroconvulsive therapy (ECT) is also an effective, rapidly acting, and safe treatment for peripartum psychosis.