Post-Partum Depression

Post-Partum Depression (PPD) is a serious condition affecting the mother following parturition of the child, and it is characterized by feeling tired all the time, despite adequate amounts of sleep, an inadequate connection with the infant, an inability or lack of desire to breastfeed, anxiety, anger, and sadness. PPD is classified into three categories; post-partum blues, post-partum depression, and post-partum psychosis. In the first category, post-partum blues, the condition usually develops in the first two weeks following parturition and is self-resolving. Post-partum blues occurs in approximately 15 to 85 percent of women. This period of post-partum blues can progress to post-partum depression.1 Post-partum depression onset is typically

The first hypothesis is due to the elevation of estrogen, progesterone, and corticosterone throughout the pregnancy, followed by the sudden decline in these hormones following childbirth. The sudden withdraw of these hormones causes many hormonal imbalances in the mother which can cause mood disorders, one of which is depression. This is change in hormone levels is the same cause of mood disturbances during the menstrual cycle. The other widely accepted hypothesis is that during pregnancy, and even following parturition, the mother is under the influence of high amounts of corticosteroids, likely due to the extra stress put on the mother and her body. This prolonged period of high glucocorticoid stimulation is thought to play a role in the development of

Treatment for PPD depends on which severity classification the patient is placed into. To treat post-partum blues the mother is not usually placed on any pharmacological therapy. Drug therapy is not used because, as mentioned earlier, the condition is usually self-resolving.2 Although no pharmacological action is taken, the healthcare provider may still recommend light exercise and increased sun exposure to help resolve the situation.4 For post-partum depression pharmacological and non-pharmacological actions are usually taken. The preferred agents for this condition are SSRI’s, or serotonin selective reuptake inhibitors. These agents are preferred because they are effective, and the safety and adverse effect profile is better than other drug therapy options such as tricyclic antidepressants (TCAs).4 One concern with drug therapy is the passing of drugs through breast milk. Although many of these patients are unable to breastfeed, it is important to counsel the patient that if she develops the ability to breastfeed, it is important that she does not. The non-pharmacological treatment is the same as post-partum blues. For post-partum psychosis, the treatment is with the same class of drugs, however the mother may be institutionalized for a period of time to make sure that she does not harm the