Postpartum blues by Dr.V.B.Kasyapa.J (MD)

Postpartum blues includes an array of psychiatric manifestations occurring in the period of post-partum, due to hormonal imbalance. Knowing in detail will help for quicker diagnosis and better outcomes.
Prepared in December, 2017.

1. Postpartum Blues Dr. V.B.Kasyapa .J (MD) Dept. of General Medicine.

2. Introduction Pregnancy causes lot of stress on the mother. Various hormones like Estrogen Progesteron hCG Play important role in causing metabolic changes, which ultimately lead to psychological illness Sudden drop in these hormones after removal of placenta plays great role It is common, but may become an emergency.

3. Types Postpartum blues/ Baby blues Postpartum Psychosis Postpartum Depression

4. Post-partum blues A self-limiting, relatively mild, mood syndrome 30-80% of mothers 3-10 days after birth; remits by 2 weeks Risk factors: No certain cause 9idiopathic) Primi Late leuteal phase dysphoria Depression history First-degree relative with depression

5. Post-partum Blues Symptoms: Mood lability Anxiety Sadness Crying spells Insomnia fatigue

6. Post-partum Psychosis Psychosis or psychotic depression in the post-partum period 2 in 1000 mothers Within first 2 weeks to 3 months Risk factors: Considered as organic disease (hormonal imbalance, heredity, h/o psychosis, etc..) Psycho social causes are secondary

7. Post-partum Psychosis Symptoms: Prodrome : worsening insomnia, without a crying baby or physical discomfort, psychomotor agitation Confusion Memory impairment Irritability Anxiety Intrusive thoughts about harming the infant Paranoid and religious delusions Auditory hallucinations Thought insertion, withdrawal and broadcasting Brief periods of elation followed by inexplicable sadness or rage Lucid intervals can be seen

8. Post-partum Depression An intermediate, prolonged syndrome like post partum blues 5-10% of mothers, who had postpartum blues Insidously , with in 3 weeks post-partum

9. Post-partum Depression Risk factors Hereditary, h/o psychiatric illness Psychosocial Marital discord Stressful life during pregnancy Ambivalence about motherhood Lower socio economic status Isolation from family or friends

10. Post-partum Depression Symptoms Blues symptoms sustain Crying spells Poor concentration Indecisiveness Profound sadness Thoughts like failure and inadequacy Suicidal ideation Physical signs of hypothyroidsm (cold intolerance, fatigue, dry skin, slowed mentation, constipation, fluid retention)

11. When to meet a doctor? Assess all the pregnant at their first visit to hospital Provide counselling regarding stress-free environment and family support Counsel all the mothers, who had history of psychiatric illness or relatives with psychiatric disorders, and their family members regarding this disease and its symptoms Any undue agitation/ sadness/ insomnia/ fatigue should not be taken lightly and immediate consultation is needed Other suicidal or homicidal tendencies towards the baby or undue injuries to the baby, when alone with the mother should bring up a doubt and immediate psychiatrist consultation is mandatory.

12. Treatment Post-partum blues can be managed with re-assurance and support of the family It rarely needs medication Other two are ‘psychiatric emergencies’ Need to be hospitalized immediately

13. Treatment

14. It may not be preventable and hard to cure, but it is not invincible.