PT Health Life – Postpartum depression in some cases can lead to mothers killing their newborn babies, so this disease needs to be detected and treated early.
According to the American Psychiatric Association (APA), postpartum depression is a depressive condition that appears within 4 weeks after giving birth with symptoms that meet the diagnostic criteria for depression according to DSM 5 (diagnostic manual). Diagnosis of mental diseases, 5th edition). The rate ranges from 8-15% depending on the author and depending on statistics in different countries.
The varying degrees of depression manifest as mood swings, commonly known as “Baby Blues.” This is a mild and transient form of postpartum depression, usually lasting only 1-2 weeks (most mothers overcome it on their own) to more severe cases of depression (major depression) that require intervention. Medical interventions range from psychological counseling to antidepressants.
Many cases of postpartum depression originate during pregnancy, so many British and American authors tend to combine both the pregnancy and postpartum periods together.
1. Screening for postpartum depression
Because postpartum depression accounts for a fairly high rate with many different levels, the American Association of Pediatrics (AAP) recommends screening mothers for depression when their babies are 1, 2, and 4 years old. months old.
The American College of Obstetricians and Gynecologists (ACOG) also recommends screening pregnant women for depression at least once during pregnancy.
10 signs of postpartum depression (According to Mayo Clinic-USA)
1/ Changeable, explosive emotions (mood swings in baby blues)
2/ Feeling sad most of the day.
3/ A feeling of difficulty breathing as if being pressed tightly
4/ Excessive worry with signs of restlessness and insecurity.
5/ Withdraw and refuse social interactions.
6/ Memory loss and poor concentration.
7/ Sobbing (for trivial reasons)
8/ Sleep disorders.
9/ Loss of appetite.
10/ A feeling of exhaustion and loss of energy.
If there are 5 or more symptoms, of which at least 3 symptoms are ranked from 1 to 5, you need to see a psychiatrist.
Note that if a pregnant woman has abused or abused a child or, more seriously, has an idea of ”killing the baby” or having an idea of suicide for both mother and child, it is a mental emergency and requires medical intervention. urgent.
2. Risk factors that promote postpartum depression
– Have a history of previous depression.
– Have a history of bipolar disorder, especially type 2 (bipolar disorder with a tendency to be more depressed than manic)
– Have a history of previous anxiety disorders.
– There were psychological events before the birth (loss of relatives, loss of job, domestic violence…)
– Have a history of alcohol or drug abuse.
Factors that promote depression include economic difficulties, unwanted pregnancy, pregnancy and birth without relatives or friends. In Vietnam, the husband’s family factor is added. Pregnant women should return to their biological parents’ home if possible. Premature babies, sick babies, and babies who cry a lot make it very hard for the mother.
3. Reason
Like most mental illnesses, depression and postpartum depression have no known cause. A sudden drop in the sex hormones estrogen and progesterone is thought to be one of the causes along with risk factors and precipitating factors.
4. Is it difficult to treat postpartum depression?
After the examination, the treating doctor will decide on the treatment method after considering the benefits (the child cannot breastfeed because the mother is taking medication) and the risks (the child is abused). Mild cases may only need psychological counseling (both husband and wife, biological mother/mother-in-law’s family if living together). In case of intent to kill or commit suicide, urgent intervention is needed. The fact that the baby is not breastfed becomes secondary to the safety of mother and baby.
There are a number of medications used in this disease that need attention such as:
– MAOI group: absolutely do not use.
– The tricyclic group is not recommended to be used because of the slow onset and high risk of suicide with antidepressants (due to the high toxicity of the tricyclic group).
– SSRI group (selective serotonine reuptake inhibitor) is the preferred choice due to its rapid onset and low toxicity. In this group, Fluoxetine is not recommended to be used because it can increase restlessness, which is common in depressed patients, and its half-life (T1/2 is quite long).
– If the mother has a lot of insomnia and if she has someone to take care of the baby, mirtazapine may be a good choice because the onset is quite quick (compared to SSRIs).
Note : Because antidepressants can increase the risk of suicide within the first 2 weeks, mothers who have suicidal thoughts should pay close attention for 2 weeks after starting use. Antidepressants.
In case there are psychotic symptoms, psychosis needs to be treated first. Benzodiazepine may be given in case the mother is anxious and restless.
5. What to do to prevent postpartum depression?
– Screen for cases of depression during pregnancy and cases with a history related to previous depression.
– Strengthen health education and reproductive health care for mothers before and after giving birth.
– Because most cases of postpartum depression often occur in people giving birth to their first child, the Vietnamese custom of “older children go to the mother’s house, middle-aged children go to the husband’s house” is very good and will help mothers not to fall. into loneliness and feelings of despair.
