Psychic disturbances in the postpartum period: an increasing problem?

Abstract

Postpartum psychic disorders can be mainly divided into 3 groups: The so-called postpartum blues, the postpartum depression and the postpartum psychosis. The postpartum blues occurs 3 - 5 days postpartum in 50 - 70 % of deliveries mostly disappearing after one week without specific therapy. However, 20 - 30 % of patients will develop a depression in their further postpartum course so that a thorough evaluation concerning depression is warranted, if blues symptoms persist more than 2 weeks. Postpartum depression can be found in 10 - 15 % of deliveries and mostly occurs several weeks or months after delivery with symptoms of depressive mood, sleeping disorders, anxiety, loss of interest and accord and feelings of guilt up to suicidal ideas. In order not to misinterpret them as postpartum blues specific questions concerning the mood of the young mother during the postpartum examination - if necessary using the Edinburgh scale - are recommended. In patients with known risk factors for a postpartum depression (i. e. postpartum depression or psychosis in previous pregnancies, depression disorder, anxiety disorder, bipolar illness), a thorough survey is mandatory and - if necessary - a prophylactic treatment in cooperation with the psychiatrist. Less severe forms of postpartum depression can mostly be treated with psychotherapy and sociotherapy on an outpatient basis. In more severe cases, antidepressant drugs (selective serotonin reuptake inhibitors, SSRIs or some tricyclic drugs) are indicated. Postpartum anxiety and compulsive disorders respond well to psychotherapy; besides in anxiety disorders benzodiazepines are recommended, in compulsive disorders SSRIs. Postpartum psychoses (about 0.1 - 0.2 %) most often occur in bipolar or schizoaffective disorders or after postpartum psychosis. They require a hopitalization mainly because of the danger of suicide and homicide toward the newborn; ideally this is performed in mother-child-units.