Thursday, September 3, 2015

Postpartum depression: the importance of getting help

A recent study found that as many as one in every seven women suffers postpartum depression. Very effective treatments exist to help mothers through this time.

Postpartum depression: the importance of getting help

Experimental Antidepressant Appears Quick-Acting, Safe
Experimental Antidepressant Appears Quick-Acting, Safe

Postpartum depression (PPD) is characterized by a full-blown episode of depression that occurs within four weeks of delivery.  It is more serious and severe than the “baby blues,” the weepiness that lasts just three to seven days post-delivery.  A recent study in the April issue of JAMA Psychiatry now shows that as many as one in every seven women suffers postpartum depression.

Postpartum depression is associated with adverse outcomes for both mother and child, beyond the misery and guilt women afflicted with this disorder typically experience. For instance, postpartum depression predicts maternal suicide. Although postpartum women are less at risk for suicide than the general population of women, suicide is the second leading cause of death among them and accounts for 20 percent of deaths.  Moreover, postpartum depression can adversely affect attachment between mother and child, and maternal mental illness is highly predictive of later child psychological problems.

The research examined 10,000 women four to six weeks after they had given birth at Margee-Womens Hospital at the University of Pittsburgh. Women were first screened for symptoms of postpartum depression using the Edinburgh Postnatal Depression Scale (EDPS), a well-researched and common measure of the disorder.  What made this study unique is that women who were identified as “at-risk” via a cut-off score of 10 or above on the EDPS were then visited in their homes for a full face-to-face diagnostic interview.  During the two to three hour interview, an experienced clinician could determine with more sensitivity if the mother met criteria for actual postpartum depression, as well as any other psychological disorders.

Results showed that 14 percent of the 10,000 women screened were at risk for PPD and 3.2 percent reported thoughts of self-harm.  Of those at-risk women who consented to in-depth psychological interviews, 68.5 percent met criteria for major depressive disorder. The majority identified the onset of their depression as postpartum (40 percent), followed by during their pregnancy (33.4 percent), and prior to pregnancy (26.5 percent).

A striking finding was that 22.6 percent of interviewed women met criteria for bipolar disorder. This was a higher prevalence than expected, even though prior research has shown that women are most likely to experience first and recurrent bipolar episodes during the postpartum period.  Of those women who met criteria for depression, more than half (66 percent) also met criteria for another psychological disorder, overwhelmingly (82.9 percent) an anxiety disorder such as generalized anxiety disorder, panic disorder, social phobia, and post-traumatic stress disorder.  Based on the results, researchers called for more thorough screening of women during the postpartum period, with increased attention to bipolar and anxiety disorders.

Women (and their partners) who are concerned about the possibility of PPD can ask their doctors for screening and referrals during routine post-natal care.  Results of well-controlled studies have indicated that common antidepressants such as Prozac and Paxil are effective in treating PPD and that Interpersonal Therapy (IPT) and Cognitive Behavioral Therapy (CBT) are effective therapies.

Read more from the Healthy Kids blog »

Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
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The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

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Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Magee DeFelice, M.D. Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Emiliano Tatar, M.D. Pediatrician at Einstein Healthcare Network Roxborough Plaza
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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