Puerperal Depression (PD) is a severe from of depression or elation occurring in the first few weeks after the baby is born. The term `puerperal' refers to the six week period immediately following childbirth. This disorder however, is a relatively rare, affecting at most 1 woman in every 500 who have given birth. Postpartum illness was initially conceptualized as a group of disorders specifically linked to pregnancy and childbirth and thus was considered diagnostically distinct from other types of psychiatric illness. More recent evidence suggests that postpartum psychiatric illness is virtually indistinguishable from psychiatric disorders that occur at other times during a woman's life. Puerperal Depression is also known as Post Partum Psychosis, Postpartum and Puerperal Psychosis. The disorders main characteristics follow very closely Major Depression and are listed as:

The symptoms are usually an acute state of confusion, fluctuating mood, disordered thinking and behavior and 'psychotic' symptoms of hallucinations and delusions.

In most cases, the onset is in the first few weeks after childbirth. In the same 2 weeks, the patient has had 5 or more of the following symptoms, which are a definite change from usual functioning. Either depressed mood or decreased interest or pleasure must be one of the five:

Mood. For most of nearly every day, the patient reports depressed mood or appears depressed to others.

Interests. For most of nearly every day, interest or pleasure is markedly decreased in nearly all activities (noted by the patient or by others).

Eating and weight. Although not dieting, there is a marked loss or gain of weight (such as five percent in one month) or appetite is markedly decreased or increased nearly every day.

Sleep. Nearly every day the patient sleeps excessively or not enough.

Motor activity. Nearly every day others can see that the patient's activity is agitated or retarded.

Fatigue. Nearly every day there is fatigue or loss of energy.

Self-worth. Nearly every day the patient feels worthless or inappropriately guilty. These feelings are not just about being sick; they may be delusional.

Concentration. Noted by the patient or by others, nearly every day the patient is indecisive or has trouble thinking or concentrating.

Death. The patient has had repeated thoughts about death (other than the fear of dying), suicide (with or without a plan) or has made a suicide attempt.

These symptoms cause clinically important distress or impair work, social or personal functioning.

The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Associated Features:

Sufferers may have a family history of psychotic illness, or have had a psychotic illness themselves in the past. Irrational preoccupations concerning the newborn baby. General features include:

Anxiety
Panic Attacks
Sleeplessness even when baby is asleep
Aches and Pains or generally feeling unwell
Memory loss and/or unable to concentrate
Tearfulness or unexplained crying
Hopelessness and isolation
Loss of interest in the baby
Feeling of unreality
Obsessional or suicidal thoughts fear of being alone
Hostility
Overactivity
Anger and/or aggression
Hallucinations
Delusions
Paranoia

Differential Diagnosis:

Some disorders have similar symptoms. The clinician, therefore, in his diagnostic attempt, has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

Baby Blues -Sometime around the third day, or so, the happy period ends abruptly and, for 60% of women, or more, the `Baby Blues' are experienced.

Pinks - For the first three days or so after giving birth most women, although tired, experience a `high', that is they feel happy, excited, thrilled with the baby and themselves, and they may experience difficulties sleeping.

Postnatal Depression - whose symptoms generally start some weeks after the baby is born. Women affected commonly describe feelings of tiredness, irritability and anxiety. Many women assume that what they are experiencing is due to being tired from coping with the new baby and perhaps other children, or having interrupted sleep due to the baby crying.

Cause:

The cause of Puerperal Depression is unclear. It is a biological, including the hormonal changes that occur following childbirth or chemical, form of mood disorder like other depressive illness or manic depression. Woman with a history of manic-depression run the greatest risk of developing puerperal depression after giving birth. Psychological and social factors such as the demands, obligations and responsibilities of motherhood are other causal factor. Fear that the mother may be inadequate and not able to live up to her own and/or other people's expectations. Women which have caesarean section or a stillbirth also have a slightly increased risk of experiencing this condition. Biological factors may also play a role.

Treatment:

Treatment of puerperal depression is usually with medication however in the past electroconvulsive therapy (E.C.T.} was frequently used as a treatment. Psychotherapy, for those that do not wish to use any form of medication, and support group participation have also be found helpful.

Counseling and Psychotherapy [ See Therapy Section ]:

Interpersonal therapy, a form of psychotherapy that may be particularly suitable for use in postpartum women because it focuses on the patient's interpersonal relationships and changing roles. Individual and group therapy may also be considered. Spouses and significant family members should also be counseled about the nature and treatment of PD and what they can do to assist in the mothers support structure. Women with severe marital discord should be referred for couples therapy.

Pharmacotherapy [ See Psychopharmacology Section ] :

The medication is generally continued over a six to twelve month period after the initial upset. Drugs used include:

Amitriptyline (Elavil)
Desipramine (Norpramin)
Imipramine pamoate (Tofranil-PM)
Nortriptyline (Pamelor)
Clomipramine (Anafranil)
Fluoxetine (Prozac)
Sertraline (Zoloft)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Bupropion (Wellbutrin)
Venlafaxine (Effexor)
Nefazodone (Serzone)
Mirtazapine (Remeron)

If a woman decides to take drugs to alleviate the symptoms of PD and wishes to breast feed whilst receiving treatment she should consider evaluating the extent of the infants exposed to any antidepressant through breast milk.