Післяпологова депресія

Symptoms of postpartum depression are similar to those of major depression and may include

• Extreme sadness

• Mood swings

• Uncontrollable crying

• Insomnia or increased sleep

• Loss of appetite or overeating

• Irritability and anger

• Headaches and body aches and pains

• Extreme fatigue

• Unrealistic worries about or disinterest in the baby

• A feeling of being incapable of caring for the baby or of being inadequate as a mother

• Fear of harming the baby

• Guilt about her feelings

• Suicidal ideation

• Anxiety or panic attacks

Typically, symptoms develop insidiously over 3 months, but onset can be more sudden. Postpartum depression interferes with women’s ability to care for themselves and their baby.

Women may not bond with their infant, resulting in emotional, social, and cognitive problems in the child later.

Partners may also be at increased risk of depression, and depression in either parent may result in relationship stress.

Without treatment, postpartum depression can resolve spontaneously or become chronic depression. Risk of recurrence is about 1 in 3 to 4.

Other potential psychiatric disorders in the postpartum period include anxiety and, rarely, postpartum psychosis.

Untreated postpartum psychiatric disorders increase the risk of suicide and infanticide, which are the most severe complications.

• Clinical evaluation

• Criteria for major depressive disorder

Early diagnosis and treatment of postpartum depression substantially improve outcomes for women and their infant (1).

Postpartum depression is diagnosed based on the same criteria as major depressive disorder, which are ≥ 5 symptoms for > 2 weeks; symptoms include depressed mood and/or loss of interest or pleasure and (2)

• Significant weight loss, loss of appetite, or weight gain

• Insomnia or hypersomnia

• Psychomotor agitation or retardation

• Feeling of worthlessness or guilt

• Diminished ability to concentrate

• Suicidal or homicidal thoughts (women should be asked specifically about such thoughts)

Many women have postpartum "baby blues," which may include depressive symptoms but does not meet full criteria for postpartum depression.

Because of cultural and social factors, women may not report symptoms of depression, so clinicians should ask women about such symptoms before and after delivery. Also, women should be taught to recognize symptoms of depression, which they may mistake for the normal effects of new motherhood (eg, fatigue, difficulty concentrating).

All women should be screened at the postpartum visit for postpartum depression using a validated screening tool. Such tools include the Edinburgh Postnatal Depression Scale and the Postpartum Depression Screening Scale (2).

Depressive symptoms such as dysphoria, insomnia, fatigue, and impaired concentration can be present in both postpartum blues and postpartum depression. However, the diagnosis of postpartum blues does not require a minimum number of symptoms, whereas postpartum depression requires a minimum of 5 symptoms. In addition, the symptoms of postpartum blues are generally self-limited and resolve within 2 weeks of onset. By contrast, the diagnosis of postpartum depression requires that symptoms be present for > 2 weeks.

Patients should also be screened for anxiety disorders.

Patients with hallucinations, delusions, or psychotic behavior should be evaluated for postpartum psychosis.

• Zuranolone or brexanolone

• Other antidepressants

• Psychotherapy

Treatment of postpartum depression includes antidepressants and psychotherapy. Two medications have been approved by the U.S. Food and Drug Administration specifically for postpartum depression: brexanolone given intravenously, and zuranolone given orally. Both are neurosteroids that modulate GABA-A receptors in the brain (1, 2, 3).

If a woman has significant anxiety, she may be treated with anxiolytics (4).

Treatment of postpartum psychosis typically requires psychiatric hospitalization and antipsychotic medications.