Postnatal Depression: Causes and Treatment

Symptoms

Postpartum depression is a mental illness that begins in women within the first few months after delivery. Depending on the source, onset is reported within 1 to 12 months after delivery. It manifests itself in the same symptoms as other depressions and lasts several weeks to months. Postpartum depression is common and affects between 10% to 15% of new mothers. Possible symptoms include:

  • Depressed mood, sadness, loss of interest, anxiety, hopelessness.
  • Sleep disturbances
  • Lack of energy, listlessness, difficulty concentrating.
  • Irritability
  • Frequent crying, brooding
  • Suicidal thoughts
  • Lack of appetite

Causes

The exact causes are not fully understood. Hormonal, physical and social factors are held responsible. As a risk factor, a predisposition (vulnerability) is particularly important. Those who already have depression have an increased risk.

Diagnosis

Early detection is important. Diagnosis is made in medical care using the patient’s history, a questionnaire (Edinburgh Postnatal Depression Scale, EPDS), or with a structured interview. To be distinguished from postpartum depression is the common “baby blues” (postpartum dysphoria, crying days), which lasts only hours to days and occurs in the first 7-10 days after birth. More rarely, other mental disorders occur after birth, for example, postpartum psychosis with sensory disturbances or anxiety disorders. Organic causes such as iron deficiency or hypothyroidism can also cause symptoms similar to postpartum depression. Link: Edinburgh Postnatal Depression Scale

Treatment

Like other depressions, postpartum depression is treated with psychotherapeutic approaches and medications, among other methods. If severe, inpatient treatment in a maternity unit is indicated. Antidepressants are used for drug treatment. The literature mainly mentions SSRIs such as citalopram, paroxetine and sertraline and tricyclic antidepressants such as nortriptyline, amitriptyline and trimipramine. This raises the question of whether breastfeeding can continue. According to the literature, some antidepressants can be taken during breastfeeding. The benefits of breastfeeding and the possible risks for the infant must be weighed against each other on an individual basis. The effects of antidepressants are delayed within 2-4 weeks. Brexanolone (Zulresso) is a neuroactive agent from the group of GABA-A receptor modulators for the treatment of postpartum depression. The substance corresponds to the progesterone metabolite allopregnanolone, the levels of which are highest in the third trimester of pregnancy. The drug is administered under medical supervision for 60 hours as a continuous intravenous infusion. The most common possible adverse effects include drowsiness, dry mouth, a loss of consciousness, and flushing.