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Types of Postpartum Mood and Anxiety Disorders

 

Postpartum Blues: 50-85% mothers in first 2 weeks postpartum; Symptoms: irritability, anxiety, fluctuating mood, & increased emotional reactivity; Mild & spontaneously remits, not considered psychiatric disorder. Postpartum Depression: 13% of mothers in first year postpartum; Symptoms: excessive guilt, anxiety, loss of interest, insomnia, & psychomotor retardation; Mild to severe functional impairment and distress, necessitates treatment. Postpartum Psychosis: 0.1% of new mothers in first 3 months postpartum; Symptoms: mixed or rapid cycling, agitation, delusions, hallucinations, disorganized behavior, cognitive impairment, & low insight; Severe, considered psychiatric emergency & often necessitates inpatient treatment.

Postpartum mood and anxiety disorders exist on a spectrum, from relatively mild and non-clinically significant postpartum blues to severely impairing episodes of postpartum depression or postpartum psychosis.

Because the postpartum period requires considerable adjustment at a highly vulnerable time for physical and emotional health,1 it is not surprising that this is a period of risk for developing psychiatric complications such as postpartum blues, postpartum depression, and postpartum psychosis.2-4

Postpartum Blues

Of these three complications postpartum blues is the most common, yet the least severe.5 Also referred to as baby blues, postpartum blues occurs in 50-85% of women during the first few weeks postpartum.1, 2, 5, 6 Symptoms such as irritability, anxiety, fluctuating mood, and increased emotional reactivity typically begin within one week of delivery.2, 5, 6 Treatment is not necessary since symptoms are usually mild and non-impairing, and spontaneously remit around two weeks postpartum.2, 5, 6 However, the baby blues is an early precursor of some cases of postpartum depression, particularly for women with a history of mood disorders.7-9 Therefore, women with baby blues should be monitored for increasing severity of symptoms and assessed for postpartum depression if symptoms do not remit within 12 days after childbirth.6  

Postpartum Depression

Postpartum depression is the second most common postpartum psychiatric complication, occurring in 13% of women.2, 10 In contrast to baby blues, postpartum depression often develops insidiously three weeks after delivery and persists for at least three months.11 Over one-half of women remain depressed at 5-9 months,12 and one-third of women are still depressed from 12-18 months after childbirth.13, 14 In addition to having a prolonged course, the greater severity of symptoms differentiates postpartum depression from postpartum blues.5, 15

Postpartum Psychosis

The symptoms of postpartum depression are less severe than those of postpartum psychosis, which include mixed or rapid cycling between manic and depressive episodes, agitation, delusions, hallucinations, disorganized behavior, cognitive impairment, and low insight.6, 16-18 However, postpartum psychosis is relatively rare, occurring in just 0.1-0.2% of women.2, 6, 16-18 Due to its high prevalence and clinically significant symptoms, this website focuses on postpartum depression.

References

  1. Carlson, K. J., Eisenstat, S. A., & Ziporyn, T. D. (2004). The new Harvard guide to women’s health (2nd ed.). Cambridge, MA: Harvard University Press.
  2. Nonacs, R. M. (2005). Postpartum mood disorders. In L. S. Cohen & R. M. Nonacs (Eds.), Review of psychiatry: Mood and anxiety disorders during pregnancy and postpartum (Vol. 24, pp. 77-96). Washington, DC: American Psychiatric Publishing.
  3. Registered Nurses’ Association of Ontario (2005). Nursing best practice guideline: Interventions for postpartum depression. Retrieved from http://www.rnao.org/Storage/11/600_BPG_Post_Partum_Depression.pdf
  4. Vesga-Lopez, O., Blanco, C., Keyes, K., Olfson, M., Grant, B. F., & Hasin, D. S. (2008). Psychiatric disorders in pregnant and postpartum women in the United States. Archives of General Psychiatry, 65(7), 805-815. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=fyh&AN=MFS-33136732&site=ehost-live&scope=site
  5. Bick, D., MacArthur, C., & Winter, H. (2009). Depression and other psychological morbidity. In Postnatal care: Evidence and guidelines for management (2nd ed.; pp. 141-156). China: Elsevier Limited.
  6. Burt, V. K., & Stein, K. (2011). Treatment of women. In R. E. Hales, S. C. Yudofsky, & G. O. Gabbard (Eds.), The American psychiatric publishing textbook of clinical psychiatry (5th ed.). doi: 10.1176/appi.books.9781585623402.317165.
  7. Beck, C. T. (2001). Predictors of postpartum depression: An update. Nursing Research, 50(5), 275-285. Retrieved from https://auth.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=2001108214&site=ehost-live&scope=site
  8. Reck, C., Stehle, E., Reinig, K., & Mundt, C. (2009). Maternity blues as a predictor of DSM-IV depression and anxiety disorders in the first three months postpartum. Journal of Affective Disorders, 113, 77-87. doi: 10.1016/j.jad.2008.05.003
  9. Henshaw, C., Foreman, D., & Cox, J. (2004). Postnatal blues: A risk factor for postnatal depression. Journal of Psychosomatic Obstetrics & Gynecology, 25(3), 267-272. doi: 10.1080/01674820400024414
  10. O’Hara, M. W., Swain A. M. (1996). Rates and risk of postpartum depression: A meta analysis. International Review of Psychiatry, 8, 37-54. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=flh&AN=MRB-FSD0069987&site=ehost-live&scope=site
  11. Gundersen, D. C. (2001). Postpartum psychiatric disorders. In J. Jacobson & A. Jacobson (Eds.), Psychiatric secrets (2nd ed.). Retrieved from http://www.mdconsult.com.libproxy.lib.unc.edu/das/book/body/172005763-9/0/1167/1.html
  12. Coates, A. O., Schaefer, C. A., & Alexander, J. L. (2004). Detection of postpartum depression and anxiety in a large health plan. Journal of Behavioral Health Services & Research, 31(2), 117-133. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=aph&AN=12910992&site=ehost-live&scope=site
  13. Beeghly, M., Olson, K. L., Weinberg, M. K., Pierre, S. C., Downey, N., & Tronick, E. Z. (2003). Prevalence, stability, and socio-demographic correlates of depressive symptoms in black mothers during the first 18 months postpartum. Maternal & Child Health Journal, 7(3), 157-168. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=c8h&AN=2004033558&site=ehost-live&scope=site
  14. Beeghly, M., Weinberg, M. K., Olson, K. L., Kernan, H., Riley, J., & Tronick, E. Z. (2002). Stability and change in level of maternal depressive symptomatology during the first postpartum year. Journal of Affective Disorders, 71(1-3), 169. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=aph&AN=7859210&site=ehost-live&scope=site
  15. Miller, L. J. (2002). Postpartum depression. Journal of the American Medical Association, 287(6), 762-765. doi: 10.1001/jama.287.6.762
  16. Munk-Olsen, T., Laursen, T. M., Pedersen, C. B., Mors, O., & Mortensen, P. B. (2006). New parents and mental disorders: A population-based register study. Journal of the American Medical Association, 296(21), 2582-2589. Retrieved from http://jama.ama-assn.org/content/296/21/2582.long
  17. National Institute for Health and Clinical Excellence. (2007). Antenatal and postnatal mental health: Clinical management and service guidance. Retrieved from http://www.nice.org.uk/nicemedia/live/11004/30433/30433.pdf
  18. Sit, D., Rothschild, A. J., & Wisner, K. L. (2006). A review of postpartum psychosis. Journal of Women’s Health, 15(4), 352-368. doi: 10.1089/jwh.2006.15.352

Last Updated July 6, 2011