Makindo Medical Notes

Related Subjects: |Psychiatric Emergencies |Depression |Mania |Schizophrenia |Suicide |Acute Psychosis |Delusions |General Anxiety Disorder |Obsessive-Compulsive disorder |Wernicke Korsakoff Syndrome |Medically Unexplained symptoms |Postpartum/Postnatal Depression |Postpartum / Postnatal Psychosis

🌸 Postpartum Depression (PPD)

• Affects up to 20% of women in the first year postpartum.
• Onset: typically within 24 hrs – 3 months, but can occur any time in first year.
• Screening: Universal screening is recommended. – Edinburgh Postnatal Depression Scale (EPDS) commonly used. – Some regions mandate screening by law.
• DSM-5: Specifies onset within 4 weeks postpartum, though clinicians recognise episodes within 1 year as PPD.

🧠 Diagnostic Criteria

≥ 5 symptoms for ≥ 2 weeks, including depressed mood OR loss of interest/pleasure.

• Sleep disturbance (insomnia or hypersomnia)
• Psychomotor agitation or retardation
• Fatigue, exhaustion, loss of energy ⚡
• Appetite change (↑ or ↓)
• Feelings of guilt/worthlessness 😔
• Poor concentration, indecisiveness
• Recurrent suicidal thoughts/ideation 💭

👩‍👦 Clinical Features

• Persistent insomnia, loss of appetite, crying spells 😢
• Difficulty coping with daily tasks (“acopia”)
• Irritability, anxiety, social withdrawal
• Guilt, low confidence, fear of being alone
• Loss of joy or pleasure (“anhedonia”)
• Suicidal thoughts → ⚠️ Red flag for urgent referral

⚠️ Risk Factors

• History of depression or psychiatric illness
• Adverse life events (financial stress, bereavement)
• Domestic violence or marital conflict 💔
• Unplanned/unwanted pregnancy 🤰
• Lack of social support or isolation

Unlike obstetric complications, psychosocial stress is the major driver of PPD.

🛠️ Management

• Tailored to severity + patient preference → collaborative care 🤝
• Psychological therapies: – CBT or IPT are first-line for mild–moderate depression. – Supportive psychotherapy helps with adjustment.
• Pharmacological: – SSRIs (e.g. sertraline) = first-line. – Risks/benefits must be weighed if breastfeeding 🤱.
• Social interventions: – Family/partner involvement. – Peer support groups. – Health visitor follow-up in UK practice.

📊 Quick Teaching Table