Role of Family Physician in Management

of Postpartum Depression (PPD)

Dr. Asmaa Fathy
Lecturer of Family medicine
 Baby
Blues

Post partum
Post partum Psychosis
Depression
 Causes
 Cause unclear
 Rapid decline in reproductive hormones
 Several factors increase risk
 Baby Blues
50-85% women experience baby blues
Transient
Heightened emotional reactivity
Peaks 3-5 days after delivery
Lasts up to 10-14 days
 Baby Blues
Characteristics:
Mild mood swings
Irritability
Anxiety
Decreased concentration
Insomnia
Tearfulness
Crying spells
Usually don’t affect mother’s ability to function and
care for child
 Postpartum depression
(PPD)

Nearly every seven women one women affected)

Average duration 7 months

¼ still affected at child’s first birthday

Overlooked and under diagnosed

 Why worry about PPD
PPD is common
• 13% of all postpartum women
• PPD symptoms don’t just last a few days
• 1/2 of women are symptomatic at 6 months
• 1/3 of women continue to be symptomatic at 12
months
• Preliminary work suggests it is under recognized
and under-treated.
Postpartum Depression: Effects
Depression negatively effects:
 Mother’s ability
 Mother—infant relationship
 Emotional and cognitive development of the child
especially when the mother have longer duration
of PPD or have other mental health illness
 Postpartum Depression:
Maternal Behaviors
 Gaze less at their infants

 Take longer to respond to infant’s utterances

 Show fewer positive facial expressions

 Lack awareness of their infants

 Postpartum Depression:
Maternal Attitudes

 Infants perceived to be more bothersome

 Make harsh judgments of their infants

 Feelings of guilt, resentment, and ambivalence

toward child

 Loss of affection toward child

 PPD: Why do we miss it?
 Patient without a primary care physician don’t
know who to turn to
 Patient, society, and physicians dismiss or
minimize patients experiences as “normal”
 Women’s fear and shame about not being a “good
mother”

 Patients don’t present with CC of depression

Severe MILD
Severe Symptoms:
 Thoughts of dying
 Thoughts of suicide
 Wanting to flee or get away
 Being unable to feel love for the baby
 Thoughts of harming the baby
 Thoughts of not being able to protect the infant
 Hopelessness
 Risk Factors for Development of
Postpartum Depression
During Pregnancy After Birth
A young and single Labor/Birth
mother
Complications
H/O Mental illness or
substance abuse Low confidence as a
Financial or relationship parent
difficulties Problems with Baby’s
Previous Pregnancy or Health
postpartum depression Lack of supports
Major Life change at the
same time as birth of the
baby
 investigations
You should exclude other clinical problems before
proceeding to treat a patient with PPD
Hb, feritin
TSH,T3,T4(Thyroid function test)
Vit D3
 Postpartum Psychosis

2:1,000 births
Psychiatric emergency
Usually within 3 weeks
Usually manifestation of bipolar
70% women experience recurrence in PPP in next
pregnancy
 PPP Symptoms

Initial signs are restlessness, irritability,

Insomnia
Severe disturbance
Infanticide: 4% of untreated PPP
Suicide: 5% of untreated PPP
 Postpartum Psychosis Symptoms
Confusion/disorientation Hyperactivity
Extreme disorganization Not feeling need to sleep
of thought Rapid speech
Bizarre behavior Loss of touch with reality
Unusual hallucinations
Visual, olfactory, or tactile
Delusions (often centered
on the infant)
 PPD identification and management

 Screen
A good start
 Diagnose

Further assess suicidal ideation if present

 Treat

Emergency support for suicidal concerns •

Medication ,Counseling
 PPD identification and management

 Follow up
Biggest problem is loss to follow up
Provide tools to make it easier
Nurse tools , Physician tools
Nurse phone calls • Recurrent visits
 Postpartum depression &breast
feeding
A number of studies report that women who are not
breastfeeding are more likely to have higher levels of
depressive symptoms than women who are
breastfeeding
 Postpartum depression &breast
feeding
Postpartum depression resulting in lower rates of
breastfeeding initiation and early cessation

 Number of more recent studies have revealed that

women who formula feed have higher rates of
depression than women who breastfeed
 Postpartum depression &breast
feeding
Although postpartum depression has been identified
as a risk factor for early breastfeeding cessation early
negative breastfeeding experiences may be a risk
factor for postpartum depression
 Role of family physician in mangement of
postpartum depression
 Primary care physicians are crucial members of
the caregiving team that can help manage and even
thwart postpartum depression.

 PCPs through their longitudinal relationship with

the patients have their personal and family history
of depression , other mental health illness or
substance use disorders prior to birth
 Role of family physician in mangement of
postpartum depression
 Any woman can be affected by postpartum
depression, but a past history of these disorders puts
women at a greater risk for the condition

Family physician know their patients well and

wheather they have support at home or not.
Family Physicians trained well on early diagnosis of
PPD (Risk factors and the warning signs of
postpartum depression, such as stress during
pregnancy
 Role of family physician in mangement of
postpartum depression
Other warning signs may include anxiety, sadness,
sleeping issues, changes in appetite, excessive mood
swings or disinterest in the baby, family and friends

After childbirth, physicians should ask their patients

if they feel low or blue most of the time for 2 weeks
or more,
 Role of family physician in mangement of
postpartum depression
 At risk patients require more follow-up.

 PCPs should educate their patients that these

symptoms may be present in the first 2 weeks after
childbirth and are the “baby blues,” However, if
these symptoms persist longer it may be an
indication of postpartum depression.
 Role of family physician in mangement of
postpartum depression
 Treatmentcan include medication and/or
psychotherapy.

 Women who decide to breastfeed should be

advised to not take lithium
 Role of family physician in mangement of
postpartum depression
 Educate the new mom that all new moms have bad thoughts
when the baby is crying inconsolably in the middle of the
night.

 If she is afraid that she might lose control and actually do

something to harm the baby, she should let you know
because there is help.

 Women are reluctant to admit bad thoughts, so it’s a little bit

of a touchy conversation. Women often fear losing custody
 Role of Family Physician in Mangement of
Postpartum depression
 Breastfeeding is controversial . If the woman
needs medication, she may want to move to bottle
feeding or wean the baby, so she can take any
medicine she needs without worrying that it will
have an effect on her baby. All medicine gets into
breast milk.

 Ifsomeone else can feed the baby a bottle at night,

the new mom will be able to sleep better.