POSTNATAL DFPRESSION

“ BEYOND THE BLUES”

Presented b
Mrs. Sukhbir Kaur
ASSOciate Professor,
B.Sc.(N), PGDHM, M.Sc.(N) Ph.D. Scholar
Sri Guru Raw Das College of Nursing,
Sri Guru Ram Das university of Health
Sciences.
 CONTENTS
• Introduction
■ Epidemiology
• Definition
• Risk factors
• Causes
• Sign and symptoms
• Onset and dUl‘atiOf1
■ Diagnosis
• Prevention and treatlnent
POSTNATAL BLUES or baby blues: Many women feel a
bit down, tearful or anxious in the first week after giving
birth. This is ofien called the "baby blues" and is so
common that it's considered normal. The "baby blues"
don't last for more than two weeks after giving birth.
impact on how you live your life, you
ț

problem.
DFPRESSION IN WOMF.N
» 50% 50% of wOine8
to experience “baby
transient
blues” within the first two
weeks following delivery
» 0.1 % to 0.2% of
wOmcn expei'ieiice
postpartiim psychosis
usually within the tirst 4
weeks following
EPIDEMIOLOGY OF
PPD
Difference between Baby
blues md

POST PARTUM BLUES OsT PARTUM

EPRESSION (PPD)

Onsetat 3or4" dey Önset caa be anytiœe

post- delivery and ons year air
can laat from a few delivery and last more
days than 2
Postpartum
BIued

SO-8S9+mothers in first 2 13a» mothers io first year

weeks postpartum |gOSt ga £ t U T

Symptoms: irr inability, Symptoms: excessive gulit.

anxiet'y, fTuctuat iog mood, etc, a hedonia.
& In E r eas e d e m o t iona T depressed mood,
/hyp
reactivity
suicidal ideat ion. & fatigue

Mlld & spontaneously Moderate to severe

remlts, no1 considered symptoms. prolonged
psychiatric disorder course
• While many women experience
symptoms postpartum,
limited mil self-
,postpartu d depression should be
suspected
m when symptoms are
severe
and have lasted over two weeks.

• While the causes of PPD are

not understood, a number of factors
have been suggested to increase the
risk:
Risk
fact
Postnatal depression is often misunderstood and there are many
myths surrounding it. These include:

depression.

Post‹tetnl depression is entirely caused by hormonal changes.

Postnatal depression will cooo pass•

Postnatal depression only aRects women. Research has actually

rou»d that up Io l in 25 new fathers become depressed after hevii
g

a baby.
 Sci
In the US, the
eening
American Colleqe of Obstetricians and
GynecDloqists suggests healthcare providers consider depression
screening for perinatal women.
Additionally, the American Academy of Pediatrics recommends
pediatricians screen mothers for PPD at 1-month. 2-month and 4-
month visits.
However, many providers do not consistently provide screening
and appropriate follow-up.— For example in Canada, Alberta is
the only
province with universal PPD screening. This screening is carried out
by
Public Health nursed with the baby'6 immunization schedule.
The Edinburgh Postnatal Depression Scale , a

standardized self-reported questionnaire. If the

new mother scores 13 or more, she likely has PPD

and further assessment should follow.

In india Prime MD today questionnaireis used

—

primary care evaluation for mental

disoroers

translated into 11 indian languages

 TREATMFNT
1. Psychological treatments : Talking treatment
Psychological therapies are usually the first treatment
recommended for women with postnatal
depression.
The main types used are described below.
a. baited self-help
b. Cognitive behavioral therapy
c. liiterpe s trial therapy
2. Antidepressants
 Interpersonal
therapy
Interpersonal therapy (IPT)
involves talking to a therapist
about the problems you're
experiencing.
2. ANTI DEPRESSANTS usually need
to be taken for at Ii•aSt a week before
thi= benefit starts to be felt, so it's
important to keep taking them even if
you don't notice straight away.
usually need to take thRFEi for around
six months after you start to feel better.
If you

SSRIs sertraline,

Newer drugs : Buprppion.

Escitalopram
 Nursing Interventions/Patient
Education
1. Listen to the woman regarding her adjustment to
role
of mother and observe lor any clinical
manifestations
suggesting dep ession.
2.Ask the woman about the infant's behavior
Negative
statements about the infant may suggest that
the woman is having difficulty coping.
3. Provide support and encourage husband,
family and
friends to su»pon and assist with the inlant
and mother.
Physical support as well as emotiona! support
may be
indicated.
5. Educate the woman that treatment may help
alleviate
hersymp|oms and allowhe |o bene‹cae o
he‹se# and infant.
Active- listen and identify client's perceptions
of
Ertiphasizc tic need for continucd
communication
able
Encourage vcrbalization of fear and anxieties
and ’ fi
Discuss the realities of parenting and the fact thnt it
may be exhausting.
Point out infant cues and explain their meaning. This
helps het fat better abottt liersGlf and her ability to
care for the infant
Include the spouse in discussions about the woman

Emphasize the importance of the mother taking

the for PPD and may bc continued for 6nionths or

more.
Assist the mother and leer partner in
identifying
RESEARCH STUDIES :
. Shival Ii S, Gururaj N (20 l S) conducted a study
on
Postnatal
di Depression among Rural Women in South
sucio-demographic,
obstctric outcomc yrcdictors
Postnatal Depression Karnataka state.
India. HOspital based analytical sectional
study dcsi @ n was takcn and was conducted in rural
tertiary care hospital of Mandys District, Karnataka
state. PND prevalence based estimated Sample of
102 women who crime for posmatal follow up front
4tli to l0tli week of lactation was takcn. The
Edinburgh Postnatal Depression Scale t EPDS)
was tised to assess PPD.
 a Risk of PND among ruml postnatal women was
high
/ (31.4%). Birth of female baby, poverty and
' complications in pregnancy or known medical
' illness could predict the high risk of PN D, PN D .
/
,' scrcening should be an integral part of postnatal
care. Capaciy
building or’ grass root level workers and feasibility J'
triols for screeninii PND by theiii Rre needed.
 / References
• Anteuetel end posinazuf me»tef healJ: cfiniro/ j
' cianugement )
arid cervice guidance. NICE CGI92 (2014) National Institute
' for Health and Care Excellence. London.
' 1
• Musters C, McDonald fi, Jones L (2008) Muitugemeiti n
[
• jfJN.Sf12fffN/Dennis
4/dI’W.s.¥/f9Ji. British Medical Journal, 337, 399-403.
CL, Hodneu ED (2007j Psychosocial end
' p@'rfiofogicu/ } ioren'enfion.s for treating yosiperzrim
drprerrioo. Cocfira»e 1 Dataha.se nfsycteinatic Reviews. Oct.
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([ • Raj EB, . 0 4. Dcbr's Mcntel

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