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At least 19 recordsLinked to original sources
PubMed2007

Dysregulation of the hypothalamic-pituitary-adrenal axis in postpartum depression.

Postpartum depression (PPD) affects at least 10% to 15% of postpartum women, including more than 600,000 American mothers in 2003 alone. Dramatic changes in the hypothalamic-pituitary-adrenal (HPA) system in the transition from pregnancy to postpartum coupled with research on the psychobiology of depression provided the foundation for this study. The purpose of this study was to compare the reactivity and regulation of the HPA axis components, adrenocorticotropic hormone (ACTH) and cortisol, in depressed and nondepressed postpartum women. A comparative, longitudinal study design was used with 22 normal, healthy, nondepressed pregnant women. Physiologic and postpartum depression data were collected at 6 and 12 weeks postpartum at a university clinical research center. Maximal treadmill exercise stimulated plasma ACTH and serum cortisol levels which were measured before, during, and after 20 min of exercise. Postpartum depression was measured with the Postpartum Depression Screening Scale. Lag within-subject ACTH levels predicting cortisol regression slopes were significantly different between the depressed and nondepressed groups at both 6 and 12 weeks. The depressed group showed no relationship between their ACTH and cortisol levels, with higher ACTH and lower cortisol levels when compared with the nondepressed group. The expected regulated relationship with cortisol levels rising in response to rising ACTH levels was found in the non-depressed group. These findings indicate that the HPA axis was dysregulated in the depressed group, but regulated in the nondepressed group at 6 and 12 weeks postpartum. This pattern of higher ACTH levels to stimulate less cortisol is similar to patterns found in women with early life stresses.

Adrenocorticotropic Hormone↗
PubMed1984

Postpartum depression.

Postpartum depression (PPD) occurs in 4% of women during the puerperium. Patients with a previous history of depression, especially a postpartum depression, have a much greater incidence of PPD. Those patients should be evaluated carefully during the six-week period following parturition. PPD is to be differentiated from "baby blues," which occur in more than 50% of women postpartum. Baby blues are characterized by intermittent, mild affective symptoms that remit spontaneously after several days.

Antidepressive Agents↗
PubMedDate not supplied

Identifying and treating postpartum depression.

Postpartum depression affects 10% to 20% of women in the United States and negatively influences maternal, infant, and family health. Assessment of risk factors and depression symptoms is needed to identify women at risk for postpartum depression for early referral and treatment. Individual and group psychotherapy have demonstrated efficacy as treatments, and some complementary/alternative therapies show promise. Treatment considerations include severity of depression, whether a mother is breastfeeding, and mother's preference. Nurses who work with childbearing women can advise depressed mothers regarding treatment options, make appropriate recommendations, provide timely and accessible referrals, and encourage engagement in treatment.

Antidepressive Agents↗
PubMedDate not supplied

Complementary therapies as adjuncts in the treatment of postpartum depression.

Postpartum depression affects an estimated 13% of women who have recently given birth. This article discusses several alternative or complementary therapies that may serve as adjuncts in the treatment of postpartum depression. The intent is to help practitioners better understand the treatments that are available that their clients may be using. Complementary modalities discussed include herbal medicine, dietary supplements, massage, aromatherapy, and acupuncture. Evidence supporting the use of these modalities is reviewed where available, and a list of resources is given in the appendix.

Acupuncture↗
PubMedDate not supplied

[Therapeutic education and the increased risk of postpartum depression].

Postpartum depression affects approximately 13% of women irrespective of ethnic group and culture. In fact, it represents the main request for hospitalisation of a non-obstetric type for pregnant women. This is a particularly significant fact considering that women affected by postpartum depression have a depressive relapse twice as frequently compared with other women during a period of five years. Their children are exposed to an ambiguous relationship which does not help their cognitive, psychological and emotional development. Furthermore, in the most severe cases it can determine a serious risk for their life. Despite this, the syndrome symptoms and consequences are still not widely known and data seem to be underestimated both quantitatively and qualitatively. The present survey tries to study the causes producing this situation. It offers as well therapeutical and educational trends of intervention of a preventive and predictive type in order to control at least the major risk that can occur.

Depression, Postpartum↗
PubMedDate not supplied

Transcultural analysis of postpartum depression.

Postpartum depression (PPD) strikes about 1 in 10 Western women. Studies of Western women have demonstrated that this emotional experience can occur during pregnancy and/or after delivery, and even in women who adopt an infant. Is PPD a universal experience or a morbid condition that is culture specific to Western/industrialized countries? The purpose of this literature review was to examine other cultures to ascertain whether PPD is a universal experience. The literature describes women throughout the world experiencing degrees of sadness postnatally, which persist up to 1 year. The risk factors for PPD also share similar themes cross-culturally, with one notable exception--the impact that the sex of the infant had on PPD, for a higher value for male children over female offspring was reported in literature from China, Turkey, and India. This literature review demonstrated that, although PPD is an experience that women in all cultures experience, the underlying cause for this malady in non-Western cultures is not attributed to biologic causes, and treatment is not generally based on a Western medical model.

Anthropology, Cultural↗
PubMed1999

A Review of Postpartum Depression.

Postpartum depression (PPD) is an irritable, severely depressed mood that occurs within 4 weeks of giving birth and possibly as late as 30 weeks postpartum. Manifestations include crying spells, insomnia, depressed mood, fatigue, anxiety, and poor concentration. Patients may experience mild, moderate, or severe symptoms. Many psychosocial stressors may have an impact on the development of PPD. Recent studies conclude that the majority of factors are largely social in nature. The greatest risk is in women with a history of depression or other affective illness and in those who have experienced depression during past pregnancies. Women with significant risk factors should be followed closely in the postpartum period. The severity of symptoms and degree of impairment guide the approach to treatment. Treatment should begin with psychotherapy and advance to pharmacotherapy if needed; however, many patients benefit from concomitant treatment with both psychotherapy and medication. Common forms of psychotherapy include interpersonal therapy and short-term cognitive-behavioral therapy. Postpartum depression demands the same pharmacologic treatment as major depression does, with similar doses as those given to patients with nonpuerperal depression. It is essential to use an adequate dose of antidepressants in a duration sufficient to ensure complete recovery. Mothers should continue medication for 6 to 12 months postpartum to ensure a complete recovery. Inadequate treatment of depression puts women at risk for the sequelae of untreated affective illness, and the depression may become chronic, recurrent, and/or refractory. Family physicians are key players in the detection and treatment of PPD owing to the nature of the disease and the tendency for new mothers to negate their feelings as something other than a treatable psychiatric illness.

Journal Article↗
PubMedDate not supplied

Postpartum depression and postpartum adaptation: overlapping constructs?

In order to examine the course of normal postpartum adjustment compared to the symptomatology of postpartum depression, 25 postpartum women who met Research Diagnostic Criteria for either major or minor depression were compared to 24 non-depressed postpartum women. The Schedule for Affective Disorders and Schizophrenia (SADS) and the Beck Depression Inventory (BDI) were administered to all subjects. Results suggest that sleep disturbances and loss of sexual interest are common concomitants of normal postpartum adjustment. A discriminant function analysis indicated that the cognitive-affective symptoms of loss of energy, guilt, difficulties in concentration, and loss of interest in usual activities discriminated between depressed and non-depressed women most efficiently. Finally, there was a lack of concordance between the BDI and the SADS interviews, which suggests that the BDI may not be an appropriate instrument for diagnosing depression in a postpartum sample.

Adaptation, Psychological↗
PubMed2005

The neurobiology of postpartum depression.

Postpartum psychiatric changes can range from maternity blues to psychosis. Causality is still undetermined, but explanations for these disturbances often focus on hormonal changes and dysregulation. Researchers have begun the process of delineating what neurobiological factors may be associated with depressive disorders in pregnancy and the postpartum. This article reviews the current literature on the roles of gonadal and pituitary hormones in the psychopathophysiology of postpartum mood disorders. Other biological factors, such as biogenic amines, neuroactive steroids, cholesterol, and fatty acids, are also discussed. The potential benefits of neuroimaging to aid in understanding neuropsychiatric changes that occur in the context of postpartum depression are also considered.

Brain↗
PubMed2000

Caregiver support for postpartum depression.

BACKGROUND: Supportive relationships during the perinatal period may enhance a mother's feeling of wellbeing and control. Support to women during labour and after birth has shown benefits and this may also be the case for mothers with postpartum depression. OBJECTIVES: The objective of this review was to assess the effect of professional and/or social support interventions for the treatment of postpartum depression. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing additional support from caregivers with usual forms of care in the postpartum period, in women who were clinically depressed in the six months after giving birth. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted by both reviewers. Study authors were contacted for additional information. MAIN RESULTS: Two studies involving 137 women were included. There is potential for bias in at least one study, due to large numbers of women refusing to take part in the trial as well as significant losses to follow-up during the trial. Treatment of postpartum depression with support was associated with a reduction in depression at 25 weeks after giving birth (odds ratio 0.34, 95% confidence intervals 0.17 to 0.69). REVIEWER'S CONCLUSIONS: There is some indication that professional and/or social support may help in the treatment of postpartum depression. The types of support should be investigated to assess which models are most effective.

Caregivers↗
PubMed2004

Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health.

BACKGROUND: Much attention has been paid to the problem of postpartum depression in women. However, there is some indication that men also experience depression after the birth of a child, and that paternal depression is linked to maternal depression. AIMS: The purpose of this integrative review was to examine current knowledge about postpartum depression in fathers. Specific aims were (1) to examine the incidence of paternal depression in the first year after the birth of a child, (2) to identify the characteristics and predictors of paternal postpartum depression, (3) to describe the relationship between maternal and paternal postpartum depression, and (4) to discuss the influence of paternal depression on the family and infant. METHODS: A literature search from 1980 to 2002 was carried out using the CINAHL, PsychInfo, and Medline electronic databases. Twenty research studies were identified that included incidence rates of paternal depression during the first year postpartum. These were further examined and synthesized regarding onset, severity, duration, and predictors of paternal depressive symptoms, and for information about the relationship between maternal and paternal depression. FINDINGS: During the first postpartum year, the incidence of paternal depression ranged from 1.2% to 25.5% in community samples, and from 24% to 50% among men whose partners were experiencing postpartum depression. Maternal depression was identified as the strongest predictor of paternal depression during the postpartum period. The implications of parental depression for family health were discussed. CONCLUSIONS: Postpartum depression in men is a significant problem. The strong correlation of paternal postpartum depression with maternal postpartum depression has important implications for family health and well-being. Consideration of postpartum depression in fathers as well as mothers, and consideration of co-occurrence of depression in couples, is an important next step in research and practice involving childbearing families.

Depression, Postpartum↗
PubMed2006

Is paternal postpartum depression associated with maternal postpartum depression? Population-based study in Brazil.

OBJECTIVE: To describe the prevalence of paternal postpartum depression (PPD) as well as its association with maternal PPD. METHOD: A population-based random sample of 386 couples was assessed from the sixth to the 12th week postpartum for demographic characteristics, alcohol misuse (AUDIT) and depressive symptoms [Beck Depression Inventory (BDI)]. Logistic regression was employed to control for potential confounders. RESULTS: In the BDI, 26.3% of mothers and 11.9% of fathers scored above the selected threshold of 10. Mild maternal depression [odds ratio (OR) 3.31, 95% CI 1.52-7.20] and moderate to severe maternal depression (OR 8.44, 95% CI 3.53-20.21) were associated with paternal PPD. CONCLUSION: Paternal PPD is a clinically meaningful phenomenon. Fathers should be evaluated for mood disorders in the postpartum, especially when their partner is depressed.

Brazil↗
PubMed2006

Screening for postpartum depression in military women with the Postpartum Depression Screening Scale.

Each year, approximately 16,000 women on active duty in the U.S. military experience the birth of a child. A descriptive, longitudinal, prospective design was used to gather data with the Postpartum Depression Screening Scale. Depression was measured after delivery but before hospital discharge (time 1), 2 weeks after delivery (time 2), and 6 to 8 weeks after delivery (time 3). Mothers were found to be experiencing the greatest severity of symptoms in the category of sleeping and eating disturbances. Almost one-half of the mothers in this study scored either significant postpartum depressive symptoms or positive screening for postpartum depression after delivery. This number remained virtually unchanged at time 2. By time 3, 40% of women still reported depressive symptoms. At 2 weeks and 6 weeks after delivery, 13% and 11% of mothers, respectively, had positive screening for postpartum depression, consistent with the national average of 10 to 15%. Future research is needed to examine issues surrounding postpartum depression of military women.

Adolescent↗
PubMedDate not supplied

Postpartum depression beyond the early postpartum period.

OBJECTIVE: To review the literature concerning maternal postpartum depression beyond the early postpartum period. DATA SOURCES: A literature search was conducted using Cinahl, Medline, and PsychInfo electronic databases. Keywords included postpartum depression, postpartum depressive symptoms, course, prevalence, incidence, and remission. STUDY SELECTION: Studies selected included incidence of maternal depression or depressive symptoms, existing in the early postpartum period, and measured again at postpartum points from 6 months through 2 1/2 years after delivery. Only studies published in English were included. Twenty-three articles were located, and a recent relevant study conducted by the current author also was included. DATA EXTRACTION: Studies were reviewed and data organized according to year, sample characteristics, time of depression assessment, instrument used, cutoff score, rate of depression, and factors associated with depression at later postpartum time points. DATA SYNTHESIS: For a significant percentage of women, postpartum depressive symptoms continue for months or even years after giving birth. Factors associated with postpartum depression at later time points are identified. CONCLUSIONS: Continued evaluation of women with elevated depression levels at initial screening, and treatment for women whose depression does not remit spontaneously within the first few weeks or months postpartum is recommended. Further research is needed to understand the phenomenon of persistent postpartum depression.

Chronic Disease↗
PubMed2002

A controlled study of postpartum depression among Nepalese women: validation of the Edinburgh Postpartum Depression Scale in Kathmandu.

OBJECTIVES: To measure the prevalence of depression amongst postpartum and non-postpartum Nepalese women in Kathmandu using the Edinburgh Postpartum Depression Scale (EPDS) and to assess the ease of use and validity of the scale compared with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for major depression. METHODS: We screened 100 women 2-3 months post-delivery and 40 control women using the EPDS. All those who screened positive for depression and 20% of the negatives also underwent a structured interview to assess depression by DSM-IV criteria. RESULTS: Predictive errors were minimized by using an EPDS score > or =13 to define depression. Using this threshold, there was no difference in depression prevalence between postpartum women (12%) and the control group (12.5%) (Fisher's exact test, P > 0.05). Compared with DSM-IV, the sensitivity, specificity and positive predictive values were 100, 92.6 and 41.6%, respectively. CONCLUSIONS: The prevalence of postpartum depression (PPD) in Nepalese women and the validity and ease of use of the EPDS in the setting of a postnatal clinic in Kathmandu are all surprisingly similar to the results of numerous studies in developed countries. Despite poor living conditions, PPD is no more common than the background depression rate amongst Nepalese women. It can be reliably detected by trained clinical nurses using the EPDS screening test. These results may have implications for the planning of mental health resources for women in other developing countries.

Case-Control Studies↗
PubMed2006

Development of Postpartum Depression Screening Scale (PDSS): a Thai version for screening postpartum depression.

To validate a Postpartum Depression Screening Scale (PDSS) for screening postpartum depressive disorder in Songkhla Thai population, a screening test was conducted. A Thai version of the PDSS was developed using back translation and pre-tested on a prospective cohort of 400 postpartum women at 6-8 weeks from November 2003 to September 2004 in a university hospital, Southern Thailand. The diagnosis of postpartum depression was determined using DSM-IV diagnostic criteria for minor and major depressive disorders. The alpha reliability for the total PDSS was 0.9. The recommended cut-off scores of 51for screening major or minor depressive disorders and of 90 for screening major depressive disorder Area under the receiver operating characteristics (ROC) curve was 0.8 for major and minor depressive disorders and 0.9 for major depressive disorder In conclusion, this is a useful and beneficial instrument as there is no other Thai version validated instrument for postpartum depression.

Adolescent↗
PubMed2000

Efficacy of interpersonal psychotherapy for postpartum depression.

BACKGROUND: Postpartum depression causes women great suffering and has negative consequences for their social relationships and for the development of their infants. Research is needed to evaluate the efficacy of psychotherapy for postpartum depression. METHODS: A total of 120 postpartum women meeting DSM-IV criteria for major depression were recruited from the community and randomly assigned to 12 weeks of interpersonal psychotherapy (IPT) or to a waiting list condition (WLC) control group. Subjects completed interview and self-report assessments of depressive symptoms and social adjustment every 4 weeks. RESULTS: Ninety-nine of the 120 patients completed the protocol. Hamilton Rating Scale for Depression (HRSD) scores of women receiving IPT declined from 19.4 to 8.3, a significantly greater decrease than occurred in the WLC group (19.8 to 16.8). The Beck Depression Inventory (BDI) scores of women who received IPT declined from 23.6 to 10.6 over 12 weeks, a significantly greater decrease than occurred in the WLC group (23.0 to 19.2). A significantly greater proportion of women who received IPT recovered from their depressive episode based on HRSD scores of 6 or lower (37. 5%) and BDI scores of 9 or lower (43.8%) compared with women in the WLC group (13.7% and 13.7%, respectively). Women receiving IPT also had significant improvement on the Postpartum Adjustment Questionnaire and the Social Adjustment Scale-Self-Report relative to women in the WLC group. CONCLUSIONS: These findings suggest that IPT is an efficacious treatment for postpartum depression. Interpersonal psychotherapy reduced depressive symptoms and improved social adjustment, and represents an alternative to pharmacotherapy, particularly for women who are breastfeeding.

Depression, Postpartum↗