Download Postpartum Depression Fall 2015

Postpartum Depression
Fall 2015
A nurse educator has provided an in-service session to nursing staff, and the topic of the
discussion is postpartum blues. Which statement by a nursing staff member would indicate
the need for further discussion?
 1.“Postpartum
blues are usually described
as transient and mild mood disturbances.”
 2.“Postpartum blues usually start at
approximately the third day postpartum
and usually last 2 to 3 days.”
 3.“Some women may experience
postpartum blues for several weeks.”
 4.“Postpartum blues are always due to a
psychological alteration in the woman.”
Postpartum Depression
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Postpartum Depression
Without Psychotic Features
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PPD is an intense and
pervasive sadness with severe
and labile mood swings
Is more serious and persistent
than postpartum blues
Intense fears, anger, anxiety,
and despondency that persist
past the baby’s first few weeks
are not a part of postpartum
blues
Symptoms rarely disappear
without outside help
Postpartum Depression
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Mother’s ruminations of guilt
and inadequacy feed her
worries about being and
incompetent and inadequate
parent
PPD, there may be odd food
carvings (often sweet desserts)
and binges with abnormal
appetite and weight gain
A distinguishing feature of
PPD is irritability
Postpartum Depression
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Women with postpartum major
depressive episodes often
have severe anxiety, panic
attacks, and spontaneous
crying long after the usual
duration of baby blues
Prominent feature of PPD is
rejection of the infant , often
caused by abnormal jealousy
Mother may be obsessed by
the notion that the offspring
may take her place in her
partner’s affection
Postpartum Depression
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Medical Management
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Natural course is one of
gradual improvement over
the 6 months after birth
Supportive treatment alone
is not efficacious for major
postpartum depression
Treatment options include
antidepressants, anxiolytic
agents, and
electroconvulsive therapy
Postpartum Depression

Postpartum Depression with
Psychotic Features

Postpartum psychosis is a
syndrome most often
characterized by
depression, delusions, and
thoughts by the mother of
harming either the infant or
herself

May occur more often in
primiparas

Mean time for the onset of
symptoms is 2 to 3 weeks
and almost always within 8
weeks after birth
Mental Health Disorders and
Substance Abuse

Delusions are
present, they are
often related to the
infant
 Mother may think the
infant is possessed by
the devil, has special
powers, or is destined
for a terrible fate
Postpartum Depression
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Specific illness included in depression
with psychotic features is bipolar
disorder (formerly called manic
depressive disorder)
Mood disorder os preceded or
accompanied by manic episodes,
characterized by elevated, expansive,
or irritable moods
Clinical manifestations of a manic
episode, include at least three of the
following symptoms that have been
significantly present for at least 1
week:

Grandiosity

Decreased need for sleep

Pressured speech

Flight of ideas

Distractibility

Psychomotor agitation
Postpartum Depression

Medical Management

Mood disorders are usually
espisodic, women may
experience another
episode of symptoms
within a year or two of the
birth

Postpartum psychosis is a
psychiatric emergency, and
the mother will probably
need psychiatric
hospitalization

Antipsychotics and mood
stabilizers such as lithium
are the treatments of
choice
Postpartum Depression
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Assessment and Nursing
Diagnosis
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Nurse should be an active
listener
Demonstrate a caring
attitude
Nurse should observe for
signs of depression and
ask appropriate questions
to determine moods,
appetite, sleep, energy and
fatigue levels, and ability to
concentrate
Postpartum Depression

Plan of Care and Interventions

On the Postpartum Unit
• Postpartum nurse must
observe the new mother
carefully for any signs of
tearfulness and conduct
further assessment as
necessary
• Nurses must discuss PPD
to prepare for potential
problems in the
postpartum period
• Family must be able to
recognize the symptoms
and know where to go for
help
Mental Health Disorders and
Substance Abuse

In the Home and
Community

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Postpartum home visits
can reduce the incidence of
or complications from
depression
Brief home visit or phone
call at least once a week
until the new mother
returns for her postpartum
visit may save the life of a
mother and her infant
Mental Health Disorders and
Substance Abuse
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Psychotropic Medications
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MAOIs, mood stabilizers, and
antipsychotic medications may
be prescribed for
nonbreastfeeding mothers
Hypertensive crisis is the main
reason that MAOIs are not
prescribed more frequently
Woman should be taught to
watch for signs of
hypertensive crisis-throbbing:
occipital headache, stiff neck,
chills, nausea, flushing,
retroorbital pain,
apprehension, pallor,
sweating, chest pain, and
palpitations
Postpartum Depression
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Postpartum Onset of Panic Disorder
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Panic attacks are discrete periods
in which there is sudden onset of
intense apprehension, fearfulness,
or terror
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During these attacks, symptoms
such as shortness of breath,
palpitations, chest pain, choking,
smothering sensations, and fear
of losing control are present

Treatment is usually a
combination of medications,
education, psychotherapy, and
cognitive behavioral interventions,
along with an attempt to identify
any medical or physiologic
contributors