How Common is Postpartum Depression?

Postpartum depression refers to women who have obvious depressive symptoms or typical depressive episodes during the puerperium, and are part of the puerperal psychiatric syndrome with postpartum moodiness and postpartum psychosis. The incidence is between 15% and 30%. Typical postpartum depression occurs within 6 weeks after delivery, and can recover on its own in 3 to 6 months, but severe cases can also last for 1 to 2 years, and recurrence rates of 20% to 30% during pregnancy. Its clinical characteristics are not significantly different from other episodes of depression.

Basic Information

English name: postpartum depression
Visiting department: Psychiatry, Obstetrics and Gynecology

Multiple groups: Maternal within 6 weeks after giving birth
Common causes: Endocrine, genetic, obstetric factors, somatic diseases, etc.
Common symptoms: Gloomy expression, listlessness, drowsiness, easy to cry, cry

Causes of postpartum depression

Biological factor

(1) Endocrine factors During pregnancy and childbirth, the endocrine environment of the body has changed greatly, especially within 24 hours after the birth, the rapid changes in the hormone levels in the body are the biological basis for the occurrence of postpartum depression. The study found that the placental steroid release reached the highest value before delivery, and the patient showed emotional joy; the patient showed depression when the placental steroid secretion suddenly decreased after delivery.

(2) Genetic factors . Women with a family history of mental illness, especially those with a family history of depression, have a high incidence of postpartum depression.

(3) Obstetric factors The prenatal mentality is related to the incidence of postpartum depression. Postpartum, postpartum complications, dystocia, delayed labor, use of assisted reproduction technology, long first birth period, vaginal midwifery, surgery, etc. will be given to the mother. Brings tension and fear, leads to increased physical and psychological stress, and induces postpartum depression.

(4) Physical disease factors Postpartum depression has occurred in women with physical illness or disability, especially when infection and fever have a certain effect on the development of postpartum depression. In addition, the susceptibility to central nervous system function, the influence of emotional and motor information processing and regulation system (such as dopamine), may be related to the occurrence of postpartum depression.

2. Socio-psychological factors

Maternal personality traits, inadequate psychological preparation before childbirth, maladjustment after childbirth, poor postpartum mood, insufficient sleep, too tired to take care of the baby, young maternal age, relationship between husband and wife, lack of social support, family economic status, attitude of medical staff during childbirth, Infant gender and health status are closely related to the occurrence of postpartum depression.

Clinical manifestations of postpartum depression

Emotional change

The patient's most prominent symptom was a persistent depression, manifested by a gloomy expression, listlessness, drowsiness, easy tearing, and crying. Patients often use words such as "depressed", "desolate", "depressed", "emptiness", "loneliness", "seems to be separated from others by a wall" to describe their mood. Patients often feel depressed, depressed, and often lose their temper due to small things. For a long period of time, most of the time the mood is low, even if there are a few days or 1 to 2 weeks during which the mood improves, it quickly falls into depression. Nevertheless, the patient's depression is generally not severe, and emotional reactions still exist. A few humorous phrases can make him laugh. A light conversation can make him feel better temporarily. Patients can also perceive their emotional abnormalities, but often blame them on others or the environment.

2. Decreased self-evaluation

Excessive anxiety about baby's health; self-blame, worrying about not taking good care of the baby; self-violence, self-guilt; feeling hostile towards those around him, and uncoordinated relationships with family and husband.

3. Lack of confidence in life

Reluctant to feed babies; feel life is meaningless; reduced initiative and impaired creative thinking; severe cases have suicidal ideation or behaviors that harm babies.

4. Physical symptoms

Easily tired; difficulty falling asleep and waking up early; loss of appetite; loss of sexual desire or even complete loss.

Postpartum depression check

Screening scales currently used for postpartum depression assessment are:

1. Edinburgh Postpartum Depression Scale (EPDS)

It is the most widely used self-assessment scale for primary care screening. This table contains 10 items. A survey at 6 weeks postpartum can indicate the presence or absence of depressive disorder, but the severity of the condition cannot be assessed.

2.Zung Self-rating Depression Scale (SDS)

This table includes 20 questions, which divide the degree of depression into 4 levels. It has the advantage of not being affected by factors such as age and economic status. It is mainly used to measure the severity of depression and changes in treatment.

3. Baker Depression Questionnaire (BDI)

It is a questionnaire with 21 questions, which has better consistency and reproducibility in the diagnosis of postpartum depression, but the results of the questionnaire will be higher than other methods.

4. Hamilton Depression Scale (HAMD)

This table is simple, accurate, and easy to grasp. It is the most commonly used scale for clinically assessing depression. It lists 24 symptoms of depression and is graded on a 5-point scale. But sometimes it is not easy to distinguish from anxiety.

5. Symptom self-rating scale (SCL90)

It can distinguish whether there are psychological symptoms, and is suitable for detecting whether there is a psychological disorder, what kind of disorder and its severity, and is widely used for outpatient examinations of mental disorders and psychological diseases.

Diagnosis of postpartum depression

There is no unified judgment standard for the diagnosis of postpartum depression. Currently, two-step screening is generally used, that is, the screening scale is used to detect suspicious patients, and then the diagnostic criteria used in the research are used for diagnosis. The most widely used is developed by the American Psychiatric Association in the "Diagnostic and Statistical Manual of Mental Illness" (1994): 5 or more of the following symptoms (including 1 and 2) within 4 weeks after delivery (Must have), and for more than 2 weeks, the patient feels pain or the social function of the patient has been seriously affected. Symptoms include:

1. Depression.

2. A clear lack of interest or pleasure in all or most activities.

3. Significant weight loss or gain.

4. Insomnia or excessive sleep.

5. Psychomotor excitement or block.

6. Fatigue or fatigue.

7. Feeling meaningless or guilty when you are in trouble.

8. Loss of thinking or distraction.

9. Repeated thoughts of death or suicide.

Postpartum depression treatment

Psychotherapy

(1) Supportive psychotherapy Supportive psychotherapy is also called supportive therapy. Refers to the reasonable use of persuasion, encouragement, sympathy, comfort, support, understanding and assurance in the psychological state of patients during the implementation of medical care, which can effectively eliminate the patient's bad mood and put them in the best treatment Psychological state, so as to ensure the smooth progress of treatment and make the disease recover soon.

(2) Interpersonal psychotherapy This depression psychotherapy method is mainly used to treat the onset of the acute stage of depression in adults. It aims to relieve the symptoms of depression and improve some social problems of depressed patients. Common interpersonal problems in depression patients include four aspects: abnormal sad reactions, interpersonal conflicts, difficulty in changing roles, and lack of interpersonal communication.

(3) Music therapy The most popular method of psychological treatment for depression is music therapy. The limbic system of the brain and the reticular structure of the brainstem play a major role in regulating internal organs and body functions, and music can directly or indirectly affect these neural structures.

(4) Focus shifting If you do face serious unpleasant life events, or even difficult problems to solve, do not let your energy always focus on adverse events. The more you think about unpleasant things, the worse your mood will be. The worse you are, the easier it will be to dig into the horns of your horns, and your mood will be lowered and you will fall into the vicious circle of emotions. Therefore, it is necessary to appropriately divert your attention, which is a method of diverting your attention to some pleasant things and paying attention to your preferences. You can not only shift your mind, but also participate in the happy activities within your ability.

(5) Behavior adjustment method In view of the fact that women are not suitable for strenuous exercise after childbirth, some appropriate relaxation activities are very necessary, such as deep breathing, walking, meditation, meditation and calm pictures, listening to soothing and beautiful music, etc.

(6) Spill vent method Find a friend or relative to communicate, tell your heart song, cry a little, and let go of your depression.

(7) Don't forget the role alternation method . Although she is a mother, she is still the husband s cousin s wife and parents beloved daughter. No one can only be a 24-hour full-time mother, so you must change your role to enjoy the coquettish wife s beloved daughter. that power.

(8) Self-encouraging method Self- appreciation, see more of your own advantages, more of the benefits of things, think more about the side of things that may succeed.

(9) Self-actualization. Having children is only a way for women to achieve themselves, but it is by no means the only way, so do nt forget that there are other potentials and needs for self-actualization. Maybe while taking the maternity leave, you can also pay attention to what you are good at. When the maternity leave ends, a new look will appear.

2. Drug treatment

(1) Antidepressants include selective 5-HT reuptake inhibitors (SSRIs), tricyclic antidepressants, tetracyclic antidepressants, and monoamine oxidase antidepressants. Among them, SSRIs are the first-line treatment drugs for postpartum depression. Representative drugs are fluoxetine, paroxetine, sertraline, fluvoxamine, and citalopram. Special attention should be paid to the dose of the drug, starting from a low dose and gradually increasing to a sufficient amount and a course of foot treatment.

(2) Hormones Estrogen has a variety of neuroregulatory functions. Estrogen replacement therapy can increase 5-HT energy and can be used as an adjuvant treatment for postpartum depression. Hypothyroidism can be treated with thyroxine.

3. Physical therapy

(1) Cranial microcurrent stimulation therapy can stimulate the brain by microcurrent, which can directly regulate the brain to secrete a series of neurotransmitters and hormones that help improve depression. It can promote the secretion of norepinephrine by increasing the secretion of 5-HT. Release, enhance the excitability of nerve cell activity, and thus have the effect of alleviating individual depression.

(2) Treatment of electric shock Patients with depression should strictly prevent suicide and suicide. The application of electric shock to those who have a strong sense of suicide can obtain immediate results, and then use drugs and consolidation after the condition is stable.

(3) Other studies have shown that traditional Chinese medicine acupressure can improve the psychological state and quality of life of postpartum depression patients. Exercise therapy, light therapy, music therapy, diet therapy, etc. can also be used to help treat postpartum depression.

Postpartum depression prevention

1. Strengthen perinatal health

Use pregnant women's schools and other channels to popularize common knowledge about pregnancy and childbirth, reduce pregnant women's nervousness and fear of pregnancy and childbirth, and improve self-care.

2. Watch closely

Pregnant women with a family history of mental illness should be closely monitored regularly to avoid all adverse stimuli and give more care and guidance.

3. Full attention

The childbirth process and pain have a greater impact on postpartum depression, especially for women with long labor periods and high mental stress, which should be given full attention.

4. Psychological grooming

For women with high risk factors such as a history of bad births, stillbirths, malformed fetuses, and emotional abnormalities during pregnancy, they should be given more attention and psychological counseling should be conducted early.