1. TOPIC: POSTNATAL DEPRESSION Presented by: Mrs. Sukhbir Kaur Associate Professor, B.Sc.

(N),
PGDHM, M.Sc.(N) Ph.D. Scholar Sri Guru Ram Das College of Nursing, Sri Guru Ram Das university of
Health Sciences. “ BEYOND THE BLUES”
2. 2. CONTENTS  Introduction  Epidemiology  Definition  Risk factors  Causes  Sign and
symptoms  Onset and duration  Diagnosis  Prevention and treatment
3. 3. TERMINOLOGY PERINATAL : means the period of time covering your pregnancy and up to
roughly a year after giving birth. It’s made up of two parts: • peri meaning ‘around’ and natal
meaning ‘birth’. POSTPARTUM : postnatal or postpartum meaning ‘after birth’ DEPRESSION: it is
major depressive disorder in which there is low mood and aversion activity that can affect a
person’s thought, behavior, feelings and sense of well – being.
4. 4. POSTNATAL BLUES or baby blues: Many women feel a bit down, tearful or anxious in the first
week after giving birth. This is often 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.
5. 5. Having a baby is a big life event, and it’s natural to experience a range of emotions and reactions
during and after your pregnancy. But if they start to have a big impact on how you live your life,
you might be experiencing a mental health problem.
6. 6. INTRODUCTION Depression is more common in women than men. The report on Global Burden
of Disease estimates the point prevalence of unipolar depressive episodes to be 1.9% for men and
3.2% for women, and the one- year prevalence has been estimated to be 5.8% for men and 9.5%
for women. The incidence among women is twice that of men and peaks between 18 to 44 years of
age - the childbearing years
7. 7. DEPRESSION IN WOMEN Women are at increased risk of mood disorders during periods of
hormonal fluctuation- premenstrual postpartum Perimenopausal .
8. 8. THE RANGE OF POST-DELIVERY MOOD DISORDERS  50% to 80% of women experience transient
“baby blues” within the first two weeks following delivery  0.1% to 0.2% of women experience
postpartum psychosis usually within the first 4 weeks following delivery
9. 9. Around one in five Women will experience a mental health problem during pregnancy or in the
year after giving birth. Postnatal depression is common mental health problem and is a type of
depression that many parents experience after having a baby
10. 10. It's a common problem, affecting more than 1 in every 10 women within a year of giving birth. It
can also affect fathers and partners, although this is less common.
11. 11. It's important to seek help as soon as possible if you think you might be depressed, as your
symptoms could last months or get worse and have a significant impact on you, your baby and
your family. With the right support, which can include self-help strategies and therapy, most
women make a full recovery.
12. 12. 700 B.C. • The earliest reports of women experiencing emotional difficulties after childbirth
were found 1700 • Women often did not report their symptoms for fear of being institutionalized
with the diagnosis of neuroticism and insanity . 1850 • Postpartum depression is defined as mental
disorder and was referred to as postpartum psychosis 1950 • Popular magazines and journals such
as vogue and ladies home journal begin publishing articles that raised awareness of postpartum
depression
13. 13. 1980 • The DSM- III was published and first step towards treating the symptoms of PPD were
made 2000 • There is an increase in the amount of reports of postpartum depression and
celebrities giving public testimonials of their battle with PPD. 2014 • The treatment of this disorder
calls women to adapt to the role of motherhood rather than adapting the role of motherhood to fit
the women
14. 14. EPIDEMIOLOGY OF PPD Postpartum depression is found across the globe, with rates varying
from 11% to 42%. According to the National Institutes of Mental Health, studies show that the
 childbearing years are when a woman is most likely to experience depression in her lifetime. 6.8%
to 16.5% of women experience postpartum depression (PPD) also known as postpartum major
depression (PMD)
15. 15. More than 10 million cases per year in India. It affects 20% of mothers in developing
countries according to WHO. African American mothers have been shown to have the highest risk
of PPD at 25%, while Asians had the lowest at 11.5%
16. 16. Among men, in particular new fathers, the incidence of postpartum depression has been
estimated to be between 1% and 25.5%. In the United States, postpartum depression is one of the
leading causes of the murder of the children less then one year of age which occurs in about 8 per
100,000 births
17. 17. DEFINITION Postpartum depression (PPD), also called postnatal depression or maternal
depression , is a type of clinical depression which can affect both sexes after childbirth. Symptoms
may include sadness, low energy, changes in sleeping and eating patterns, reduced desire for sex,
crying episodes, anxiety, and irritability.
18. 18. According the Mayo Clinic, Postpartum Depression may seem like Baby Blues at first; however,
the symptoms are more intense and longer lasting, eventually impacting a mother’s ability to care
for her baby. Maternal depression is the mood disorders with symptoms similar to the “blues” that
persist beyond 2 weeks. Symptoms can be mild to severe.
19. 19. Difference between Baby blues and PPD POST PARTUM BLUES Onset at 3rd or 4th day post-
delivery and can last from a few days to a few weeks. POST PARTUM DEPRESSION (PPD) Onset can
be anytime one year after delivery and last more than 2 weeks
20. 20.  While many women experience self- limited, mild symptoms postpartum, postpartum
depression should be suspected 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:
21. 21. Risk factors Prenatal depression or anxiety A personal or family history of depression
Moderate to severe premenstrual symptoms Maternity blues Birth-related psychological
trauma Birth-related physical trauma Previous stillbirth or miscarriage
22. 22. Formula-feeding rather than breast-feeding Cigarette smoking Low self-esteem Childcare
or life stress Poor marital relationship or single marital status[ Low socioeconomic status and
social support Infant temperament problems/colic Unplanned/unwanted pregnancy Elevated
prolactin levels Oxytocin depletion Violence against women
23. 23.  The cause of PPD is not well understood. Hormonal changes, genetics, and major life events
have been hypothesized as potential causes.  Evidence suggests that hormonal changes may play
a role.  Hormones which have been studied include estrogen, progesterone, thyroid hormone,
testosterone, corticotrophin releasing hormone, and cortisol. Causes
24. 24. After childbirth, a dramatic drop in estrogen and progesterone may contribute to postpartum
depression Decreased in thyroid hormone . -tired and depressed feelings - Changes in blood
pressure, - immune systems and metabolism can lead to fatigue and mood swings. Emotional
changes . - sleep deprivation - trouble handling even minor problems. - anxiety related to ability to
care for a newborn. - feel less attractive - feel they have lost control over their life.
25. 25. S  Lifestyle influences can also be a cause of Postpartum Depression. These include: • A
demanding baby • Older siblings • Difficulty breast-feeding • Exhaustion • Financial problems • A
lack of support from loved ones  Fathers, who are not undergoing profound hormonal changes,
can also have postpartum depression. The cause may be distinct in males.
26. 26. EMOTIONAL SYMPTOMS  Increased Crying  Irritability  Hopelessness  Loneliness  Sadness
 Uncontrollable mood swings  Feeling overwhelmed  Guilt  Fear of hurting self or baby  Ideas
of suicide SIGN AND SYMPTOMS
27. 27. BEHAVIORAL SYMPTOMS Lack of, or too much, interest in the baby Poor self-care Loss of
interest in otherwise normally stimulating activities Social withdrawal and isolation Poor
concentration, confusion
28. 28. MYTHS ABOUT POSTNATAL DEPRESSION Postnatal depression is often misunderstood and
there are many myths surrounding it. These include:  Postnatal depression is less severe than
other types of depression.  Postnatal depression is entirely caused by hormonal changes. 
Postnatal depression will soon pass.  Postnatal depression only affects women. Research has
actually found that up to 1 in 25 new fathers become depressed after having a baby.
29. 29. Diagnosis Postpartum depression in the DSM-5 is known as "depressive disorder with
peripartum onset". Peripartum onset is defined as starting anytime during pregnancy or within the
four weeks following delivery. The criteria required for the diagnosis of PPD are the same as those
required to make a diagnosis of non-childbirth related major depression or minor depression. In
ICD – 10 PPD is classified under F 53.0 as Mental and behavioral disorders associated with
puerperium, not elsewhere classified.
30. 30. Screening In the US, the American College of Obstetricians and Gynecologists 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 nurses with the baby's immunization
schedule.
31. 31. 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 questionnaire is used – primary care evaluation for mental disorders translated
into 11 indian languages
32. 32. Prevention A 2013 Cochrane review found evidence that psychosocial or psychological
intervention after childbirth helped reduce the risk of postnatal depression, including home visits,
telephone-based peer support, and interpersonal psychotherapy, as depressed mothers
commonly state that their feelings of depression were brought on by "lack of support" and "feeling
isolated."[
33. 33. Prevention A major part of prevention is being informed about the risk factors, and the
medical community can play a key role in identifying and treating postpartum depression.
Women should be screened by their physician to determine their risk for acquiring postpartum
depression. Also, proper exercise and nutrition appear to play a role in preventing postpartum,
and depressed mood in general.
34. 34. TREATMENT 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. Guided self-help b. Cognitive behavioral therapy c. Interpersonal
therapy 2. Antidepressants
35. 35.  A. guided help :  Guided self-help involves working through a book or an online course on
your own or with some help from a therapist.  The course materials focus on the issues you might
be facing, with practical advice on how to deal with them.  The courses typically last 9 to 12 weeks
36. 36.  Example, some women have unrealistic expectations about what being a mum is like and feel
they should never make mistakes. As part of CBT, you'll be encouraged to see that these thoughts
are unhelpful and discuss ways to think more positively.  CBT can be carried out either one-to-
one with a therapist or in a group. Treatment will often last three to four months. B. Cognitive
behavioral therapy (CBT)
37. 37. Interpersonal therapy Interpersonal therapy (IPT) involves talking to a therapist about the
problems you're experiencing. It aims to identify problems in your relationships with family,
friends or partners , marriage and how they might relate to your feelings of depression. Treatment
also usually lasts three to four months.
38. 38. 2. ANTI DEPRESSANTS usually need to be taken for at least a week before the benefit starts to
be felt, so it's important to keep taking them even if you don't notice an improvement straight
away. You'll usually need to take them for around six months after you start to feel better. If you
stop too early, your depression may return. Ex. SSRIs : fluoxetine, sertraline, venlafaxine, Newer
drugs : Bupropion, Escitalopram
39. 39. Alternative remedies St John's Wort is a herbal Cranial nerve stimulation Bright light therapy
Folic acid Omega 3 – fatty acids : flax seeds, fish, salmon Vitamins B- 2 : riboflavin SAMe – S-
adenosyl methionine Acupuncture Exercise
40. 40.  Adjunctive therapy as Hormone therapy : ERP therapy can be given along with
antidepressants.
41. 41. There are a number of things you can try yourself to improve your symptoms and help you
cope. These include:  talk to your partner, friends and family  don't try to be a "super mum" 
make time for yourself  rest when you can  exercise regularly  eat regular, healthy meals and
don't go for long periods without eating  don't drink alcohol or take drugs, as this can make you
feel worse  Keep a daily diary of your emotions and thoughts  Give yourself a credit for things
you accomplish  Give permission to yourself to feel overwhelmed  Join a support group
42. 42. The N.U.R.S.E. Approach
43. 43. 1. Active- listen and identify client’s perceptions of current situation. 2. Emphasize the need for
continued communication with the partner or a close friend who is available 3. Encourage
verbalization of fears and anxieties and expressions of feelings depression. 4. Discuss the realities
of parenting and the fact that it may be exhausting. 5. Point out infant cues and explain their
meaning. This helps her feel better about herself and her ability to care for the infant. 6. Include
the spouse in discussions about the woman’s condition. 7. Emphasize the importance of the
mother taking the medication as ordered. Antidepressants are often used for PPD and may be
continued for 6months or more. 8. Assist the mother and her partner in identifying people who are
available to provide support.
44. 44. RESEARCH STUDIES : 1. Shivalli S, Gururaj N (2015) conducted a study on Postnatal Depression
among Rural Women in South India, in order to elicit socio-demographic, obstetric and pregnancy
outcome predictors of Postnatal Depression (PND) in Karnataka state, India. Hospital based
analytical cross sectional study design was taken and was conducted in rural tertiary care hospital
of Mandya District, Karnataka state. PND prevalence based estimated sample of 102 women who
came for postnatal follow up from 4th to 10th week of lactation was taken. The Edinburgh
Postnatal Depression Scale (EPDS) was used to assess PPD.
45. 45. Conclusion  Risk of PND among rural 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
PND. PND screening should be an integral part of postnatal care. Capacity building of grass root
level workers and feasibility trials for screening PND by them are needed.
46. 46. 2. Dr Prabha Chandra of the Department of Psychiatry, Nimhans, Bangalore conducted a study
titled 'Delusions related to infants and their association with mother-infant interactions in
postpartum psychotic disorders’. This study, done on about 100 women, found that nearly 50% of
them ended up developing delusions in the postpartum period. These women were subsequently
admitted to Nimhans for treatment. The study also showed that 40% of the women with
postpartum depression had thoughts of killing their baby while nearly 36% exhibited such
behavior.
47. 47. 'With help, there is light at the end of the tunnel'
48. 48. References  Antenatal and postnatal mental health: clinical management and service
guidance. NICE CG192 (2014) National Institute for Health and Care Excellence: London.  Musters
C, McDonald E, Jones L (2008) Management of postnatal depression. British Medical Journal, 337,
399-403.  Dennis CL, Hodnett ED (2007) Psychosocial and psychological interventions for treating
postpartum depression. Cochrane Database of Systematic Reviews. Oct. Issue 4.  Raj E.B . 2014.
Debr’s Mental health psychiatric Nursing. EmmesMedical publishers. Banglore. 133- 154.