Postpartum Affective/ Anxiety Disorders (Complications)

Postpartum Affective Disorders

• Postpartum Blues

• Postpartum Depression

• Postpartum Psychosis

Postpartum Blues

• “Baby blues”

• Very common

  • 50% - 75% of PP women

• Emotional lability

• Usually self-limiting

• Typically starts on postpartum day 3

  • Usually resolves by postpartum day 10

• Tx:

  • Will resolve itself (PP day 10)

• If persistent Sx for 2 weeks or more:

  • Contact physician

  • Postpartum depression

Postpartum Blues Sx

• Mild depressive Sx

  • Insomnia

  • Irritability

  • Tearfulness

  • Mood instability, anxiety

  • Fatigue

Postpartum Depression

• More severe than baby blues

• At least a 2 week period of depressed mood or loss of interest in almost all activities

• Signs:

  • Changes in appetite, weight, sleep, &/or psychomotor

  • Decreased energy

  • Feelings of worthlessness or guilt

  • Difficulty thinking, concentrating, or making decisions

  • Recurrent thoughts of death or plans or attempts of suicide

Postpartum Depression Screening Tools

• Edinburgh Postnatal Depression Scale

Postpartum Depression Tx

• Call provider!

• Antidepressants:

  • Zuranolone

• Psychotherapy

• Marital counseling

Postpartum Psychosis

• Impaired ability to recognize reality, communicate, & relate to others

• Occurs in 1-2 out 1000 births

• May occur anytime in the first year postpartum

• Onset can be abrupt & unexpected

• Escalates to thoughts of suicide &/or infanticide

• Emergency psychiatric condition

Postpartum Psychosis Sx

• Delusional beliefs

• Disorganized thinking

• Hallucinations

• Disorientation

• Rapidly shifting moods

Postpartum Psychosis Tx

• IMMEDIATE hospitalization

• Psychotropic meds

• Psychotherapy/ group therapy

Postpartum Affective Disorders Risk Factors

• Poor coping skills

• First pregnancy

• Low self-esteem

• Numerous life stressors

• Hx of abuse

• Previous psychological probelms

• Substance abuse

• Limited social support network

Postpartum Affective Disorders Observations

• Activity level

• Sleeping habits

• Fatigue

• Difficulty concentrating

• Anxious behaviors

• Poor personal hygiene

• More than expected weight loss

• Not responding to infant’s cues

Postpartum Anxiety Disorders

• Panic disorder

• Postpartum OCD

• Posttraumatic Stress disorder

PP Anxiety Disorders (Panic Disorder)

• Tachycardia

• Palpitations

• SOB

• Chest pain

• Fear of “going crazy”

PP Anxiety Disorders (Panic Disorder) Tx

• Antianxiety medications

• Antidepressant medications

• Counseling

PP Anxiety Disorders (Postpartum OCD)

• Consuming often intrusive thoughts & fears about baby’s safety

• Repetitive behaviors to neutralize those thoughts

• Can occur w/ anxiety & depression

PP Anxiety Disorders (Postpartum OCD) Tx

• Cognitive Behavioral Therapy

• Pharmacotherapy

PP Anxiety Disorders (PTSD)

• Perceives childbirth as a traumatic event

• Nightmares & flashbacks

What Can a Nurse do to Help?

• Become educated & educate family about life changes

• Encourage verbalization of feelings

• Reinforce need for good nutrition/ rest/ exercise

• Social work consult for referrals for support after discharge while in hospital

• Use Edinburgh Postnatal Depression Scale

• Provide educational emotional disorders