Puerperal Depression Lecture Note

‭Puerperal depression‬ ‭During pregnancy‬ ‭Depression during pregnancy occurs mainly in the first trimester and is generally‬ ‭general,‬ ‭moderate‬ ‭in‬ ‭intensity,‬ ‭non-psychotic‬ ‭and‬ ‭often‬ ‭anxious.‬ ‭They‬ ‭can‬ ‭remain‬ ‭unrecognized‬ ‭because‬ ‭the‬ ‭symptomatology‬ ‭is‬ ‭often‬ ‭only‬ ‭the‬ ‭exacerbation‬ ‭of‬ ‭the‬ ‭usual‬ ‭symptoms‬ ‭of‬ ‭pregnancy:‬ ‭permanent‬‭dysphoria‬‭with‬‭repeated‬‭crying‬‭attacks,‬‭somatic‬‭complaints‬‭and‬‭significant‬‭fatigue,‬‭feeling‬ ‭of‬‭discouragement‬‭and‬‭sometimes‬‭incapacity‬‭and‬‭depreciation,‬‭emotional‬‭dependence‬‭with‬‭demands‬ ‭for care and attention, anxious concerns about pregnancy, childbirth and the baby (her health, her‬ ‭fate), as well as sleep and appetite disorders.‬ ‭Melancholic‬ ‭depressions‬ ‭are‬ ‭rare‬ ‭and‬‭occur‬‭during‬‭the‬‭3rd‬‭trimester.‬‭They‬‭tend‬‭to‬‭continue‬‭into‬‭the‬ ‭postpartum period and are prone to anxiety and delusions.‬ ‭In the postpartum‬ ‭●‬ ‭Puerperal‬ ‭melancholyconstitutes‬ ‭a‬ ‭severe‬ ‭form‬ ‭with‬ ‭early‬ ‭onset‬ ‭(1st‬ ‭month).‬ ‭It‬ ‭is‬ ‭characterized‬‭by‬‭a‬‭feeling‬‭of‬‭incapacity‬‭and‬‭guilt‬‭towards‬‭the‬‭child‬‭which‬‭often‬‭reaches‬‭a‬‭delusional‬ ‭tone.‬ ‭The‬ ‭patient‬ ‭feels‬ ‭harmful‬ ‭to‬ ‭him‬ ‭or‬ ‭may‬‭claim‬‭to‬‭have‬‭killed‬‭him‬‭with‬‭accusatory‬‭voices‬‭and‬ ‭sometimes,‬ ‭funeral‬ ‭visions.‬ ‭The‬ ‭risk‬ ‭of‬ ‭suicide,‬ ‭double‬ ‭suicide‬ ‭or‬ ‭infanticide‬ ‭is‬ ‭extreme.‬ ‭The‬ ‭short-term‬‭outcome‬‭is‬‭generally‬‭favorable‬‭under‬‭treatment,‬‭but‬‭the‬‭long-term‬‭prognosis‬‭is‬‭marked‬‭by‬ ‭the frequency of recurrences and the bipolar course.‬ ‭●‬ ‭Postnatal‬ ‭depressionare‬ ‭moderate‬ ‭and‬ ‭frequent‬ ‭forms‬ ‭(10‬ ‭to‬ ‭20%‬ ‭of‬‭women),‬‭with‬‭2‬‭peaks:‬ ‭between‬ ‭the‬ ‭6th‬ ‭and‬ ‭12th‬‭weeks‬‭and‬‭during‬‭the‬‭second‬‭semester.‬‭The‬‭beginning‬‭is‬‭insidious‬‭from‬‭a‬ ‭“postpartum blues” which continues:‬ ‭lack of pleasure in caring for the baby, with the feeling of being overwhelmed and incapable‬ ‭physically to meet his needs. Care is therefore given without momentum‬ ‭often irritability towards the husband, other children and those around them. Sometimes the‬ ‭fear of harming the child, pushes the mother to distance the child or to‬ ‭relieve‬ ‭himself‬ ‭of‬ ‭his‬ ‭care.‬ ‭Psychomotor‬ ‭slowing‬ ‭aggravates‬ ‭the‬ ‭difficulty‬ ‭in‬ ‭mothering,‬ ‭with‬ ‭the‬ ‭slowness‬ ‭and‬ ‭asthenia‬ ‭that‬ ‭it‬ ‭causes.‬ ‭These‬ ‭depressions‬ ‭are‬ ‭difficult‬ ‭to‬ ‭diagnose,‬ ‭which‬ ‭can‬ ‭have‬ ‭consequences‬ ‭for‬ ‭the‬ ‭child's‬ ‭development.‬ ‭In‬ ‭half‬ ‭of‬ ‭the‬ ‭cases,‬ ‭the‬ ‭progression‬ ‭is‬ ‭towards‬ ‭spontaneous resolution.‬