June 2002 · Vol. 14, No. 6In postpartum depression, early treatment is key
The tragedy of Andrea Yates, the Texas mother convicted of drowning her 5 children, raises questions about the role of physicians in identifying and treating women at risk for severe postpartum depression. In most cases, Ob/Gyns are the first line of defense.
SHAILA
MISRI,
MD;
XANTHOULA
KOSTARASDr. Misri is a professor of psychiatry and OBG at the University of British Columbia and director of the Reproductive Mental Health Program at St. Paul’s Hospital and British Columbia Women’s Hospital, both in Vancouver, Canada. Ms. Kostaras is a research assistant in the Reproductive Mental Health Program at St. Paul’s Hospital in Vancouver.
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Key Points
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Between 12% and 16% of women experience a major depressive episode in the postpartum period. Of these, approximately 30% have thoughts of suicide or infanticide/homicide.
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Postpartum depression (PPD) often is associated with comorbid anxiety disorders.
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Women who have had repeated episodes of depression almost always relapse when they discontinue an antidepressant during pregnancy.
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Selective serotonin reuptake inhibitors (SSRIs) and tricyclics are used most commonly to treat PPD. When psychosis is present, antipsychotic drugs and/or electroconvulsive therapy also are options.
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In the postpartum period, between 12% and 16% of women experience a major depressive episode that can have severe and long-lasting consequences for both mother and infant.1,2 If left untreated, postpartum depression (PPD) can impair maternal-infant bonding and hinder the child’s cognitive and emotional development.
This article is based on our experience caring for women with PPD, and aims to help the Ob/Gyn detect and diagnose the disorder more quickly and make psychiatric or psychotherapeutic referrals when appropriate.
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