IMPACT of UNTREATED POSTPARTUM DEPRESSION

1. IMPACT of UNTREATED POSTPARTUM DEPRESSION Dr Violet Okech- Helu Department of Mental Health, KNH Email:violet.okech@gmail.com

2. Postpartum Depression: The Facts • Depression is one of the commonest, treatable yet undiagnosed mental health disorders with a HUGE impact on bio-psycho-social functioning. • Approximately 10% of mothers experience postpartum depression. • Numbers could be higher due to under-diagnosis. • Left untreated can severely affect the mother,baby,father, siblings and wider society.

4. Baby blues or Postpartum depression? • Many women experience the "baby blues" after childbirth. • Symptoms • Mood swings • Crying easily, • Poor concentration • Irritability • Sadness • Resolve within 1-2 weeks • Due to hormonal changes & physiological changes • Postpartum Depression • More severe symptoms Last longer than 2 weeks • Interfere with Mom’s ability to care for: • Baby • Herself • Family • Daily tasks • In postpartum psychosis hallucinations may pose harm to the baby or Mom

5. Postpartum depression(PPD) • Loss of appetite • Insomnia • Intense irritability and anger • Overwhelming fatigue • Loss of interest in sex • Lack of joy in life • Feelings of shame, guilt or inadequacy • Severe mood swings • Difficulty bonding with your baby • Withdrawal from family and friends • Thoughts of harming yourself or your baby • NB:PPD is not a sign of weakness nor mom’s fault. It’s a disease.

6. Postpartum psychosis • Symptoms • Confusion and disorientation • Hallucinations and delusions • Paranoia • Attempts to harm yourself or your baby • An EMERGENCY! Mom’s should seek help if.. • Symptoms last more than two weeks • Are getting worse • Difficulty in baby care • Difficulty in completing everyday tasks • Have thoughts of harming self or your baby

7. Risks for postpartum depression • Previous depression, either during pregnancy or at other times • Previous postpartum depression • Recent stressful events.. complicated pregnancy illness, job loss. • Bipolar mood disorder • Unplanned or unwanted pregnancy • Financial difficulties • Young, unwed mother • Problems with spouse or baby’s dad/family • Weak social support system • Please Screen for these risks actively…

8. Edinburgh Postnatal Depression Scale • The Edinburgh Postnatal Depression Scale (EDPS) was developed in 1987 to help doctors determine whether a mother may be suffering from postpartum depression. • The scale has since been validated and confirmed to be both reliable and sensitive in detecting depression. • During the postpartum period, 10 to 15% of women develop significant symptoms of depression or anxiety. • Unfortunately, many moms are never treated, and although they may be coping, their enjoyment of life and family dynamics may be seriously affected.

9. Edinburgh Postnatal Depression Scale • In the past 7 days: • 1. I have been able to laugh and see the funny side of things - • a. As much as I always couldb. Not quite so much nowc. Definitely not so much nowd. Not at all • 2. I have looked forward with enjoyment to things - • a. As much as I ever didb. Rather less than I used toc. Definitely less than I used tod. Hardly at all • 3. I have blamed myself unnecessarily when things went wrong - • a. Yes, most of the timeb. Yes, some of the timec. Not very oftend. No, never • 4. I have been anxious or worried for no good reason - • a. No, not at allb. Hardly everc. Yes, sometimesd. Yes, very often

10. Edinburgh Postnatal Depression Scale • 5. I have felt scared or panicky for no good reason - • a. Yes, quite a lotb. Yes, sometimes • c. No, not muchd. No, not at all • 6. Things have been getting on top of me - • a. Yes, most of the time I haven’t been able to cope at allb. Yes, sometimes I haven’t been coping as well as usualc. No, most of the time I have coped quite welld. No, I have been coping as well as ever • 7. I have been so unhappy that I have had difficulty sleeping - • a. Yes, most of the timeb. Yes, some of the timec. Not very oftend. No, not at all • 8. I have felt sad or miserable - • a. Yes, most of the timeb. Yes, some of the timec. Not very oftend. No, not at all • 9. I have been so unhappy that I have been crying - • a. Yes, most of the timeb. Yes, quite oftenc. Only occasionallyd. No, never • 10. The thought of harming myself has occurred to me - • a. Yes, quite oftenb. Sometimesc. Hardly everd. Never

11. Impact on baby • Difficulty in attachment and breastfeeding • Difficulty in regulating emotion • Reduced cognitive ability • Poor social skills and the ability to from successful relationships • Increased fussiness and irritability • Increased risk of mental illness in later life-elevated cortisol, reduced dopamine and serotonin

12. Impact on baby • Difficulty in matching facial expression to emotion • Reduced ability to show empathy-conduct disorder, later development of psychopathic behaviour?... • Increased impulsivity • Increased social withdrawal • Decreased access to healthcare options, immunization etc..

13. Impact on mother/father/family • Decreased use of postpartum care for Mum and child • Reduced chances or time for breastfeeding • Inconsistent parenting leading to reduced ability of children to listen to and obey instructions • Increased likelihood of marital conflict over sex and family roles • Maternal withdrawal or over-intrusiveness • Possible harm to baby in psychotic episodes

14. Managing Postpartum depression • Early detection • Medication • Psychotherapy-personal and couple • Destigmatization of PPD • Increasing social support • Mom “me” time/selfcare • Promoting adherence to treatment