The video below is the section for Peripartum Major Depressive Episode from Part 7 of TSM’s lecture series on DSM-5 and the EPPP, followed by a transcript. This lecture series aims to equip those preparing for the EPPP with everything you need to know about the impact DSM-5 will be having on the EPPP. To watch all of Part 7, click HERE. To watch earlier lectures in this series, or register for our webinar series on DSM-5 and the EPPP, click HERE.
Transcript of DSM-5 EPPP Lecture Video: Peripartum Major Depressive Episode
Between 50 percent to 80 percent of new mothers will experience a mild form of “postpartum blues” or “baby blues” after giving birth. Symptoms of postpartum blues might include temporary mood swings, tearfulness, irritability, and more emerging three to four days after delivery and dissipating within two weeks. Major Depressive Disorder with Peripartum Onset is characterized by the onset of a full Major Depressive Episode during pregancy or within four weeks after giving birth. Fifty percent of Women with “Postpartum” major depressive episodes actually begin experiencing symptoms prior to delivery, thus the name “Peripartum.” Women with Peripartum Major Depressive Episodes often have severe anxiety and possibly panic attacks along with the depression.
Peripartum-onset depressive episodes may present “with psychotic symptoms,” or “without psychotic features.” Once a woman has had a postpartum episode with psychotic features, the risk of recurrence with each subsequent delivery is between 30% and 50%.
Approximately 10 percent to 15 percent of new mothers develop peripartum onset depression. Although most cases resolve themselves within eight weeks, it is possible for symptoms to persist for more than a year after childbirth.
Despite its prevalence in the media, only one or two cases per 1,000 deliveries display Major Depression with Peripartum Onset, with Psychotic Features, which is more likely to occur in women with a pre-existing Bipolar Disorder, women who have had previous episodes of postpartum psychosis, and first-time mothers.
A history of premenstrual mood symptoms, mood or anxiety symptoms during pregnancy, or Major Depressive Episodes at any time in life are also associated with increased risk. Social and interpersonal factors that increase a woman’s vulnerability include low perceived social support, low socioeconomic status, having an infant with a difficult temperament, and stressful life situations (Barlow, Durand & Stewart, 2006).
The preferred treatment modalities for Major Depressive Disorder, peripartum onset, are cognitive-behavioral therapy and interpersonal therapy. Antidepressants may also be employed, as certain SSRIs and tricyclic antidepressants are considered relatively safe for breast-feeding mothers and their infants.
Regarding effects of postpartum depression on children, research shows that children with mothers who experienced severe depression while pregnant have adjustment problems. Also, infants of mothers with postpartum depression tend to be more passively noncompliant, have lower levels of independence, are poorly attached, and may demonstrate delays in language, behavior, and mental development.
Major Depressive Episode with Peripartum Onset
1. Refers to episode of major depression with onset during pregnancy or within four weeks of delivery of baby
2. Prevalence: 10 percent to 15 percent of mothers
3. Distinguish from “postpartum blues” — transient mood swings, tearfulness, irritability, difficulty sleeping, usually emerging three to four days after giving birth and dissipating within two weeks — which may occur in two-thirds of mothers after giving birth
4. May have deleterious effects on infant’s development
Major Depressive Episode with Paripartum Onset, with Psychotic Features
1. Extremely rare, one to two per 1,000
Risk factors for Major Depressive Episode with Postpartum Onset
1. A previous similar episode, history of premenstrual mood symptoms, mood or anxiety symptoms during pregnancy, or Major Depressive Episodes at any time in life
2. Low perceived social support, low socioeconomic status, infant with difficult temperament, stressful life situations also implicated
1. Cognitive-behavioral therapy
2. Interpersonal therapy
3. Antidepressant medications
All of the following are predictors of Major Depressive Disorder, Peripartum-onset, except:
A. a history of Major Depressive Disorder unrelated to pregnancy or childbirth.
B. a history of Peripartum-onset depression with previous births.
C. low socioeconomic status and low social support.
D. experience of transient mood swings, tearfulness and irritability with previous births.
D is correct, as there is no association between childbirth after age 30 and paripartum onset depression. All of the other responses (history of Major Depression, history of Peripartum-onset, low SES/low social support) are, in fact, associated with Postpartum Onset of a Major Depressive Episode.