Postpartum period depression

Female gender Prior history of depression Family history of depression Active substance abuse Recent stressful life event Poor social supports Previous suicide attempt Postpartum period Chronic medical illness... 

Case Example A 28-year-old woman had been stable on lithium treatment for several years. When she became pregnant, her lithium was discontinued, and within a few weeks she was hospitalized for a severe exacerbation of mania unresponsive to CPZ in doses up to 1,200 mg/day. After a course of ECT she became euthymic and was adequately maintained on lower doses of CPZ (i.e., 50 to 100 mg/day) for the remainder of her pregnancy. The delivery and the immediate postpartum period went well, but lithium was not resumed because she opted to nurse her infant. Several weeks later, she was rehospitalized for an episode of depression, which also responded to a course of ECT. She then agreed to discontinue nursing her child and resume lithium. The patient was doing well at follow-up 1 year later. 

FIGURE 14-28. Several issues of importance in assessing women s vulnerability to the onset and recurrence of depression are illustrated here. These include first onset in puberty and young adulthood premenstrual syndrome (PMS) and menstrual magnification as harbingers of future episodes or incomplete recovery states from prior episodes of depression and two periods of especially high vulnerability for first episodes of depression or for recurrence if a woman has already experienced an episode, namely, the postpartum period and the perimenopausal period. 

Immedlafe posfpartum period is a high-risk time for depression, especially in women who have had prior depressive episodes, so drug may need fo be reinsfifufed lafe in fhe fhird frimesfer or shortly after childbirth to prevent a recurrence during the postpartum period... 

Bipolar disorder may recur during the postpartum period, particularly if there is a history of prior postpartum episodes of either depression or psychosis... 

Immediate postpartum period is a high-risk time for depression, especially in women who have had prior depressive episodes. 

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