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Very common—up to 85%
Mood lability, emotional hypersensitivity, no dysfunction
80% resolves by week 2, 20% evolves to become postpartum
Support, reassurance, clinical monitoring (particularly
for women with past histories of mood disorders or postpartum disorders).
If severe, disabling, or beyond 12 days, consider another diagnosis.
Approximately 12%–13% major depression;
minor depressive symptoms more common
Major depression with obsessive, anxious symptoms
Mother unable to sleep even when child care is provided for
Individual psychotherapy (cognitive-behavioral or interpersonal),
conjoint therapy to address interpersonal difficulties, group therapy
for peer support, psychosocial assistance (child care, home care
assistance), antidepressant, sometimes anxiolytic. For psychotic
or suicidal depression, hospitalize, consider antipsychotic, ECT.
Nursing mothers: educate regarding medications and breast-feeding;
assess maternal and infant well-being.
Up to 1/1,000
Early onset, usually by day 2–3; often presents
as mixed/rapid cycling with psychotic features
Mother unable to sleep
Caution: risk of infanticide
Hospitalize patient, educate and reassure family, emphasize
medications and supportive care. Medications: mood stabilizer, antipsychotic, benzodiazepine,
possibly antidepressants (caution in case of manic induction), consider
ECT if refractory. In most cases, postpartum psychotic mothers should
provides the ideal form of nutrition for babies.
fosters bonding between mother and infant.
invariably results in sleep deprivation.
many new mothers with psychiatric illness, the best way to ensure
their emotional stability is to avoid sleep deprivation. Consideration
should therefore be given to ways in which to maximize sleep (e.g.,
formula feeding, supplementation of breast-feeding with formula).
psychiatric medications are excreted into breast milk.
of exposure via breast milk is invariably less than through maternal–fetal
circulation (in pregnancy).
infants generally have immature P450 enzymes and therefore may be
at greater risk for side effects or toxicity when exposed to medications
via breast milk.
of neonatal medication exposure via breast milk on infant development
is not known.
appetite and weight in breast-feeding women on psychiatric medications
to ensure maternal well-being and to optimize nutritional quality
of breast milk.