As the nurse you are working with a postpartum woman who appears to be having some postpartum mental health issues what would you include in your assessment and what assessments or questions would you want to ask about the newborn? What would alert you that you should be concerned that the newborn may not be getting adequate care related to the mother’s condition?
Approximately one in ten women suffer from postnatal depression. As a nurse working with a postpartum woman with postnatal depression symptoms, it is very important to assess the mother’s mental health on time. As evidence shows that postnatal depression impacts the ability of the mother to make interaction with responsiveness and sensitivity as a caregiver. It may affect the self-regulatory skills of an infant, making him/her more prone to psychopathology in the future. So, where it is essential to diagnose postnatal depression in a mother, it is essential to look for the signs of negligence from a mother in a newborn (Wittkowski et al., 2015). As a nurse, I will be concerned for the mother’s health first. If she is taking care of herself properly only then she will be able to take care of her baby. So, my initial questions from her will be how is her sleep patterns? How fresh or exhausted does she feel? How many meals does she takes in a day, and does she has felt any major weight loss after delivery? And then I will question about her relationship with the newborn like how many times she holds her baby? How long does she hold her baby, and does she make any eye contact? Does her baby smile and respond to her? How many times does she feed her baby? Does it make her happy to spend time with the baby or she feel unhappy? And lastly, I will assess her mental health level one step further and will ask her does she have any suicidal or harmful thoughts for herself or her baby? If her response is below average for most of the questions then I will be concerned that the newborn is not getting adequate care from the mother.
If a patient were to be treated for postpartum depression with psychotropic medications would she still be able to breastfeed and is this a safe practice? Discuss at least three medications that could potentially be used as a treatment option in both the lactating and nonlactating patient. As you discuss the medications, I want you to state what classification they are in, how do they work at the cellular level and what are some of the adverse effects?
Anxiety, mood swings, and insomnia have always been associated with postpartum depression. During the lactation period, the aim of the medication is to achieve a consistent balance between maternal psychiatric health and the safety of the lactating baby. Benzodiazepine and Z drugs are often the choice of interest for` curing postpartum depression (Uguz F., 2019).
Many antidepressants are present in feeding mothers’ milk. The drug concentration in the milk parallels the body fluid concentration of the drug but due to the milk’s affinity for the lipid environment, the drug concentration of the milk results higher than the body plasma. This concentration change can be used as a clinical parameter. Another parameter of the clinical significance is relative neonatal drug level (Uguz F., 2019).
Citalopram is a widely recommended antidepressant for PPD; it comes under the class Selective Serotonin Reuptake Inhibitor (SSRI). Citalopram initiates the serotonergic activities in the CNS; also, the lactating mothers experience delayed onset of lactogenesis II. How the infant maintains the drug’s serum level is mainly determined by his/her genetic metabolic capacity. Behavioral side effects like fussiness and sleepiness are most evident as the side effect of citalopram if the mother takes the antidepressant during breastfeeding. Researchers have also evaluated that infants who have been exposed to the drug in utero during the last trimester experience poor neonatal adaption (Sharbaf Shoar N, 2020).
Diazepam belongs to the class benzodiazepine and is frequently used to avert the withdrawal symptoms caused by postpartum depression. The drug acts as a sedative and facilitates the action of GABA neurotransmitters. It is often the preferred antidepressant because of its slow secretion in breast milk. The milk to plasma ratio and the infant’s relative drug dosage is very low, being 0.2-0.58. no adverse reactions have been reported at this minimal level (Uguz F., 2019). The drug’s chronic high dosages can lead to weight loss, feeding difficulty, and sedation of the infant.
Paroxetine is one of the most commonly prescribed SSID (Seminar Infectious Diseases) for curing postpartum depression. It depresses serotonin production by re-up taking of serotonin via the serotonin receptor. The milk to plasma ratio is 0.39. Paroxetine is regarded as a safe SSID antidepressant as the dosage transferred to the neonate is 10% by weight of the dosage consumed by the mother, there are no adverse effects associated with this low concentration.(Uguz F., 2016).
Compare postpartum “blues” and postpartum depression. You will need to discuss the differences in symptoms, onset, pathophysiology, and treatment. You must be detailed in your discussion and use several sources to develop your response.
A postpartum psychological state is often divided into three classes depending upon the degree of severity. The first is the baby blues, the second is the postpartum depression, and the last is postpartum psychosis. Postpartum blues are generally less severe than psychic disorders; clinically, both can be differentiated based on timeline and symptoms.
Symptoms:
Baby blues:
The classical symptomatic signs of baby blues are anxiety, a sense of detachment, an urge for crying, and higher irritability. A few mothers also experience a lack of sleep and loss of appetite.
Postpartum depression:
The symptoms of baby blues and postpartum depression are identical at first, but with time, the postpartum depression symptoms grow intense. The signs and symptoms are depression and societal withdrawal insomnia. Intense irritability, fear of not becoming a good mother, fidgetiness, thoughts of harming the baby, and suicidal thoughts (Bass III, 2018).
Onset:
Baby blue manifests itself 1 to 3 days after the parturition time and lasts for just a week or two. Postpartum depression initially starts as baby blues, but the symptoms last longer, raging up to months depending upon the psychological condition and efficacy of the medication.
Treatment:
Baby blues are generally treated with counseling sessions; new mothers experiencing the baby blues are advised to take a good sleep, talk to their spouse about their feelings, engage themselves in recreational activities, and spend time with the newborn.
However, for postpartum depression, along with the therapeutic sessions, antidepressants and psychotherapy are also advised. As the hormonal shift is the baseline cause of postpartum depression, hormonal therapy like estrogen replacement can help to cope with the depression (Shea, A. K., 2017).
Pathophysiology of Baby blues and PPD:
Among all the new mothers, approx. 80% of women experience baby blues. The reason behind this is the immense physical, hormonal, and psychological changes associated with childbirth. Research has highlighted various factors as the contributors to PPD; these include genetic, epigenetic, biochemical circuit-level changes, and neuroinflammation (Furtado, M., 2019). Consistent bouts of stress and a family history of depression serve as a predisposition for Postpartum depression. Epigenetic changes at HP1BP3 (Heterochromatin protein 1, binding protein 3) in the later stages result in the development of postpartum depression. As the gene is concerned with estradiol regulation and thus is a key determinant of the mother’s health.
References
Wittkowski, A., Tsivos, Z., Calam, R., & Sanders, M. (2015). Interventions for postnatal depression assessing the mother– infant relationship and child developmental outcomes: a systematic review. International Journal Of Women’s Health, 429. https://doi.org/10.2147/ijwh.s75311
Uguz F. (2019) Benzodiazepines and Z-Drugs During Lactation. In: Uguz F., Orsolini L. (eds) Perinatal Psychopharmacology. Springer, Cham. https://doi.org/10.1007/978-3-319-92919-4_12
Sharbaf Shoar N, Fariba K, Padhy RK. Citalopram. [Updated 2020 Oct 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. NCBI: https://www.ncbi.nlm.nih.gov/books/NBK482222/
Uguz F., Arpaci N., .Breastfeeding Medicine.Nov 2016.487489.http://doi.org/10.1089/bfm.2016.0095
Furtado, M., Van Lieshout, R. J., Van Ameringen, M., Green, S. M., & Frey, B. N. (2019). Biological and psychosocial predictors of anxiety worsening in the postpartum period: a longitudinal study. Journal of Affective Disorders, 250, 218-225.
Bass III, P. F., & Bauer, N. S. (2018). Parental postpartum depression: More than” baby blues”. Contemporary Pediatrics, 35(9), 35-38.
Shea, A. K., & Wolfman, W. (2017). The role of hormone therapy in the management of severe postpartum depression in patients with Turner syndrome. Menopause, 24(11), 1309-1312.
