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Primary care physicians can help prevent, manage postpartum depression
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Up to one in seven women experience postpartum depression, but with proper treatment, recovery is possible, according to the American Psychiatric Association.
Primary care physicians are crucial members of the caregiving team that can help manage and even thwart postpartum depression.
To aid in preventing the condition, PCPs should ask their patient if they have a personal or family history of depression, other mental illness or substance use disorders prior to birth, Leslie Hartley Gise, MD, clinical professor department of psychiatry at John A. Burns School of Medicine at the University of Hawaii, and past president of the North American Society for Psychological Obstetrics and Gynecology, told Healio Internal Medicine. Any woman can be affected by postpartum depression, but a past history of these disorders puts women at a greater risk for the condition, according to Gise.
She also suggested that physicians ask their patients if they have support at home or from their partner.
Physicians should be aware of warning signs of postpartum depression, such as stress during pregnancy, according to Gise.
Other warning signs may include anxiety, sadness, sleeping issues, changes in appetite, excessive mood swings or disinterest in the baby, family and friends, according to the American Psychiatric Association.
After childbirth, physicians should ask their patients if they feel low or blue most of the time for 2 weeks or more, according to Gise.
At risk patients require more follow-up, Gise said.
PCPs should educate their patients that these symptoms may be present in the first 2 weeks after childbirth and are the “baby blues,” according to Gise. However, if these symptoms persist longer, it may be an indication of postpartum depression.
“Treatment can include medication and/or psychotherapy,” Gise said.
Women who decide to breastfeed should be advised to not take lithium, according to Gise.
“Breastfeeding is controversial,” she said. “If the woman needs medication, she may want to move to bottle feeding or wean the baby, so she can take any medicine she needs without worrying that it will have an effect on her baby. All medicine gets into breast milk.”
Gise noted that if someone else can feed the baby a bottle at night, the new mom will be able to sleep better.
PCPs should also ask their patients if they have had any bad thoughts about harming themselves or the baby, she said
“One worries about harm to the baby, but that’s rare,” Gise said. “Educate the new mom that all new moms have bad thoughts when the baby is crying inconsolably in the middle of the night. If she is afraid that she might lose control and actually do something to harm the baby, she should let you know because there is help. Women are reluctant to admit bad thoughts, so it’s a little bit of a touchy conversation. Women often fear losing custody.” – by Alaina Tedesco
Disclosure: Gise reports no relevant financial disclosures.