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Birth is one of the most important life events for women. Postpartum period is a period in which a new order is established with the participation of a new member in the family. American Hospital, Department of Psychiatry Gülçin Arı Sarılgan tells about the ones who are curious about depression, the most common psychiatric illness after birth.
Women are at significant risk for psychiatric disorders (anxiety disorders, obsessive-compulsive disorder, depression and rarely psychosis) in the first year after birth. However, since depression is the predominant one in terms of these diseases, the first thing that comes to mind when we talk about postpartum psychiatric illness is postpartum depression. Although the frequency is reported to be 5-20%, the overall basal frequency is considered to be 10%.
The signs of postpartum depression may be difficult to distinguish from part Postpartum Blues or Puerperian Sadness görülen, which is common in the first postnatal days. Postpartum Blues occurs in a normal state of sadness or anxiety in 50-70% of mothers who have just given birth, easy and frequent crying and tight dependence on their closest relatives. This usually lasts for a maximum of ten days and the symptoms spontaneously disappear with the social support and care of relatives. Causes of Puerperal Sadness; sudden hormonal changes in women with childbirth, worries about the birth process and the baby, and the awareness of the responsibilities that the maternal role brings to the woman. Rarely, one in ten women who have given birth may develop a more severe depression. Postpartum depression usually starts later than the 2nd to 8th weeks and lasts for up to 1 year. In untreated women, it may resolve spontaneously between 3 months and 1 year. The mother's indifference towards the baby or hostile feelings are at the forefront. The mother may attempt to harm her baby. The saddest part of the disorder is the behavior of infanticide or filicide which can be seen in 4% of the patients. For this reason, the disease should be cared for and cared for by the person's environment. Suicidal thoughts or attempts can be seen in addition to severe depressive symptoms. A severe depression after birth may also be the first episode of Bipolar Disorder-Manic Depressive Disease that will affect the future life of a woman. Therefore, women with PPD should be monitored by a psychiatrist for a long time. It is known that postpartum depression is more common in women with some risk factors. These risk factors include unemployment of the woman or her partner, insufficient social support, marital problems, unexpected life events (death, separation), unplanned pregnancies, multiparity, previous depression, having high risk pregnancy, loss of pregnancy and childbirth experiences, early maternal-infant separation and care for the baby. Women with one or more risk factors should be screened for postnatal depression. The most commonly used method for screening is the Edinburgh Postpartum Depression Scale.
(Biological factors, both genetic and hormonal births of women who have given birth to reduce the threshold of anxiety, causes more difficult to deal with daily stressful situations.
Genetic factors are emphasized because first-degree relatives of women with postpartum depression have a higher rate of temperament disorder than normal population. When the hormonal causes are examined, some data suggest that the role of estrogen hormone plays a role, but the studies did not support it. Some investigators have shown that postpartum transient thyroid dysfunction is associated with PPD. Depressive temperament is thought to be related to thyroid disorder. )
When PPD is considered, breastfeeding can have positive and negative effects. Women who give breast milk can easily enter into a negative mood because they have little time to spare, sleep deprivation due to breastfeeding, and worry about harm to the baby when they need to use medication. In addition, rapid discontinuation of breast milk is thought to worsen depressive symptoms through some hormonal changes. In a study by Misri et al., 51 women who had PPD and whose breast milk was discontinued, 83% reported that depression began after the discontinuation of breastmilk, 17 patients were discontinued due to depression, and the severity of depression with breast milk It has been shown to affect significantly.
Although postpartum depression is common, it is often not possible to diagnose it. In addition, PPD can be omitted because the interest of the environment is more on the newborn baby.
The studies on PPD in our country are quite inadequate. The risk factors specific to Turkish society can be determined more clearly with the studies to be performed with multicentre and large number of pregnant women after birth. Health care workers should be more sensitive to this disease, which poses a serious threat to the mother and baby, and appropriate intervention should be performed in a timely manner. If the PPD is mild or moderate, the mother is advised to stop breastfeeding and antidepressant treatment is initiated. The patient is closely monitored and the patient's spouse is also interviewed and informed about his condition. Supportive therapy is applied. Psychiatric hospitalization may be considered in some cases where the condition is severe. If depression is severe, electroshock therapy may be considered. If PPD is not treated early and is not treated adequately, it may become difficult to treat for years.