Peripartum mood disturbances medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunita Kumawat, M.B.B.S[2]

Overview[edit | edit source]

To manage peripartum mood disturbances efficiently, a multidisciplinary and comprehensive approach is used.

Medical Therapy[edit | edit source]

Reassurance, familial and social support, psychoeducation, and, in certain circumstances, psychotherapy and/or pharmacologic treatment are all used in the treatment of PPDs. Medical therapy for postpartum depression includes:
All Postpartum Depression ^[1]

• Investigate and manage social stressors, psychiatric and medical comorbidities
  
• Psychosocial support strategies.
  
• Self-care
  
• Sleep protection
  
• Exercise

Postpartum depression: moderate severity or not in remission from self-care and psychosocial strategies

• Psychological treatments, including CBT and IPT
  
• Add SSRI if insuffiecient response (for lactation safety)
  

Postpartum Depression: Severe

• SSRI alone or with psychological intervention (for lactation safety)
  
• Consider antidepressant switch and augmentation startegies if no response to SSRI alone.
  
• Consider ECT with severe suicidality, psychosis or treatment resistance.
  

Additional therapeutic options: bright light therapy, yoga, relaxation training, massage and acupunture.
Alternative treatment options are omega-3 PUFAs, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which have fewer side effects.

Postpartum psychosis is a medical emergency and requires prompt inpatient treatment. Once the organic causes of psychosis are ruled out the treatment is given according to the symptom profile.
Antipsychotics, mood stabilizers and benzodiazepines are used in acute therapy. Insomnia should be treated promptly. ECT is used when the condition is treatment resistant or a quicker response is required because of symptoms severity or safety concerns. Antimaniac and antipsychotic agents benefit a patient who has a known history of the illness or a family member has a history.^[2]
Before being discharged from the hospital, a strategy must be in place that includes close monitoring, appropriate sleep, and stress reduction.^[3]

• The majority of cases of Postpartum blues are self-limited and temporary. The mainstay of therapy is supportive care. As a result, it resolves on its own, requiring reassurance, education, validation, and psychological support.^[4]

References[edit | edit source]

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