How is post-birth depression diagnosed and treated?

The article was consulted professionally by Specialist Doctor II Pham Thi Tuyet Mai – Obstetrician and Gynecologist – Obstetrics and Gynecology Department – Share99 Hai Phong International Health Hub.

Post-birth depression is a fairly common pathology today. The disease not only directly affects the person, but also adversely affects the family and society.

It is not yet possible to determine the exact cause of post-birth depression. This pathology is a consequence of various effects such as psychological, physical and hormone disorders. Here are some suggested causes that can cause post-birth depression:

• Biologically : duringpregnancy, female hormone levels increase but come after the birth of this hormone decreases very quickly. The sudden change of hocmon entails many psychological and physical changes. In addition, apyroid hormone and thyroid hormone decrease also contribute to post-birth depression.
• Physically :women with a history of depression are 3-5 times more likely to suffer from post-birth depression than normal women. Post-birth women have to take care of their children, leading to fatigue, lack of sleep regularly also makes depression more likely to appear. In addition, women with a history of psychological illness, stress, anxiety or young women are also more susceptible to post-birth depression.
• Psychologically:post-birth maternity is under a lot of pressure such as the problem of caring for children, family, change of appearance, work transformation, or not receiving the attention of the family … All of those factors can affect the psychology of the maternity, causing the maternity stress, fatigue and susceptibness to post-birth depression.

For the diagnosis of post-birth depression,it is possible to rely on the standard of DSM-5 or ICD-10. Here are common standards for diagnosing depression

DSM-5 Diagnostic Standard

There are at least 5 symptoms that coexist for a minimum period of 2 weeks and have functional changes compared to the previous one in which at least 2 symptoms are depressive mood and loss of interest including:

1. Depressive temperament manifests it all day and lasts.
2. Reduce or lose interest in any activities that were previously inherent.
3. Reduce body weight by more than 5%/1 month.
4. Insomnia at the end of sleep (waking up at least 2 hours earlier than usual).
5. Inhibition of motor neuromusction provokes in a narrow range (agitation in the range around his bed).
6. Fatigue or a prolonged feeling of energy loss.
7. There is a feeling of useless or feelings of excessive self-sin or other inappropriate feelings.
8. Reduce thought energy, reduce attention focus, reduce the ability to make decisions.
9. Intending to kill himself.

• These symptoms cause clinical distress, affecting social, professional or other important areas.
• Symptoms are not caused by the biological effects of a substance or a certain disease.
• These symptoms do not meet the diagnostic standards of the mixed stage

Diagnostic standards according to ICD-10

There are at least 2 of the following 3 characteristic symptoms:

1. Depressive temperament.
2. Reduce or lose any interest and enjoy interest.
3. Decreased energy leads to fatigue and decreased activity.

There are at least 3 of the following 7 common symptoms:

1. Reduce attention concentration.
2. Reduces self-esteem and confidence.
3. There are guilty and unworthy ideas.
4. Look at the bleak and pessimistic future.
5. Have ideas and acts of suicide.
6. Sleep disorders.
7. Eating unsym appetite

*Symptoms must persist for at least 2 weeks

The doctor can rely on clinical symptoms and perform subclinical tests to diagnose post-birth depression. There are no specialized tests to diagnose post-birth depression but there are some tests that can support diagnosis, namely the following:

• Test for serotonin levels in the patient's plasma or in the cerebral fluid. Many studies show that serotonin levels in depressed patients are lower than in the average person, with cases only about 30% left compared to the average person. If treated with antidepressants, the patient's serotonin levels will gradually increase accompanied by an improvement in clinical symptoms.
• Electroencephalitismeasurement : Electroencephalencephaities of depressed patients often take the form of increasing beta wave index, decreasing alpha wave index and amplite.
• Cranial MRIscan : When taking MRI scans of the brain, depressed patients may detect small atrophy of some brain regions.

For effective treatment of post-birth depression, a combination of various measures is required such as: the use of antidepressants, psychological counseling from a specialist and support from the family.

3.1 Antidepressants

Antidepressants act on neurodintants, thereby helping to regulate the patient's mood. Some commonly used antidepressants include:

• 3-ring antidepressants: this group of drugs acts on both serotonin and norepinphrine levels. Common medications include: Amitriptylin, Clomipramin, Imipramin,… Side effects of this group of drugs are drowsiness, dry mouth, constipation, urinary ,…
• Selective serotonin reupposis inhibitors: include the following drugs Fluoxetin, Sertraline, Paroxetine,… These drugs are quite well tolerated and quite safe when breastfeeding because of the small amount of excreted drugs through breast milk.
• There are also other drugs used in the treatment of post-birth depression such as Selegiline, Mirtazapine, Benzodiazepine,…

Antidepressants can cause many side effects, directly affecting the mother and also the baby through breast milk. Therefore, do not use antidepressants indiscriminately, strictly follow the instructions of a specialist.

3.2 Non-medicinal treatment

Psychological counseling :this is the preferred therapy when the disease is in its mild stage. Psychiatrists, consultants will talk, support patients to overcome psychological obstacles in life.

Besides, the support and motivation from the family also plays an extremely important role. Relatives should pay more attention to the patient, pay attention to abnormal signs and ensure that the patient takes adequate medications. In addition, patients need to increase relaxation, rest, exercise, contact, talk to relatives and friends more.