POSTNATAL/POSTPARTUM DEPRESSION

The term postnatal (or postpartum ) depression describes a condition occurring in a woman after giving birth to her child. The symptoms are depression, anxiety, lack of interest in the baby, and feelings of inadequacy and incompetence as a mother. It occurs among 10 to 15 percent of mothers after delivery, with onset at five to eight weeks after delivery. It is underestimated by professionals and often denied by women, who usually do not seek medical advice. It commonly lasts six months to a year or longer. It causes a lack of attunement in the mother and infant dyad and can lead to early developmental and psychosomatic problems in the baby, making diagnosis and treatment essential (Murray, L., et al., 1991; Mazet, P., 1997). Jeni Holden et al. (1989) demonstrated the therapeutic efficacy of nondirective psychological interviews; A. F. Henderson et al. (1991) note the positive effects of estrogen therapy; R. Channi Kumar et al. (1984) and Donald Meltzer emphasize the need for professionals to coordinate their efforts in treating this pathology, which is still poorly understood and is situated at the intersection of obstetrics, pediatrics, and health services.

B. Pitt (1968) gave the first description of an "atypical postnatal depression" that affected a minority of women, but occurred at a rate of 10.8 percent in a sample of 305 women after delivery. The Edinburgh Postnatal Depression Scale (EPDS), a questionnaire for mothers developed and validated by John Cox et al. (1987), John Cox and Jeni Holden (1994), and Nicole Guedeney et al. in France (1995), makes it possible to diagnose postnatal depression from the sixth week after delivery (when the postnatal obstetrical visit is usually scheduled).

Postnatal depression can be classed among other postnatal psychiatric conditions, ranging from the blues to postpartum traumatic neuroses (Bydlowski and Raoul-Duval, 1978) and the acute postpartum psychoses that have been described since the nineteenth century (Marcé, L.-V., 1858). In a psychodynamic study, Paul-Claude Racamier et al. (1961) developed the concept of "maternality." The event of childbirth occasions reversible changes in the psyche whose transparency has been described by Monique Bydlowski (1997). This involves, on the one hand, a reactivation of the themes of the young woman's infantile neuroses, namely castration anxiety and the avatars of her pre-oedipal links to her own mother, and, on the other hand, a particular capacity for regression that enables her to achieve a psychic functioning that is more in tune with her newborn, as Donald Winnicott showed (1956). The conflicted development of this maternality is theorized as being the origin of some psychopathologies.

Postnatal depression differs from a depressive state in the strict sense, in that anxiety and the mother's feelings of inadequacy it produces often dominate the picture. It should also be distinguished from postpartum blues (Yalom, I., et al., 1968; Kennerley, H., et al., 1989), a reaction whose peak frequency occurs on the third day after delivery and which affects half of all women; it is characterized by irritability, mood swings, and crying spells, with spontaneous resolution in one to ten days. A particularly lasting or intense case of the blues may be an indicator of the subsequent likelihood of true postnatal depression (Fossey, L., et al., 1997).

Monique Bydlowski

See also: Depression; Maternal; Infant observation (therapeutic); Infantile psychosis.

Bibliography

Bydlowski, Monique. (1997). La dette de vie: itinéraire psychanalytique de la maternité. Paris: Presses Universitaires de France.

Bydlowski, Monique, and Raoul-Duval, Anne. Un avatar psychique méconnu de la puerpuéralité: la névrose traumatique post-obstétricale. Perspectives psychiatriques, 68, 321-328.

Cox, John, and Holden, Jeni (eds.). (1994). Perinatal psychiatry: Use and misuse of the Edinburgh Postnatal Depression Scale. London: Gaskell.

Cox, John L., Holden, Jeni M., and Sagovsky, R. (1987). Detection of postnatal depression. British Journal of Psychotherapy, 150, 782-786.

Fossey Luc, Papiernik, E., and Bydlowsky Monique. (1997). Postpartum blues: A clinical syndrome and predictor of postnatal depression. Journal of Psychosomatic Obstetric Gynecology, 18, 17-21.

Guedeney, Nicole, Fermanian, J., Guelfi, J.D., Delour, M. (1995). Premiers résultats de la traduction de l'Edinburgh post-natal depression scale sur une population parisienne. Devenir, 7 (2), 69-90.

Henderson, A F, Gregoire, A J, Kumar, RD, Studd, JW. (1991). Treatment of severe postnatal depression with oestradiol skin patches. Lancet, 338, 816-17.

Holden, Jeni, Sagovsky R, and Cox, John L. (1989). Counselling in a General Practice Setting: A controlled study of health visitor intervention in treatment of postnatal depression. British Medical Journal, 298, 223-226.

Kennerley, H, Gath, D. (1989, Sept.). Maternity blues I. Detection and measurement by questionnaire. British Journal of Psychotherapy, 155, 356-62

Kumar R. Channi, Robson KM. (1984). A prospective study of emotional disorders in childbearing women. British Journal of Psychotherapy, 144, 35-47.

Marcé, Louis-Victor. (1958). Traité de la folie des femmes enceintes, des nouvelles accouchées et des nourrices et considérations médico-légales qui se rattachentà ce sujet. Paris: Bailliére.

Mazet, Philippe. (1997). Quels sont les particularités cliniques des troubles dépressifs chez le nourrisson? In Les troubles dépressifs chez l'enfant: reconnaître, soigner, prévenir, devenir (pp. 25-32). Paris: Frison-Roche.

Murray, L., Cooper, PJ., and Stein, A. (1991). Postnatal depression and infant development. British Medical Journal, 302, 978-979.

Pitt, B. (1968). "Atypical" Depression Following Childbirth. British Journal of Psychotherapy. 114, 1325-1335.

Racamier, Paul-Claude. La mère et l'enfant dans les psychoses du post-partum. Evolution Psychiatrique 1961, 26, 4: 526-570.

Winnicott, Donald W. (1956). Primary maternal preoccupation. Collected papers, Through paediatrics to psychoanalysis (pp. 300-305). London: Tavistock, 1958.

Yalom, Irwin D, Lunde, T, Moos, RH and Hamburg, DA. (1968). "Postpartum Blues" syndrome. Arch Gen Psychiat, 18 : 16-27.