Peripartum mood disturbances differential diagnosis

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


Physically and emotionally, the role and occupational adjustments that come with delivery are difficult. Postpartum mental health issues can vary from the usual postpartum blues to severe psychotic symptoms that indicate postpartum psychosis. These mood disruptions can have a major influence on the woman's quality of life as well as the baby's care and development if they are not appropriately diagnosed and managed. Postpartum depression described as "A daily nightmare filled with uncontrolled anxiety attacks, overwhelming guilt, and thoughts of being alone". It is critical to recognize and address the problem as soon as possible in order to minimize the harmful effects on both the mother and the child. Mood disturbances might have a small functional impact that responds well to social support (e.g., postpartum blues) or they can cause severe functional impairment that need more aggressive therapy (e.g., postpartum depression).

Differentiating Postpartum depression from other Diseases

[1] [2] [3] [4] [5]

Postpartum anxiety Postpartum blues Hyperthyroidism or Hypothyroidism Postpartum psychosis Perinatal Obsessive Compulsive symptoms
The onset is anywhere between child birth to one year. They usually occur within a few days after child birth and improve within a week or two. Differentiated by evaluating free T4 and TSH levels. This presents within days or weeks post delivery. Occurs in approximately 3 – 5 percent of childbearing women. Because of changes in the level of estrogen and progesterone affecting transmission of dopamine and serotonin.

Presents with feelings of dread, worry, lack of concentration, sleeping and eating problems, nausea, palpitations, dizziness. The new mother has low mood, frequent crying, change in appetite and sleep, feeling of inadequacy. Mood diorders along with other physiologic symptoms The mother experiences agitation, delusions, hallucinations, sleep deprivation for several nights and change in behaviour. Intense distress, and senseless and intrusive thoughts.

Obsession is having thoughts or mental pictures of hurting or murdering one's own child.

The compulsion is bathing the baby or changing the child's clothes.

The condition does not subside on its own. The patient has to seek medical advice.[6] Does not impact day to day functioning or the capacity to look after the baby. This is acute in onset and an emergency situation with the risks of suicide and harm to the baby. Mothers know these are bizarre and unrealistic. Medical and psychotherapy are used for the treatment.


  1. Susman JL (December 1996). "Postpartum depressive disorders". J Fam Pract. 43 (6 Suppl): S17–24. PMID 8969709.
  2. Jones I, Chandra PS, Dazzan P, Howard LM (November 2014). "Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period". Lancet. 384 (9956): 1789–99. doi:10.1016/S0140-6736(14)61278-2. PMID 25455249.
  3. Wesseloo R, Kamperman AM, Munk-Olsen T, Pop VJ, Kushner SA, Bergink V (February 2016). "Risk of Postpartum Relapse in Bipolar Disorder and Postpartum Psychosis: A Systematic Review and Meta-Analysis". Am J Psychiatry. 173 (2): 117–27. doi:10.1176/appi.ajp.2015.15010124. PMID 26514657.
  4. Abramowitz JS, Nelson CA, Rygwall R, Khandker M (2007). "The cognitive mediation of obsessive-compulsive symptoms: a longitudinal study". J Anxiety Disord. 21 (1): 91–104. doi:10.1016/j.janxdis.2006.05.003. PMID 16806800.
  5. Stagnaro-Green A (June 2004). "Postpartum thyroiditis". Best Pract Res Clin Endocrinol Metab. 18 (2): 303–16. doi:10.1016/j.beem.2004.03.008. PMID 15157842.

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