SEMINAR PRESENTATION

Topic: Postpartum Depression And Its Homoeopathic Management

Presenter : Roshin Shabiha. R CRRI

Guide: Prof. Dr. N. Prassana Devi M.D. (Hom) PhD (Hom),HOD of Obstetrics and
Gynecology, Vice Principal of RVS Homoeopathy Medical College and Hospital
POSTPARTUM
DEPRESSION
 TO THE MOM
STRUGGLING WITH
POSTPARTUM
DEPRESSION
- You Are Not Alone…
TERMINOLOGY
u Postpartum means the period of time covering your
pregnancy and up to roughly a year after giving birth.

u It’s made up of two parts:

u Post meaning ‘after’ and partum meaning ‘childbirth’.

u POSTPARTUM DEPRESSION : postnatal or
postpartum meaning ‘after birth’ DEPRESSION
u Depression is a mood disorder that causes a persistent
feeling of sadness and loss of interest. Also called major
depressive disorder or clinical depression, it affects how
you feel, think and behave and can lead to a variety of
emotional and physical problems.
DEFINITION
u Postpartum Depression is a mood disorder that commences after
giving birth. Many women experience some affective symptoms
during the postpartum period, 4 to 6 weeks following delivery.
u Most of these women report symptoms consistent with "baby
blues," a transient mood disturbance characterized by mood lability,
sadness, dysphoria, subjective confusion, and tearfulness.
u These feelings, which may last several days, have been ascribed to
rapid changes in women's hormonal levels, the stress of childbirth,
and the awareness of the increased responsibility that motherhood
brings.
u No professional treatment is required other than education and
support for the new mother. If the symptoms persist longer than 2
weeks, evaluation is indicated for postpartum depression.
INTRODUCTION
u Postpartum depression is a type of depression that happens after having a baby. It affects up to 15% of
people. People with postpartum depression experience emotional highs and lows, frequent crying,
fatigue, guilt, anxiety and may have trouble caring for their baby. Postpartum depression can be
treated with medication and counselling.
u Having a baby is a life-changing experience. Being a parent is exciting but can also be tiring and
overwhelming. It's normal to have feelings of worry or doubt, especially if you are a first-time parent.
However, if your feelings include extreme sadness or loneliness, severe mood swings and frequent
crying spells, you may have postpartum depression.
u Postpartum depression doesn't just affect the birthing person. It can affect surrogates and adoptive
parents, too. People experience hormonal, physical, emotional, financial and social changes after
having a baby. These changes can cause symptoms of postpartum depression.
u Depression is more common in women than men. The report on Global Burden of Disease estimates
the point prevalence of unipolar depressive episodes to be 1.9% for men and 3.2% for women, and the
one- year prevalence has been estimated to be 5.8% for men and 9.5% for women. The incidence
among women is twice that of men and peaks between 18 to 44 years of age - the childbearing years
DISEASE CLASSIFICATION
u In ICD – 10 PPD is classified under F 53.0 as Mental and behavioural disorders associated with
puerperium, not elsewhere classified.
u The DSM (diagnostic and statistical manual of mental disorders) does not consider Postpartum
Depression as a separate disorder, but rather a type of mood disorder categorized by a major
depressive episode.
u It can occur anytime within the first year after childbirth; however, it usually occurs within the
first couple weeks.
u Many suffer for up to 6 months and about ¼ of sufferers still experience symptoms after a year if
left untreated.
• ICD-10-CM Coding Rules
• F53.0 is applicable to maternity patients aged 12 - 55 years inclusive.
• F53.0 is applicable to female patients.
EPIDEMIOLOGY
u Postpartum Blues (A.K.A. Baby Blues) - 70 - 80% Within first week to 14 days Tearfulness, anxiety, insomnia,
and mood instability
u Postpartum Depression - 10% Within first month Depression, guilt, anxiety, fear of harm to baby, and
obsession.
u Postpartum Psychosis - 0.1 - 0.2% Within first month Disorientation, Confusion, Delusions, Hallucinations, and
Rapid mood cycling

1. More than 10 million cases per year in India. It affects 20% of mothers in developing countries according to
WHO. African American mothers have been shown to have the highest risk of PPD at 25%, while Asians had the
lowest at 11.5%
2. Among men, in particular new fathers, the incidence of postpartum depression has been estimated to be between
1% and 25.5%. In the United States, postpartum depression is one of the leading causes of the murder of the
children less then one year of age which occurs in about 8 per 100,000 births
u The incidence of post-partum depression was 11% in Tamil Nadu
 TYPES OF POSTPARTUM DEPRESSION

There are three different types of postpartum mood disorders

u Postpartum Blues or Baby Blues

u Postpartum Depression

u Postpartum Psychosis
POSTPARTUM BLUES OR BABY BLUES

u The baby blues affect between 50% and 75% of people after
delivery.
u If you're experiencing the baby blues, you will have
frequent, prolonged bouts of crying for no apparent reason,
sadness and anxiety.
u The condition usually begins in the first week (one to four
days) after delivery.
u Although the experience is unpleasant, the condition usually
subsides within two weeks without treatment.
u The best thing you can do is find support and ask for help
from friends, family or your partner.
POSTPARTUM DEPRESSION
u Postpartum depression is characterized by a depressed
mood, excessive anxiety, insomnia, and change in
weight.
u Postpartum depression is a far more serious condition
than the baby blues, affecting about 1 in 7 new parents.
u The onset is generally within 12 weeks after delivery.
u Symptoms range from mild to severe and may appear
within a week of delivery or gradually, even up to a year
later.
u No conclusive evidence indicates that "baby blues" will
lead to a subsequent episode of depression.
POSTPARTUM DEPRESSION CONT…
u If you've had postpartum depression before, your risk increases to 30% each pregnancy.
u You may experience alternating highs and lows, frequent crying, irritability and fatigue, as
well as feelings of guilt, anxiety and inability to care for your baby or yourself.
u Although symptoms can last several months, treatment with psychotherapy or
antidepressants is very effective.
u Treatment of postpartum depression is not well studied because of the risk of transmitting
antidepressants to new-borns during lactation.
u Several studies do indicate that an episode of postpartum depression increases the risk of
lifetime episodes of major depression.
POSTPARTUM PSYCHOSIS
u Postpartum psychosis (sometimes called puerperal psychosis) is an example
of psychotic disorder not otherwise specified that occurs in women who have
recently delivered a baby.
u Postpartum psychosis is an extremely severe form of postpartum depression
and requires emergency medical attention.
u This condition is relatively rare, affecting only 1 in 1,000 people after
delivery.
u The symptoms of postpartum psychosis can often begin within days of the
delivery, although the mean time to onset is within 2 to 3 weeks and almost
always within 8 weeks of delivery.
u Symptoms include severe agitation, confusion, feelings of hopelessness and
shame, insomnia, paranoia, delusions or hallucinations, hyperactivity, rapid
speech or mania.
POSTPARTUM PSYCHOSIS CONT…
u Postpartum psychosis requires immediate medical attention since there is an increased
risk of suicide and risk of harm to the baby. Treatment will usually include
hospitalization, psychotherapy and medication.
u The syndrome is often characterized by the mother's depression, delusions, and thoughts
of harming either herself or her infant.
u About 50 percent of the affected women have a family history of mood disorders.
u Characteristically, patients begin to complain of fatigue, insomnia, and restlessness, and
they may have episodes of tearfulness and emotional lability.
u Later, suspiciousness, confusion, incoherence, irrational statements, and obsessive
concerns about the baby's health and welfare may be present.
u Delusional material may involve the idea that the baby is dead or defective.
u Hallucinations with similar content may involve voices telling the patient to kill the baby
or herself.
u Complaints regarding the inability to move, stand, or walk are also common.
CAUSES
u Evidence suggests that hormonal changes may play a role. Hormones which have been studied
include oestrogen, progesterone, thyroid hormone, testosterone, corticotrophin releasing
hormone, and cortisol.
u After childbirth, a dramatic drop in oestrogen and progesterone may contribute to postpartum
depression
u The levels of oestrogen and progesterone increase tenfold during pregnancy but drop sharply
after delivery. By three days postpartum, levels of these hormones drop back to pre-pregnancy
level
u In addition to these chemical changes, the social and psychological changes associated with
having a baby increase your risk of postpartum depression. Examples of these changes include
physical changes to your body, lack of sleep, worries about parenting or changes to your
relationships.
u Hormonal changes, genetics, and major life events have been hypothesized as potential causes.
HORMONES DURING PREGNANCY
ROLE OF HORMONES
u Progesterone: helps to prepare the body for pregnancy by stimulating glandular development
and the development of new blood vessels. This provides a good environment for implantation
by a fertilized egg.
u At 6–8 weeks, there is transfer of functions of corpus luteum to the placenta (luteal-placental
shift)— which acts temporarily as a new endocrine organ or powerhouse of hormone
production.
u Prolactin: Prolactin as the hormone mostly responsible for milk production, though its effects
aren’t usually felt until after giving birth. Prolactin is also known to affect dopamine, which
gives us feelings of euphoria and happiness. As a result, prolactin can sometimes be an
underlying cause behind moodiness, low energy levels, and slowed metabolism after your
baby’s birth.
ROLE OF NEUROTRANSMITTERS (Serotonin, Dopamine, Norepinephrine)
u Postpartum depression (PPD) is often associated with a neurotransmitter imbalance. Many
new mothers with PPD have low Serotonin, Dopamine and Norepinephrine levels.
u The role of Serotonin - Regulating mood, low serotonin levels have been associated with
virtually every type of depression.
u Serotonin and its group of neurotransmitters called catecholamines are chiefly made by the
adrenal glands.
u Between high prolactin production, no progesterone, potentially lower dopamine and
energy, moods, and emotions can feel jumbled after having baby!
u They all work together to stabilize our moods. When the stress in our life increases, our
adrenal glands make more catecholamines, which in turn causes our brains have less
serotonin to maintain balance. As stressful events like pregnancy and childbirth occur, the
brain can struggle to make enough serotonin to meet the new levels of catecholamines.
u Another cause of PPD in new mothers results from low levels of norepinephrine. People
with low norepinephrine - Express a lack of energy and motivation.
SYMPTOMS
u Many people have baby blues after giving birth. Baby blues and postpartum depression have
similar symptoms. However, symptoms of baby blues last about 10 days and are less intense.
u With postpartum depression, the symptoms last weeks or months, and the symptoms are more
severe.
• Have crying spells.
• Feel overwhelmed.
• Lose your appetite.
• Have trouble sleeping or wanting to sleep all the time and sudden mood changes.
• Loss of energy and motivation.
• Difficulty thinking or focusing.
• Thoughts of suicide or wishing you were dead.
• Having a baby with special needs or a baby who cries a lot, increases the intensity of the
symptoms.
POSTPARTUM DEPRESSION IN BABIES
u Behavioural problems: sleep problems, aggression and
hyperactivity
u Cognitive delays: walk and talk later, problems in school
u Social problems: difficulty developing relationships, socially
withdrawn, aggressively act out
u Emotional problems: lower self-esteem, higher levels of anxiety.
u Psychological problems: high risk of developing depression.
u Trouble bonding don't establish a connection with mother.
POSTPARTUM DEPRESSION IN BABIES CONT…
u Child may have feeding and sleeping issues.
u Child may be at higher risk for obesity or developmental disorders.
u Neglect your child's care or not recognize when they are ill.
u Thoughts of harming yourself or your baby.
u Recurrent thoughts of death or suicide.
u Depressed mood for most of the day, nearly every day for the last
two weeks.
POSTPARTUM DEPRESSION IN
FATHERS
u In fathers it is is characterized by mood changes
during their wives' pregnancies or after the babies
are born.
u These fathers are affected by several factors: added
responsibility, diminished sexual outlet, decreased
attention from his wife, and the belief that the child
is a binding force in an unsatisfactory marriage.
u 10.4% overall from 1st trimester to 1 year after
delivery, 25.6% at 3-6 months
u Life style change
u Role with partner and child and sharing attention
u Stress at work
u Feeling physically separated
DIAGNOSIS
u Diagnosis Postpartum depression in the DSM-5 is known as "depressive disorder with peripartum
onset". Peripartum onset is defined as starting anytime during pregnancy or within the four weeks
following delivery
u The criteria required for the diagnosis of PPD are the same as those required to make a diagnosis of
non-childbirth related major depression or minor depression.
u Your healthcare provider will evaluate you at your postpartum visit. This visit may include
discussing your health history, how you’ve felt since delivery, a physical exam, pelvic exam and lab
tests.
u They may do a depression screening or ask you a series of questions to assess if you have postpartum
depression.
u Your healthcare provider may order a blood test because postpartum depression can cause symptoms
similar to many thyroid conditions.
EDINBURGH POSTNATAL DEPRESSION
SCALE
u The 10-question Edinburgh Postnatal Depression Scale (EPDS) is a valuable and efficient way of
identifying patients at risk for “perinatal” depression.
u The EPDS is easy to administer and has proven to be an effective screening tool.
u Mothers who score above 13 are likely to be suffering from a depressive illness of varying severity.
u A careful clinical assessment should be carried out to confirm the diagnosis.
u The scale indicates how the mother has felt during the previous week. In doubtful cases it may be useful to
repeat the tool after 2 weeks.
u The scale will not detect mothers with anxiety neuroses, phobias or personality disorders.
INSTRUCTIONS FOR USING EDINBURGH
POSTNATAL DEPRESSION SCALE
1. The mother is asked to check the response that comes closest to how she has been feeling in
the previous 7 days.
2. All the items must be completed.
3. Care should be taken to avoid the possibility of the mother discussing her answers with others.
(Answers should come from the mother or pregnant woman.)
4. The mother should complete the scale herself, unless she has limited English or has difficulty
with reading.
SCORING
u QUESTIONS 1, 2, & 4 (without an *)
u Are scored 0, 1, 2 or 3 with top box scored as 0 and the bottom box scored as 3.
u QUESTIONS 3, 5,10 (marked with an *)
u Are reverse scored, with the top box scored as a 3 and the bottom box scored as 0.

u Maximum score: 30
u Possible Depression: 10 or greater Always look at item 10 (suicidal thoughts)
RISK FACTORS
u Having a personal or family history of depression, postpartum depression or premenstrual dysphoric disorder
(PMDD).
u Limited social support.
u Pregnancy complications like health conditions, difficult delivery or premature birth.
u You're younger than 20 or a single parent.
u Formula-feeding rather than breast-feeding
u Cigarette smoking, Alcoholism
u Low self-esteem
u Life stress, poverty
u Poor marital relationship or single marital status
u Unplanned/unwanted pregnancy
u Violence against women
RISK FACTORS CONT…
u Birth of female baby
u Prenatal depression or anxiety
u Moderate to severe premenstrual symptoms
u Birth-related psychological trauma
u Birth-related physical trauma
u Previous stillbirth or miscarriage
u Women with a previous history of depression or anxiety
u Stressful event during pregnancy
u Premature or complicated birth
u Illnesses
u Diabetes (50% more likely)
u Thyroiditis (33% more likely)
LIFESTYLE INFLUENCES
u Lifestyle influences can also be a cause of Postpartum Depression.
These include:
u A demanding baby
u Older siblings
u Difficulty breast-feeding
u Exhaustion
u Financial problems
u A lack of support from loved ones
TREATMENT
u 1. Psychological treatments : Talking treatment Psychological therapies are usually
the first treatment recommended for women with postnatal depression.
The main types used are described below.
a. Guided self-help
b. Cognitive behavioural therapy
c. Interpersonal therapy
u 2. Antidepressants
PSYCHOTHERAPY

u Postpartum depression is often treated with psychotherapy (also

called talk therapy or mental health counselling).
u Psychotherapy help to talk through your concerns with a psychiatrist,
psychologist or other mental health professional.
u Through therapy, you can find better ways to cope with your
feelings, solve problems, set realistic goals and respond to situations
in a positive way.
u Sometimes family or relationship therapy also helps.
GUIDED SELF-HELP
u Guided self-help involves working through a book or an online
course on your own or with some help from a therapist.
u The course materials focus on the issues you might be facing, with
practical advice on how to deal with them.
u The courses typically last 9 to 12 weeks
COGNITIVE BEHAVIOURAL THERAPY
u Cognitive behavioural therapy (CBT) is a very
effective treatment for postpartum depression and
anxiety.
u Treatment is often short-term (12-16 sessions) and is
focused on identifying unhelpful thoughts, feelings,
and behaviours.
u You can learn to avoid “triggers” for depression or
anxiety and identify “automatic” negative thoughts.
u You will also learn different ways of thinking and
reacting to situations that trigger depression and/or
anxiety.
COGNITIVE BEHAVIOURAL THERAPY
CONTD…
u Therapists teach behavioural activation, which involves scheduling
activities, such as exercise, social activities, or even just “getting out of
the house,” that make you happy, as well as looking for ways to help you
get additional support to help with your baby or household duties.
u CBT might also involve sessions with your partner or spouse and finding
ways of improving communication so that you can ask for help when you
need it.
u Research has shown that women with perinatal depression are
significantly more likely to see a reduction in depressive symptoms if
they are in CBT.
INTERPERSONAL THERAPY
u Interpersonal therapy (IPT) is a short-term form of Psychotherapy,
usually 12 to 16 sessions, that is used to treat depression and other
conditions.
u IPT focuses on your interpersonal relationships and social
interactions—including how much support you have from others
and the impact these relationships have on your mental health.
u It addresses current problems and relationships rather than
childhood or developmental issues.
u Interpersonal therapy (IPT) involves talking to a therapist about
the problems you're experiencing. It aims to identify problems in
your relationships with family, friends or partners , marriage and
how they might relate to your feelings of depression.
u Treatment also usually lasts three to four months.
ANTI DEPRESSENTS
u Antidepressants usually need to be taken for at least a week before the benefit starts
to be felt, so it's important to keep taking them even if you don't notice an
improvement straight away.
u Some of the Antidepressants are fluoxetine, sertraline, venlafaxine,
u Newer drugs : Bupropion, Escitalopram
PREVENTION
u Postpartum depression isn't entirely preventable. It helps to know warning signs of the
condition and what factors increase your risk. Be realistic about your expectations for
yourself and your baby.
u Limit visitors when you first go home.
u Ask for help — let others know how they can help you.
u Sleep or rest when your baby sleeps.
u Exercise — take a walk and get out of the house for a break.
u Keep in touch with your family and friends — don't isolate yourself.
u Foster your relationship with your partner — make time for each other.
u Expect some good days and some bad days.’
u Nutrition appear to play a role in preventing postpartum, and depressed mood in general.
GENERAL MANAGEMENT
u Active- listen and identify client’s perceptions of current situation.
u Emphasize the need for continued communication with the partner or a close friend who is
available
u Encourage verbalization of fears and anxieties and expressions of feelings depression.
u Discuss the realities of parenting and the fact that it may be exhausting.
u Point out infant cues and explain their meaning. This helps her feel better about herself and
her ability to care for the infant.
u Include the spouse in discussions about the woman’s condition.
HOMOEOPATHIC
MANAGEMENT
SEPIA
q Women who thinks that she hates her baby and her husband. Suits weak, pot bellied,
mothers who have yellow complexion and suffer from severe sleeplessness, anxiety and is
easily offended.
q There is sudden prostration with weak, empty, hollow feeling. Desire to commit suicide.
Aversion to sympathy. Irritability with indifference.
NATRUM MURIATICUM
q Women who are thin, thirsty, under nourished, reserved and seeks solitude. She wants to
be left alone. There is great weakness and weariness.
q Cheerfulness alternates with sadness. Apprehensive and revengeful. Hates sympathy and
weeps alone. Irritability, no desire to speak. Worse in morning 10 – 11 A.M.
KALI CARBONICUM
q Effective for low spirit. Anxiety as if they will lose their mind. Associated weak memory,
forgetful, restlessness, sleeplessness.
q Extreme irritability with fear of ghosts and being alone.

ARSENICUM ALBUM
q Persons who are restless, anxious, unduly perfectionist and are overly critical of them. Very good
remedy when symptoms of fear are very prominent.
q Fear of death is marked. Night aggravation especially at 3 a.m. There is great flow of thoughts.
Deeply anxious about health.
ACTEA RACEMOSA
q Sadness and tearfulness predominate. The woman is very sad, weeps a lot and the sadness gets
worse from motion and cold. In some cases, the sadness is accompanied by the fear of going mad.
Such a woman sits alone and cries. Another marked feature accompanying sadness is
suspiciousness and the woman refuses to take any medicine. The woman also imagines things that
trigger sadness like seeing rats running across the room and where everything seems confused and
dark as if a black cloud has surrounded her.
ACONITUM NAPELLUS
q Patients who have a marked fear of death. The anxiety that gets worse in crowded places and while
crossing the streets. Another symptom to take note of is extreme restlessness that makes the person
do everything hastily. The best for depression and is very beneficial in all those cases where acute,
sudden and violent attacks of anxiety occur with a marked fear of death and open air makes the
patient feel better. There’s also an increased thirst for large quantities of cold water during the
anxiety attack.
COFFEA CRUDA
q Problem of sleeplessness in women going through Postpartum Depression. The patients go
sleepless due to the mind being occupied with too many ideas.
q Oversensitive patients who have sudden mood changes from laughing to weeping and who
experience sleeplessness that gets worse after 3 am can greatly benefit from this medicine.
AURUM METALLICUM
q Is indicated in patients who feel it’s useless to live, life is a burden and constantly think of
committing suicide.
q Such women easily get angry over the slightest contradiction and any fright brings a feeling of
depression.
ANTI DEPRESSENTS
u Arsenicum album – The extreme problem of distress, in particular for those that obsess about health and
look for perfection in everything. They are often depressed when they fail to reach lofty personal
standards.
u Aurum metallicum – For workaholic people with a tendency of worthlessness, distress, and aroused
feelings of self-destruction after a defeat in a job or their personal life.
u Calcarea carbonica – When people become confused with work, and take tension from the job profile this
medicine affects them a lot. At this time a person may develop tiredness, worry, self-pity, sadness and
confusion. It is helpful for individuals who suffer from insomnia and periods of laziness.
u Causticum– When a person mourns for the loss he comes across forgetfulness, constant crying for hours,
and mental boredom. These people at particular times feel sympathetic toward others, or they can have an
annoyed and pessimistic outlook towards everything around them.
u Ignatia amara – Good for sensitive people that tend to overwhelm by frustration or painful thoughts.
These people do not want to appear as helpless, irritable and moody individuals in the eyes of others. At
times they may laugh out loud or cry without any reason.
ANTI DEPRESSENTS
u Kali phosphoricum –Has feelings of depression. These feelings of tension or emotional incidence are
occurring continuously with agitation, fatigue, lack of attention, headaches, insomnia and anaemia.
u Natrum carbonicum – The people who are sensitive and patient by nature but at times try to avoid
conflict and usually becomes depressed after some incidence of failure. They also feel lonely, become
isolated, withdraw themselves from the outside world and listen to sad music.
u Pulsatilla nigricans –For depression when people weep and feel blue. At this time they need lots of
encouragement and recognition. In short, they are moody, jealous, and whiny. Other than Pulsatilla their
mood improves with a walk in the fresh air, or cry.
u Sepia –Person wants to be alone and may become angry when other people show their concern for their
sadness. They may feel better after crying, and they prefer not to sympathize.
u Natrum muraticum –Often covers his inner feelings such as anger, fear of misfortune, grief or romantic
attachment for something. These people are reserved, and they look for solitude around them which has
proved to be one of the best homoeopathic medicine for depression.
RUBRICS

u DEPRESSION, SADNESS, CHILDBIRTH, AFTER :

u 2 Agn , 2 Anac, 1 Arg-n, 2 Aur, 2 Aur-m, 1 Bell, 2 Cimic, 2 Con, 1 Ign, 2 Kali-br, 2 Lach, 2 Lil-t, 1 Manc, 1 Nat-
m, 1 Plat, 2 Psor, 2 Puls, 4 SEP, 3 Sulph, 1 Thuj, 2 Tub, 2 Verat, 2 Verat-v, 1 Zinc
u SADNESS:DELIVERY, PARTURITION:AFTER, PUERPERAL, POST-NATAL:
u 1 Agn, 3 Anac, 1 Arg-n, 1 Aur, 3 Aur-m, 1 Bamb-a, 1 Bell, 1 Carb-an, 3 Cimic, 3 Con, 1 Foll, 1 Ign, 1 Kali-br, 3
Lach, 3 Lil-t, 1 Manc, 1 Nat-m, 1 Plat, 3 Psor, 3 Puls, 1 Ros-b, 4 SEP, 4 SULPH, 1 Thuj, 3 Tub, 3 Verat, 3
Verat-v, 1 Zinc
u (The numbers- 1, 2 and 3- signify how strongly a remedy is indicated for the disease)
Having postpartum depression
does not make you a bad mother!!!
THANK YOU