Postpartum Mood Disorders (Clinical Practice)

by Laura J. Miller

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Author: Laura J. Miller

Publisher: American Psychiatric Association Publishing

Hardcover:
ISBN 10: 0880489294
ISBN 13: 978-0880489294

A surge of clinical and research interest in postpartum mood disturbances has recently lead to a greater understanding of their phenomenology, etiologies, relationships to one another and to psychiatric disorders. Summarizing these recent advances in theory, research, and treatment, Postpartum Mood Disorders hypothesizes that the traditional categories of postpartum mood disorders -- postpartum "blues," postpartum depression and postpartum psychosis -- are not necessarily on a continuum. Though interrelated in some cases, these categories represent distinct postpartum states, with different phenomenologies, etiologies, predictive factors, and treatments.

Focusing on the biological aspects of puerperal mood disturbance, the book's first section explores how the ubiquitous, mild postpartum mood changes known as "baby blues" can be caused by the effects of sudden hormonal withdrawal. It further reviews data about how postpartum depression relates to mood changes occurring at other parts of the reproductive cycle, such as menopause; examines the pattern of mood changes across the reproductive cycle in relation to hormonal changes; and describes cultural differences in understanding, conceptualizing and reacting to postpartum mood changes.

Reviewing the clinical features and differential diagnosis of postpartum psychosis, this timely monograph investigates data about whether psychoses of postpartum onset differs from other psychoses in terms of phenomenology, family history and prognosis, and addresses the acute and long-term impact of major postpartum psychiatric disorders on children -- a central question for families and clinicians.

The book's second section covers treatment strategies for postpartum disorders, examining psychotherapeutic modalities as well as pharmacologic and psychosocial interventions, including the role of self-help groups and volunteer networks, and their relationship to professional care systems.

Authored by pioneering clinicians, researchers, and self-help volunteers who have worked with new mothers and their families in dealing with postpartum mood disturbances, Postpartum Mood Disorders provides a much-needed, thorough coverage of a highly prevalent, but often misunderstood, subject.

From The New England Journal of Medicine

Depressive disorders occur in the United States at a rate that is twice as high in women as in men, a finding that is echoed by data from other countries. The postpartum period is thought to be a time of high risk for the onset of mood disorders. For this reason, the recognition and treatment of mood disorders during the postpartum period are issues of great public health importance. Responsibility for the care of women with postpartum mood disorders is not limited to psychiatrists and other mental health specialists but falls within the purview of family practitioners, obstetricians, and gynecologists, who are more likely to have contact with women after childbirth. A book that summarizes the phenomenology and treatment of postpartum mood disorders can be an asset to clinicians who care for these women.

Postpartum Mood Disorders reviews the various types of these disorders ("maternity blues," postpartum major depressive disorder, and postpartum psychosis). The book has two sections. The first section provides background information on epidemiology, comorbidity, and the biologic underpinnings of illnesses occurring during the puerperium. The initial chapter summarizes work on the "maternity blues," and Miller presents the hypothesis that this clinical entity, which is characterized primarily by mood lability, is caused by the rapid decline in the levels of hormones that have direct and indirect effects on the central nervous system. As such, it is not a period of depression, but rather a time when affect is "released," the manifestation of which can be either euphoria or dysphoria.

Other notable chapters in the first section of the book include a review of postpartum psychosis, a chapter on the biologic factors related to postpartum mood disorders, and an interesting review of the sociocultural aspects of postpartum depression, in which Wile and Arechiga discuss the way in which various cultures (Asian, Latin, and African) traditionally manage illnesses during the postpartum period. Many customs have conferred protective benefits on new mothers, but the breakdown of traditional practices among women who have a greater degree of acculturation to Western society can result in the loss of important stress-management tools.

The second section of the book presents information on pharmacologic treatments and other therapies, including psychotherapy and electroconvulsive therapy. Most chapter authors offer valuable practical advice for treating postpartum illnesses. The reader learns about the risks to breast-fed neonates of various medications, as well as the consequences to the neonate of not treating the mother. A nicely rendered chapter explains interpersonal psychotherapy, a form of psychotherapy designed to treat postpartum mood disorders. An advantage of this therapy is that it enables women to avoid using medication if they are breast-feeding. Although physicians who are not psychiatrists would not be expected to administer interpersonal psychotherapy after reading this chapter, the description of the intervention is so clear that referring physicians can become acquainted with the principles and techniques of this treatment approach.

Most of the authors cover their subject matter thoroughly, even though some chapters suffer from the inclusion of information that is outdated. Redundancy among the various chapters is kept to a minimum. Physicians and other health care workers should find this book immensely readable and helpful in their task of caring for women during the postpartum period.

Review

"Depression and manic-depression following childbirth were identified in ancient times, and continue to plague many new mothers and their families, often eluding diagnosis and leaving lasting scars on the mother's self-esteem and family relationships, to say nothing of her emotional and physical health. In "Postpartum Mood Disorders", Laura Miller brings together world-class experts in every aspect of the subject, from basic science (both biomedical and sociocultural), to treatment, to prevention. The book offers the student, the researcher, the clinician, and the teacher both breadth and depth in the consideration of this constellation of diseases, as well as the tools to provide state-of-the-art, empathic care."-- "Nada L. Stotland, M.D., Professor, Department of Psychiatry, Rush Medical College of Rush University, Chicago, Illinois"

"A delightful, authoritative compendium of the latest information on the etiology, phenomenology, and management of postpartum mood disorders. Women and their doctors will be grateful for this newest, evidence-based arrival on the postpartum mood disorder scene. The authors combine a strong advocacy of best practice with a refreshing willingness to admit where the answers are yet unknown. I highly recommend this book to women's health clinicians and advocates."-- "Donna E. Stewart, M.D., F.R.C.P.C., Lillian Love Chair in Women's Health, The Toronto Hospital, University of Toronto, Toronto, Ontario, Canada"

"This comprehensive text, detailing recent advances in research and treatment on postpartum mood disorders, fills a long-standing need for information on women's mental health issues in general, and postpartum mood states in particular. It is outstanding in its thorough and thoughtful treatment of the subject matter and makes a significant contribution to the study and treatment of this important group of disorders."-- "Doody's Health Sciences Book Review Journal"

From the Inside Flap

About the Author

Laura J. Miller, M.D., is Assistant Professor of the Department of Psychiatry at the University of Illinois, Chicago College of Medicine in Chicago, Illinois.

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