Postpartum depression: An overview

Bringing a child into the world causes a lot of upheaval and it is normal, after childbirth, to feel sometimes happy, sometimes sad and irritable. Soon after the birth of their child, the majority of women (about 80%) experience what is called the 3rd day syndrome, or “baby blues”. Postpartum depression is a much more serious disorder that occurs around the third week after delivery. Symptoms occur for weeks to months or more. Postpartum depression can occur in the fi rst 12 months after delivery, but in the majority of cases it occurs in the fi rst few weeks after birth. It is manifested by anxiety, insomnia and depressive symptoms. The treatment of postpartum depression is essentially psychotherapeutic although SSRIs are used. A new molecule, brexanolone, may change the prognosis. Mini Review Postpartum depression: An overview Michel Bourin* Neurobiology of anxiety and mood disorders, University of Nantes, 98, rue Joseph Blanchart, 44100 Nantes, France Received: 09 November, 2018 Accepted: 30 December, 2018 Published: 31 December, 2018 *Corresponding author: Michel Bourin, Neurobiology of anxiety and mood disorders, University of Nantes, 98, rue Joseph Blanchart, 44100 Nantes, France, E-mail:


Introduction
Postpartum depressions are common, affecting at least 10% of mothers [1,2]. They are serious because of their impact on mother-baby relationships and on the child s' development [3].
However, these depressions seem very insuffi ciently diagnosed and treated: some studies have found that about half of these depressions are not recognized by the general practitioner or other health professionals working with the mother and that, among diagnosed mothers, almost a third do not follow the proposed treatment . These fi ndings highlight the importance of identifying at-risk mothers and prevention of postpartum depression, and the need for effective and well-accepted screening and treatment for installed depression.

Clinical featuress
The onset is often insidious, after a normothymic phase or prolonged "baby-blues"; it can also prolong ante-natal depression.  Ideas of death may also appear, and more rarely are associated with suicide attempts [5]. It has some clinical peculiarities such as evening worsening, emotional lability, and Impulse phobias may appear: fear of hurting the child, throwing him, etc. [6]. This is a common symptom that does not indicate either the danger or the severity of the pathology, and the patient to whom it will be explained will be reassured.
The symptomatology of the depressive episode is sometimes associated with a delusional melancholic production whose theme is centered on the baby (idea of substitution, poisoning, bewitchment) or on fi liation (negation of the couple, of maternity, child of God ...). The anxieties of death are massive and concern the child, the mother herself. The risk of suicide and / or infanticide is major.
Simple means can be used to screen at-risk mothers in the period before or after delivery [7]. It was shown that the

Etiopathology of postpartum depression
Although the pathogenesis of postpartum depression is still unclear, the authors agree that there is no single cause.  [11]. It is suggested as well that immune mechanisms may play a role in the etiopathology of postpartum depressive mood shifts [12].

Treatment
Universal screening for postpartum depression is recommended so the Postpartum Depression Scale in Edinburgh is widely used [13].  [16]. In the case of a severe picture, risk of suicide and / or infanticide, hospitalization is indicated, at best in a mother-baby unit. It contains the symptoms of the mother, supports the maternal function and accompanies the establishment of the mother-baby bond. Nevertheless, in some cases, the mother will have to be separated from her baby: in case of serious maternal failure, in case of increased symptoms in the presence of the baby or in case of immediate danger for the latter. Contacts with the baby are reinstated as soon as possible and with the mediation of the caregivers. The work of psychotherapy is spread along two axes: individual psychotherapy for the mother and therapeutic consultations mother-baby [17].
A drug specifi cally designed to treat postpartum depression is about to receive approval from the United States Health Authority (FDA): brexanolone. Immediately after birth, hormone levels decrease, as well as that of a neurosteroid supposedly activated receptors. In women with postnatal depression, these receptors are not activated, or take longer.
The brexanolone is used to reactivate, unlike antidepressants that increase levels of serotonin, a hormone that plays on mood. Submitted to the FDA in April, after successfully completing the clinical trials, the brexanolone was awarded the status of "revolutionary treatment", to speed up the approval process, which should be completed by December 19th 2018. It only remains to see if it works with all women suffering from postpartum depression [18].

Conclusion
Postpartum depression is a very common clinical entity. It can be considered as a public health problem, not only because of its frequency but also because of its harmful consequences on the newborn, on the conjugal relationship, or even on the family balance. Especially, since it can announce the beginning of a chronic pathology of the mood in the mother. Hence the need for its prevention by action on risk factors, its screening, and its multidisciplinary therapeutic management.