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A new scale for the detection and assessment of maternity blues was completed by 56 women daily for ten days after elective gynaecological surgery. When their responses were compared with those of 87 post-natal women, they differed significantly in frequencies of different symptoms at different times. The findings suggest that post-natal mood changes (‘maternity blues’) are characteristic of the puerperium and not simply non-specific reactions to physical and emotional stress.

Platelet alpha 2-adrenoceptor binding characteristics were investigated in 28 healthy women during the peripartum period. The number of platelet alpha 2-adrenoceptors fell after childbirth, corresponding to a fall in the circulating levels of oestrogen and progesterone. Two-thirds of the women had an episode of maternity blues. At 7-10 days post partum the platelet alpha 2-adrenoceptor capacity in these subjects was significantly higher than in those women who did not show signs of maternity blues and significantly higher than a control group of normally menstruating women. We conclude that platelet alpha 2-adrenoceptors may be affected by the circulating levels of endogenous oestrogen and progesterone and that a delayed or diminished fall in platelet alpha 2-adrenoceptor capacity after childbirth may be associated with the development of maternity blues.

Mental symptoms, body weight changes and electrolyte patterns have been determined in two groups of post partum women in their first post partum week, and also in a group of non-pregnant controls. Mental symptoms overall were greater in women with previous neurotic depression, and among those with symptoms in pregnancy. Headache was frequent among those with previous migraine, and depression was more common among those with previous episodes of neurotic depression. A woman's feeling towards her baby may also decline significantly on her blues' day. Body weight rose or remained stable for the first 3 or 4 post partum days and the was rapidly lost. Twenty-four hour weight losses greater than 0.5 kg did not occur in the control subjects but were frequent among the patients, particularly between days 4 and 6 post partum. Mean sodium excretion did not differ between patients and controls whereas calcium excretion was lower among post partum women. Sodium excretion correlated with weight changes and showed a significant rise between days 2 and 6. Weight and electrolyte patterns showed no difference between blues and non-blues cases, but among women with a clear cut onset of mood disturbance, the start of rapid weight loss, and a rise in sodium excretion occured at around the time of the mood swing. Similar weight and electrolyte changes sometimes occur at the onset of psychoses and migraine, both of which may be exacerbated during the early puerperium. Further exploration into post partum weight changes may be useful in elucidating the cause of the maternity blues, as well as providing valuable clues to the mechanism that triggers off puerperal psychoses and puerperal migraine.

SummaryPlasma Cortisol, free and total tryptophan were determined in 71 subjects on 8 occasions between 36 weeks gestation and 6 weeks post-partum. Affect was measured by rating scales and clinical interview. Twenty-eight subjects were judged to have experienced post-partum ‘blues'. Seasonal variation occurred in the incidence of ‘blues' and in Cortisol and free tryptophan levels. Puerperally-depressed mood was correlated with high Cortisol at 38 weeks irrespective of season. Free tryptophan was reduced in ‘blues' subjects but only at the time of year when free tryptophan was normally high. Total tryptophan was low antenatally; a rapid rise on days 1 and 2 post-partum was superimposed on a slower return to normal. This initial peak was clearly absent in 37 per cent of subjects. Its absence was significantly related to occurrence of post-partum ‘blues' and of complaints of depression in the ensuing 6 months. This finding is discussed in relation to the possible occurrence of an occult disturbance of tryptophan handling in subjects susceptible to depression.

As part of a prospective investigation of postnatal psychiatric disorder, 66 women, randomly selected antenatally, completed visual analogue scales postpartum and rated their mood state daily for two weeks following childbirth. They were then interviewed using the Goldberg Standardised Psychiatric Interview on four occasions up to 14 months postpartum. Dysphoric mood was temporally related to childbirth. Emotional lability was the important affective component of the puerperium. A significant correlation was found between the blues and subsequent postnatal depression. Lability of mood in the puerperium was related to psychiatric symptoms up to 14 months postpartum and was the strongest predictor of later psychopathology. Maternity blues ratings were not accounted for by labour variables.

In order to establish whether the maternity blues is peculiar to the puerperium a selfrating blues questionnaire was administered to women after childbirth and after surgery. A period of dysphoria, similar in many respects to the maternity blues, was experienced by women post-operatively. The main difference between maternity and post-operative patterns of dysphoria seemed to lie in the timing of the blues, but on closer analysis many post-operative dysphoric symptoms peaked in a similar way to those in the maternity group. In the search for the cause of the maternity blues it may be helpful to study the same parameters in post-operative dysphoria.

SummaryA 20 per cent prevalence of mild clinical depression was found in 120 women assessed at about six weeks postpartum. The strongest associated factor was occurrence of recent stressful life events. Previous history of psychiatric disorder, younger age, early postpartum blues, and a group of variables reflecting poor marital relationship and absence of social support were also notable. Poor marital support acted as a vulnerability factor, only producing an effect in presence of stressful life events. Previous psychiatric history produced a strong independent effect, both with and without life events. Postpartum blues were only associated with depression in the absence of life events, suggesting a small hormonal sub-group. Overall the findings indicate the importance of social stress in puerperal depression.

The dramatic endocrinologic changes that occur after childbirth and the coincident affective disturbances that range from "maternity blues" to major depression have stimulated much theorizing and some study. The role of breast-feeding and weaning has received remarkably little attention both in the more biologically oriented studies and in epidemiologic work. This paper reviews endocrinologic data which support the thesis that postpartum psychiatric disorders have a hormonal basis and discusses the possible psychiatric effects of breast-feeding and weaning. The cases of four patients who developed major depressions in close temporal association with weaning are presented and discussed.

SummaryA representative sample of 105 women were assessed by Goldberg's Standardised Psychiatric Interview (SPI) on two occasions during pregnancy and twice more in the puerperium. Total SPI scores increased significantly after childbirth. Thirteen out of the sample had a severe postnatal depression and a further 17 women had milder depression, which in 15 lasted at least four weeks. Marked deterioration of their marital relationships was reported by the depressed women but no other social or obstetric characteristics of postnatal depression were found. Women with severe postnatal blues were particularly at risk of developing persistent depressive symptoms subsequently. The only two women referred to a psychiatrist had personality disorders rather than depressive illnesses.

SummaryA group of first-time mothers (119) were interviewed repeatedly at fixed intervals during their pregnancies and until their babies were a year old; they were then followed up at four years. A similar investigation was carried out on 38 other primiparae and 39 multiparae, but only postnatally.The incidence of depressive neurosis rose significantly in early pregnancy and in the first three months after delivery (10 per cent and 14 per cent of the main sample respectively). Subjects mainly suffered either from antenatal or postnatal depression, not both. Marital conflict and severe doubts about having the baby were associated with depression at either time. Bereavement and preterm birth were the only life events to relate with the onset of depression and bereavement had a greater impact during pregnancy.Depressed mothers were more likely to express negative or mixed feelings about their three-month-old babies. Many who had become depressed for the first time in their lives continued to experience psychological problems for up to four years after childbirth.

The studies reported had two purposes: (a) to identify psychological symptoms commonly experienced by mothers in the first few days after childbirth; (b) to use psychometric methods to develop a questionnaire for detecting and measuring these symptoms. A draft 49-item questionnaire was derived by asking 100 newly delivered mothers to volunteer suitable items. The number of items was systematically reduced to 28 while testing the questionnaire on two further samples of newly delivered mothers (n = 100 and n = 50). Cluster analysis of the 28 items yielded seven clusters, the robustness of which was established in a further sample of 87 newly delivered mothers. The validity of the 28-item questionnaire was established. The questionnaire was quick and easy to administer, suitable for repeated administration on consecutive days, and well accepted by mothers.

SummaryUnder double blind conditions 55 young, bottle feeding, multiparous women received L-tryptophan 3 g daily or placebo for ten days after delivery, and were also assessed daily for psychiatric symptoms. This treatment did not reduce ‘maternity blues', but the mothers' blues scores correlated significantly with the scores for anxiety, depression and hysteria on the Middlesex Hospital Questionnaire given in the eighth month of pregnancy.

Psychological symptoms were monitored for 5 days post partum, and specimens of saliva were taken for assays of cortisol, progesterone and oestradiol. Of 40 normal primiparous mothers, the 5 who experienced most severe 'maternity blues' were matched with 5 who were symptom-free. On the day of symptoms, concentrations of progesterone and oestradiol were significantly higher in the experimental group (P less than 0.02 and less than 0.05, respectively), but mean cortisol concentrations did not differ between the groups. This pilot study has demonstrated the potential value of using a non-invasive technique (obtaining specimens of saliva) in conjunction with determinations of a predictable mood change.

SummaryThis investigation is an attempt to test the common supposition that postpartum emotional disturbance is related to hormone changes. A group of 27 normal pregnant women were assessed three times before delivery and sixteen times in the six weeks following delivery. During the first two interviews baseline data on personality and other personal variables were obtained. On each occasion blood was taken and three measures of clinical status and mood were completed. Plasma LH, FSH, total oestrogen and progesterone results are presented in detail and the results of prolactin assays mentioned more briefly. An attempt to correlate hormone findings and clinical findings is described. This failed to produce any strong evidence that hormones are related to mood at this time, although hormone changes were correlated weakly with a few specific symptoms. Some of the unexpected clinical findings and technical difficulties of the study are discussed, with special reference to possible further research in this area.

SynopsisPlatelet α2-adrenoceptor binding was measured in 108 women in the 36th week of pregnancy, at ten and twenty days and at three and six months post-partum. An age matched non-pregnant control group of women (N = 25) was also studied. The number Bmax) of α2-adrenoceptors was elevated antepartum but fell to control values on the tenth post-partum day. At three and six months post-partum, however, α2-adrenoceptor Bmax was again increased. Women who developed maternity blues (N = 59) had significantly more platelet α2-adrenoceptors than those who did not (N = 49) at both ten and twenty days post-partum. In addition their α2-adrenoceptor Bmax was greater than controls at all time points measured except the tenth post-partum day. In contrast, the α2-adrenoceptor Bmax of women without the blues did not differ from controls at any stage. It is suggested that women who develop maternity blues may have a relatively enduring abnormality in α2-adrenoceptor sensitivity which is associated with psychological symptoms when concentrations of circulating sex-steroids suddenly change.

Body weight and mental symptoms were examined in 37 women with normal pregnancies, deliveries, and puerperia, for the first seven days post partum . Mental symptoms were more severe among women with a previous history of neurotic depression, mood changes during pregnancy, or who had a depression following a previous delivery. Weight loss commenced around days four and five, among patients with and without symptoms. Seventeen out of the 28 patients with mental symptoms had a clear cut peak day of mental change, and within this peak group there was a significant trend for the onset of the weight loss and the peak mood day to coincide. Weight loss did not determine whether symptoms were present or not, or their severity, but may have been a factor determining their timing.

It is well known that women are often depressed after child-birth, but only those ill enough to be admitted to hospital have received much study. A random sample of 305 maternity hospital patients was given a questionnaire designed to measure anxiety and depression associated with childbirth in the seventh month of pregnancy and again 6-8 weeks after delivery. Potential depressives, whose scores had increased, and potential controls, free from depression, with unchanged or diminished scores, were thus obtained, and the diagnosis was confirmed or excluded by clinical interview. Depressives were followed up by questionnaire one year later. Thirty-three (10-8 per cent.) subjects developed puerperal depression. In only one of these was the illness classical; in the rest it was atypical. Twelve depressives (3.9 per cent. of the total population studied) had not improved after one year. There were also 19 subjects (6.2 per cent.) with new or exacerbated psychological symptoms who were classified as doubtfully depressed. Depressives differed most from controls in their M.P.I. scores. Their neuroticism scores were highly significantly greater, and their extraversion scores significantly less. It is unsure whether these scores represented their previous personalities, or simply the fact that they were depressed. At probably significant levels, more depressives had a history of recent dysmenorrohea, more had been married for less than three years, fewer had obstetric complications in pregnancy, and more suffered "Maternity Blues" in the early puerperium. There were no significant differences in respect of previous psychiatric, physical or obstetric disorder, age, endocrine abnormality, complicated labour or obvious psychological or social factors. Atypical depression is, therefore, a common and important complication of the puerperium, about which more needs to be known.

THE TRANSIENT mild depression occurring post partum (the "postpartum blues") is so ubiquitous and ostensibly benign that it has not often been deemed worthy of serious study. Consequently, considerable uncertainty exists about the basic characteristics and significance of this syndrome. In females, the study of stress in the life cycle demands attention to endocrine-behavioral interaction, since some of the times of greatest life stress (ie, menarche, pregnancy, and menopause) occur simultaneously with marked fluctuations in the level of circulating steroid hormones. The mild depression of the puerperium has several intriguing aspects. Although it is associated with a critical phase in the life cycle, the dysphoria curiously occurs after delivery at a time when one would expect women to feel joyous. In fact, this period is occasionally the time of onset of a major emotional upheaval—the postpartum psychosis. Furthermore, the depression

Postnatal mood disorders (maternity blues, postnatal depression and puerperal psychosis) are cross-cultural symptoms that are commonly seen in primary care by general practitioners and midwives, by gynecologists and obstetricians, and within the psychiatric services. One of several hypotheses for their causation is falling progesterone levels in the postpartum period. Progesterone supplements are therefore currently used in the treatment of postnatal mood disorders, both in primary and secondary health care settings. The evidence for this is reviewed. The MEDLINE and PSYCHLIT databases from 1966 to 1999 were searched. References reporting observational data on progesterone levels around delivery or therapeutic studies using progesterone were retrieved. Additional references were identified by citation tracking from these and direct contact with available authors. Eight papers were identified. Although there is some weak evidence for its role in maternity blues and some theoretical justification for its use, there is no robust primary research to support the use of progesterone in the treatment of postnatal mood disorders. Progesterone is being used to prevent recurrence of postnatal depression but the evidence supporting its efficacy is lacking. Its use in the treatment of postnatal mood disorders cannot be recommended on the basis of current evidence. Randomized controlled trials are needed to decide if it has a role in the treatment and prevention of postnatal mood disorders.

2019

OzetKadınlar doğum sonrası dönemde psikiyatrik hastalıklara daha fazla maruz kalırlar. Birçok kadın, hamilelik ve doğum sırasında meydana gelen fizyolojik ve psikolojik değişikliklerle karşı karşıya kaldıklarında ciddi stres yaşamaktadırlar. Doğum kadınların hayatında önemli bir deneyimdir. Olumsuz doğum deneyimlerinin postpartum psikiyatrik belirtileri, cinsel işlevleri, gelecek doğum hakkındaki beklentileri ve anne-bebek arasındaki ilişkileri olumsuz şekilde etkilediği gösterilmiştir. Doğum sonrası annede yaşanan hüznün, doğum ağrısının neden olduğu strese karşı bir reaksiyon olabileceği ifade edilmiştir. Erken postpartum dönemde doğum ağrısının yoğunluğu ile duygu durum bozuklukları arasında güçlü bir ilişkinin bulunduğu belirtilmiştir. Doğum ağrısı duygu durum bozukluklarına kadar giden duygusal kontrolün kaybına neden olabilir. Eğer müzik terapi doğum ile ilişkili ağrıyı azaltabiliyorsa, doğum sonrası depresyonu da azaltabileceği varsayılmıştır. Bu derlemede doğum sonrası ağrı ve ruh sağlığı üzerine müzik terapinin olumlu etkilerinin neler olduğu değerlendirilmiş ve bu etkiler ile ilgili yapılmış olan çalışmalar tartışılmıştır. Literatürü gözden geçirdiğimizde müzik terapinin ameliyat sonrası ağrı üzerine analjezik olarak etki gösterdiğinin ifade edildiğini tespit ettik. Sonuç olarak doğum sonrası ağrı giderme açısından müzik terapi alternatif, güvenli, kolay bir yöntem olarak tavsiye edilebilir ve umut verici bir farmakolojik olmayan müdahaledir., Women are more exposed to psychiatric illnesses during the postpartum period. Many women suffer from severe stress when faced with physiological and psychological changes that occur during pregnancy and childbirth. Childbirth is an important experience in a woman's life. It was shown that negative birth experiences affect negatively postpartum psychiatric symptoms, sexual functioning, expectations about future births and the relationship between mother and infant. It was stated that maternity blues could be a reaction to stress caused by childbirth pain. It was indicated that a strong association was found between the intensity of labor pain and mood disorders in early postpartum period. Labor pain can cause loss of emotional control leading to the mood disorders. It is assumed that “If music therapy reduces the pain associated with childbirth, it can reduce postpartum depression, too”. In this review, the positive effects of music therapy in pain after vaginal delivery and postpartum mental health are evaluated. In addition, the studies related these effects are discussed. When we review the literature, we found that reported as music therapy effect on postoperative pain as an analgesic. As a result, music therapy can be recommended as an alternative, safe and simple method for postpartum pain relieving. It is a promising non-pharmacological interventions.

Postpartum depression (PPD) affects up to 19% of all mothers, with detrimental effects on both mother and child. The antidepressant and anxiolytic effects of plasma oxytocin are well-documented, but it is still disputable whether synthetic oxytocin (synOT) may protect women against postpartum mood alterations. The current study examined the association between synOT intrapartum and maternal mood postpartum using a prospective design. Two hundred sixty women were screened for depressive symptoms in the last trimester of pregnancy and then again 6 weeks and 9 months postpartum using the Edinburgh Postnatal Depression Scale. They also completed Maternity Blues Questionnaire in the first postpartum week. The data concerning the intrapartum interventions and health status of the newborn were extracted from the medical records. Cox proportional hazards regression adjusted for a history of depression, mode of delivery, and childbirth experience showed that synOT predicted a significantly lower risk of PPD (HR = 0.65, 95% CI 0.45–0.95, p = 0.025). The risk factors for PPD included a history of depression (HR = 3.20, 95% CI 2.33–4.40, p

Second level of analysis of the data provided by Morsbach & Ors (1983) suggests that their findings are more significant than they claimed.