Challenges in Identifying and Diagnosing Post-partum Disorders

In spite of greater awareness that childbirth can be accompanied by severe emotional disorders, problems with timely identification of perinatal mental illness persist. Controversy as to whether puerperal illnesses are discrete nosological entities or instead episodes of mood, anxiety, or psychotic disorders that occur coincidentally in the puerperium or are precipitated by it, has endured for over 30 years. Recent research suggests that significant adverse mood reactions may be induced by major, albeit normal, changes in estrogen and progesterone levels in women with a biologic vulnerability to depression. Despite the fact that the etiology of perinatal mental illness is unknown, early recognition of the risk factors and the signs and symptoms of a postpartum disorder is crucial. Women who are at risk for or who may be suffering from a postpartum mood disorder can and should be identified by being asked a few simple questions during routine pregnancy or postpartum primary care, gynecologic, or pediatric visits. Rapid identification and treatment can in many cases prevent a major episode.