Case history
Case history
A 25-year-old woman presents to her general practitioner 6 weeks after the birth of her first baby. She has a history of two previous episodes of major depression in her late teens and early twenties but has been well for more than 2 years. She is finding it difficult to cope with the new baby and feels empty of all emotion. When asked, she says she has been feeling low in mood for the last 3 weeks and that it is getting worse. She has no appetite and even when the baby is sleeping, she wakes early in the morning and is unable to get back to sleep. She feels anxious and is often agitated. She lacks concentration, has reduced self-esteem, and is avoiding contact with her family and friends. On closer questioning she admits to difficulty bonding with the baby and is very concerned that she feels no strong emotion for him.
Other presentations
Postnatal depression most often occurs in the context of a unipolar depressive illness. Postnatal depression is very common in women with bipolar disorder.[14] In one sample of 10,000 US new mothers, more than 1 in 5 women who screened positive for postnatal depression had bipolar disorder.[6] The consequences of missing a diagnosis of bipolar disorder can be particularly serious, as treatment with antidepressants may precipitate mania, a mixed state, or rapid cycling, and thereby increase the risk for admission to a psychiatric hospital.[15] See Bipolar disorder in adults.
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