The clinical symptoms of postpartum depression lead to the idea that this condition is one of the variants of a “major depressive disorder,” especially since it can last for several months or even years. Postpartum depression occurs in 15% of women in labor, especially in those women who in the past have suffered conditions resembling a depressive episode. Among women with postpartum depression, most live in unhappy marriages or have signs of adverse pregnancy.
In the genesis of postpartum depression, the reduction of estrogen and progesterone levels after childbirth plays a special role, therefore, those women who have received high doses of estradiol or progesterone in recent months are more susceptible to depression than those who have not undergone such treatment.
In rare cases, postpartum depression turns into postpartum psychosis, the symptoms of which are delusions and hallucinations.
The effectiveness of the treatment of depression is enhanced subject to its early detection, accurate assessment of severity and timely initiation of therapy.
Often, recognition of depression is a difficult task, since almost half of patients suffering from this disease do not seek help from a psychiatrist, and 80% are treated by general practitioners, presenting only somatic complaints. According to T. Ustun, N. Sartorius (1995), more than half of the patients seeking medical care did not recognize the depression or were considered to be insignificant medically in comparison with any somatic disease. General practitioners cannot diagnose and, accordingly, treat from 50 to 70% of patients with anxiety and depressive disorders, since the correct diagnosis in these cases is established only in 0.5-4.5% of patients.
Many outpatient patients suffer from depression that is not recognized or treated. As a rule, they have lighter depressive episodes that do not significantly limit their activity.
The literature emphasizes the lack of awareness of doctors of various specialties working in the primary health care network regarding the diagnosis and treatment of depressive disorders. Depression in general practice is not pronounced and does not significantly affect the activity of a person, at the same time affecting the quality of his life. The primary treatment of a patient with a shallow depression that does not reach full development or includes somatic and autonomic disorders (somatized, larvirovannye depression), in a normal clinic to the therapist, and not to a psychiatrist or even a neurologist, rather than the exception.
Many researchers point out the importance of developing diagnostic and therapeutic approaches to pre-nosological forms of depression already at the stage preceding the development of the disease.
According to ICD-10, the most important diagnostic signs of a depressive episode are its main symptoms, such as decreased or sad mood and loss of interests or feelings of pleasure. Additional symptoms include: sleep disturbance, guilt or reduced self-esteem, fatigue and loss of activity, difficulty concentrating, agitation or inhibition of thinking and speech, appetite disorders, suicidal thoughts and actions, decreased sexual desire.
According to the American classification DSM-IV, the criteria for distinguishing normal sadness from depression as a mental disorder are prolonged depression (for most of the day), the disappearance of feelings of pleasure and loss of interests. The presence of depression can be assumed in the event that one of the above symptoms persists for two weeks or more and prevents a person from coping with his daily duties. The diagnosis of depression is usually made if these symptoms are combined with at least four other signs of depression among the following: a noticeable weight loss or a noticeable weight gain, loss of appetite or increased appetite; insomnia or drowsiness; accelerated or slow motion; weakness or fatigue; sense of inferiority and / or guilt; inability to concentrate (poor concentration of attention) and make decisions, reduced efficiency of thinking; repeated thoughts of death, suicide.
Helps diagnose depression monitor the dynamics of the patient’s feelings. He is trying to deal with bad thoughts about himself and about life, he is seriously worried about the lack of prospects for the future. The feeling of hopelessness and worthlessness does not leave a patient, just as it leaves no confidence that he will fail and will never succeed in the future. Lack of will, helplessness, inability to communicate are also important signs of depression.
In the process of diagnosis of depression, it is important to assess the severity of its symptoms, determine the duration of their existence, clarify the features of the dynamics and the nature of the relationship.