Evolução do blues puerperal para a depressão pós-parto: revisão integrativa.

Abstract

The maternity blues is generally regarded as a brief and fleeting disturbance of mood in newly delivered mothers that normally appears in the first few days after delivery and generally abates by ten days. This disturbance can be a recurrent finding in 85% of mothers, according to the diagnostic criteria established, and its clinical features could be confused with those related in perinatal depression by the professional groups. Postpartum depression is shown around later (2 to 4 weeks after childbirth), and it requires early diagnosis and management. This article is an integrative review about the clinical features of maternity blues and postpartum depression, focused on the evaluation of a possible evolution of postpartum blues to postpartum depression. The data employed in this paper were collected in PUBMED, LILACS e SciELO, at the last 20 years, available for free, and it has the proposal to discuss some of these questions and guide health professionals regarding diagnosis and management. Some of the risk factors pointed out to maternity blues are despondency, fatigue, anxiety and increased concern over their own (“narcissistic loss”) and the infant’s health. Postpartum depression presents, as risk factors, the postpartum blues, previous history of depression, perinatal depression in another pregnancy, the presence of stressors during pregnancy or postpartum, particularly where psychosocial and physical support is lacking. When there is any risk factor to depression, is recommended some self-rating scales originally designed to measure depressive symptoms, like "Edinburgh Postnatal Depression Scale", as a way to guide the early diagnosis. The postpartum blues does not require pharmacological intervention, while in postpartum depression, treatment is divided into non-pharmacological (psychotherapy) and antidepressant medication (selective serotonin reuptake inhibitors or tricyclic antidepressants). Hormonal therapies and treatments for insomnia have been studied with promising results and may be useful in the future.