Book Review

Postpartum Mood Disorders

N Engl J Med 1999; 341:619August 19, 1999

Article

Postpartum Mood Disorders
(Clinical Practice.) Edited by Laura J. Miller. 262 pp. Washington, D.C., American Psychiatric Press, 1999. $38.50. ISBN: 0-88048-929-4

Depressive disorders occur in the United States at a rate that is twice as high in women as in men, a finding that is echoed by data from other countries. The postpartum period is thought to be a time of high risk for the onset of mood disorders. For this reason, the recognition and treatment of mood disorders during the postpartum period are issues of great public health importance. Responsibility for the care of women with postpartum mood disorders is not limited to psychiatrists and other mental health specialists but falls within the purview of family practitioners, obstetricians, and gynecologists, who are more likely to have contact with women after childbirth. A book that summarizes the phenomenology and treatment of postpartum mood disorders can be an asset to clinicians who care for these women.

Postpartum Mood Disorders reviews the various types of these disorders (“maternity blues,” postpartum major depressive disorder, and postpartum psychosis). The book has two sections. The first section provides background information on epidemiology, comorbidity, and the biologic underpinnings of illnesses occurring during the puerperium. The initial chapter summarizes work on the “maternity blues,” and Miller presents the hypothesis that this clinical entity, which is characterized primarily by mood lability, is caused by the rapid decline in the levels of hormones that have direct and indirect effects on the central nervous system. As such, it is not a period of depression, but rather a time when affect is “released,” the manifestation of which can be either euphoria or dysphoria.

Other notable chapters in the first section of the book include a review of postpartum psychosis, a chapter on the biologic factors related to postpartum mood disorders, and an interesting review of the sociocultural aspects of postpartum depression, in which Wile and Arechiga discuss the way in which various cultures (Asian, Latin, and African) traditionally manage illnesses during the postpartum period. Many customs have conferred protective benefits on new mothers, but the breakdown of traditional practices among women who have a greater degree of acculturation to Western society can result in the loss of important stress-management tools.

The second section of the book presents information on pharmacologic treatments and other therapies, including psychotherapy and electroconvulsive therapy. Most chapter authors offer valuable practical advice for treating postpartum illnesses. The reader learns about the risks to breast-fed neonates of various medications, as well as the consequences to the neonate of not treating the mother. A nicely rendered chapter explains interpersonal psychotherapy, a form of psychotherapy designed to treat postpartum mood disorders. An advantage of this therapy is that it enables women to avoid using medication if they are breast-feeding. Although physicians who are not psychiatrists would not be expected to administer interpersonal psychotherapy after reading this chapter, the description of the intervention is so clear that referring physicians can become acquainted with the principles and techniques of this treatment approach.

Most of the authors cover their subject matter thoroughly, even though some chapters suffer from the inclusion of information that is outdated. Redundancy among the various chapters is kept to a minimum. Physicians and other health care workers should find this book immensely readable and helpful in their task of caring for women during the postpartum period.

Kimberly Ann Yonkers, M.D.
Yale University School of Medicine, New Haven, CT 06510