带孩子回家可能是女人一生中最快乐的时刻之一, but for many, 这种经历并不总是那么美好. Lauren Osborne, M.D，前副主任 约翰霍普金斯女性生殖心理健康中心 and Lindsay R. Standeven, M.D. explain what women need to know about baby blues, postpartum depression and postpartum psychosis.

The Baby Blues

事实上，大多数新妈妈都会患上产后抑郁症. 这些是荷尔蒙的变化，会导致焦虑, crying and restlessness that goes away within the first two weeks after giving birth. Also called postpartum blues, the baby blues are actually a mild — and temporary — form of depression that goes away once hormones level out.

Almost every new mother — up to 85 percent of them — will experience the postpartum blues. 你可能前一分钟还很开心，下一分钟就哭了. 

奥斯本说:“没有母亲总是快乐的。. “沮丧是正常的，有时甚至需要把孩子放下来.”

Postpartum Depression

For others, bad feelings after giving birth become more than a mild case of the blues. 多达五分之一的新妈妈患有产后抑郁症, a more serious, but highly treatable, condition. 

斯坦文说，母亲和婴儿都可能受到产后抑郁症的影响. “产后抑郁症是怀孕最常见的并发症，”她说. “Untreated depression and anxiety in pregnancy is associated with preterm delivery, higher startle reflex in babies, gestational diabetes and more.”

It can also be life-threatening. 斯坦芬说，产后抑郁症是导致20%产妇死亡的一个因素, 根据追踪该问题发生率的国家的数据. 

谁有患产后抑郁症的风险?

Postpartum depression symptoms may be more likely ― or more severe ― in some individuals. These are some factors:

焦虑或情绪障碍史. Those with bipolar disorders, 抑郁或焦虑的人患产后抑郁症的可能性要高30%到35%. Likewise, mothers who have had depression symptoms after previous pregnancies are apt to have them again.

Family history. Those who have family members who have suffered with postpartum mood disorders are more likely to experience them also.

Genetics. Researchers at the Johns Hopkins Women’s Mood Disorders Center identified epigenetic biomarkers — differences in the activity of certain genes — that may predict who’s most likely at risk for postpartum depression.

产后精神病:一种罕见的精神健康紧急情况

而产后抑郁症则相对常见, 产后精神病是一种极为罕见的疾病, affecting just 0.1 percent of new mothers. 在怀孕的母亲中，这一数字上升到30% bipolar disorder. 产后精神病的症状包括:

• 混乱和认知障碍可能来来去去 
• 进入和离开意识
• Extremely disorganized behavior
• Hallucinations or delusions

It’s important not to ignore these symptoms, even if you have no history of mood disorder. “Postpartum psychosis can occur in women with no previous history of psychiatric illness,” says Osborne.

She stresses that postpartum psychosis is a psychiatric emergency requiring immediate medical attention because it carries a high rate of suicide and harm to the baby.

The gold-standard treatment for postpartum psychosis includes both lithium (a mood stabilizer) and an antipsychotic medication. With these medications, it is important for a doctor to monitor the baby to ensure that breastfeeding is safe. 

治疗产后情绪障碍

The most important things to know about postpartum mood disorders are that they are highly treatable and not something a new mother needs to feel ashamed about. 即使在最严重的产后精神病病例中，最近的一个 study 98%的推荐十大正规网赌平台在治疗后好转了. 

产后抑郁症的治疗包括抗抑郁药物, 哪些有充分证据表明母乳喂养是安全的.

女性对药物的反应不同

Standeven notes that a body of scientific literature on the treatment of women shows they respond differently to medication than do male animals (and humans), 谁在历史上构成了最多的药物研究对象.

In addition, she says, 当涉及到药物治疗精神健康状况，如抑郁症, pregnancy, perimenopause and other hormonal changes can make some treatment and dosages less effective.

荷尔蒙的波动会改变身体对药物的反应, 包括肾脏过滤药物的速度. 雌激素会影响一些情绪稳定剂的作用. “More research on pregnancy’s impact on pharmacokinetics can help practitioners prescribe medications more effectively,” Standeven says.

布雷沙诺酮治疗产后抑郁症

The first medication solely for the treatment of postpartum depression is a drug called brexanolone. It is given as an infusion in a clinic or hospital over the course of two or three days with careful observation since it can cause sudden loss of consciousness in some people. FDA于2019年批准了布雷沙诺酮.

Brexanolone is a manufactured version of a natural byproduct (metabolite) of progesterone called allopregnanolone. When a baby is about to be born, 孕激素在母亲体内的水平是最高的. 婴儿一出生，这种激素的含量就急剧下降. Research links this sudden drop in progesterone to postpartum depression since the hormone acts on the brain and helps balance mood.

Brexanolone输注可以缓解疼痛, 悲伤和焦虑的产后抑郁症的一些人.

#TomorrowsDiscoveries: Depression and Anxiety During Pregnancy – Lauren Osborne, M.D

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预防产后情绪障碍

Osborne says not enough studies exist that look at preventing postpartum mood disorders, 尽管它们正变得越来越普遍. For example, one study showed that mothers who learned soothing and sleep-promoting methods for their babies had lower rates of postpartum depression. Another study showed that taking an antidepressant right away in the postpartum period could help prevent mood episodes in women with a history of postpartum depression. 

Sleep is another key area of  to help prevent mood disorders. 

“如果我看到一位女性有产后抑郁症的风险, 我让她和她的伴侣一起进来，这样我们就可以制定一个积极的睡眠计划,” she says. 适当的睡眠可以在预防情绪障碍方面发挥作用. Getting at least four hours of sleep may mean taking shifts for feeding or having the partner do everything but nursing.

She says the main message she’d like mothers to hear is that women shouldn’t be afraid to seek help. 

“我们需要打破精神疾病的污名, especially for new mothers, 因为它确实对治疗有反应,” she says.

生殖精神病学:支持妇女心理健康

Reproductive psychiatry is the study and treatment of psychiatric illness during reproductive transitions such as pregnancy, childbirth and menopause. These transitions can have an impact on hormone levels and a woman’s role in families and society.

Specialized training 在这一关键方面为妇女的健康提供了更快的希望, more definitive diagnoses, 有效的治疗和减少病耻感.