Descriptive Psychopathology: The Signs and Symptoms of ...

379 Chapter 16: An evidence-based classificationA twin study of parous women reported a heritability of 38% for self-reportpostpartum depressive symptoms. 55A study comparing illness patterns in the first-degree relatives of women withperinatal depression only, perinatal and non-perinatal depressions, and thosewith manic-depression with no perinatal episodes found over 60% of relativesin all three groups to have a mood disorder and most of these were non-perinatal.The groups did not differ in the prevalence of perinatal episodes. 56 While somestudies find that perinatal depression is not related to manic-depression, 57 somefind such a relationship. 58Follow-up studies from years to decades of patients with perinatal depressionfind these patients to have long-term courses similar to those of their relatives andother patients with non-perinatal depressive illness: most will have a recurrenceof depressive illness and most of these episodes will be non-perinatal. 59 Somestudies report these patients have a less severe course than those who only havenon-perinatal depression, 60 while other studies report some patients have substantialimpairment on follow-up and a manic-depressive course. 61 ECT leads toremission in most such patients within 4weeks of treatment. 62Thus, family studies and follow-up reports are consistent with the psychopathologyfindings in perinatal depressive illness that these patients do not have aunique form of depression and best fit the model of melancholic illness. They alsorespond to treatment particularly useful for melancholia. Other than “postpartumblues”, a common mild, transient state of weepiness and fatigue, all perinataldepressive illness is best considered melancholic disorder.Abnormal bereavementAbnormal bereavement is presented as a specified class of depression, but itsoperational definitions are consistent with the melancholia construct (psychosis,marked psychomotor impairment, preoccupation with worthlessness andwanting to die, suicide attempt, and failure to regain pre-death social functioningwithin two months). Although grief may persist for several years and one-third ofwidowed older persons initially meet DSM criteria for major depression, thecommon signs of depression rarely last beyond several weeks. 63 Symptomspersisting past one month after the death are associated with continuing mooddisorder and echo the classic features of melancholia. 64 Suicide remains a persistentrisk. 65 Persons identified as having abnormal bereavement have high cortisollevels and DST non-suppression. 66 This is not the case in those with normalbereavement. For example, among 19 recently widowed persons, while 58% metRDC criteria for depression, only 17% were non-suppressors on the DST. 67 Fourweeks following the death of a parent, children and adolescents have normal cortisolfunctioning. In one study of bereavement, however, 39% were non-suppressors.