Postpartum Depression

Basic Information

Following the first few weeks of birth, it is not uncommon for some mothers to feel some degree of mild postpartum depression. There are physiological as well as psychological reasons for this condition which is often referred to as "the blues". Hormonal changes occur in a woman's life during pregnancy and birth -- there is a postpartum drop to low progesterone concentration that is believed to be one of the causative factors; additionally, taking on a new twenty-four hour responsibility for a newborn can mean a lifestyle adjustment that places both physical and emotional stress on the mother. A lack of rest, especially during the first six weeks following the newborn's birth, can cause fatigue and depression which is exacerbated if the woman feels unsupported at home or troubled by adverse conditions.

Most new mothers -- at least 85% -- experience depressed moods after birth but they quickly resolve spontaneously. But 5 to 20% of new mothers have the postpartum "blues" -- or a mild depressive episode that occurs within the first two weeks of delivery, most usually during the first week between the third to seventh day. It is a condition that usually resolves rapidly with support from family and friends but sometimes it is slow to disappear or can worsen and in some cases may suddenly appear up to 6 months following delivery. In these cases counseling, therapy and antidepressant medication may be indicated.

Who is most at risk for postpartum depression?

• women from lower socio-economic classes who have financial difficulties
• women who are single mothers
• women in the midst of marital conflicts
• women who do not have an adequate network of family and friends

Other risk factors include:

• inadequate nutrition
• stress
• lack of sleep

If you have had postpartum depression after the birth of your first child you have a 1 in 3 risk for developing "the blues" when you have other children, as opposed to a risk factor of 1 in 5 for women who did not postpartum depression after the birth of their firstborn. Also, previous miscarriages, a history of infertility or a trauma associated with delivery increases the risk for a more serious or severe depression.

Symptoms

There are many symptoms associated with postpartum depression that mimic symptoms of a major depressive disorder. These include:

• insomnia
• appetite and weight loss or, conversely, overeating and weight gain
• feelings of hopelessness or unworthiness
• guilt
• headaches
• loss of energy
• psychomotor retardation, most usually resulting in slow, slurred speech
• disrupted sleep accompanied by nightmares

Diagnosis/Treatment

To be diagnosed with postpartum depression you must not meet the criteria for a major depressive disorder before birth so that this condition is not confused with a new episode in your depression, and you must exhibit at least several of the symptoms above.

Prognosis is good for a quick recovery. Early intervention is key. An effective treatment would be counseling or therapy for an approximately six-week period after which the illness will usually resolve at home. In certain cases antidepressants will be indicated but it is important to discuss with your health care provider and/or gynecologist what effects the antidepressants could have on breast feeding. You may be advised not to breast feed since antidepressants recommended for postpartum depression are excreted in breast milk. You may be advised to schedule your breast feeding during periods which avoid peak concentrations.

Though postpartum depression cannot be prevented, counseling both you and the baby's father can prepare you both for impending lifestyle changes and describe "the blues" should you get them and counsel you about how best to deal with them and how other members in your family support system may be able to play a helpful role. Follow up visits are indicated if you have had "the blues" to be certain that you have recovered (average time 6 to 8 weeks) and that relapses do not occur. If depression continues or becomes more severe, you are at risk of not developing a healthy relationship with your child, at increased risk for marital difficulties, and the infant may be put at risk for problems with social or emotional development.

Tips to help you with "the blues":

• understand that bonding with a child may take time -- acknowledge that mixed feelings may come with motherhood and don't feel guilty about it
• talk about your feelings with others -- don't keep them bottled up
• don't isolate
• get plenty of rest -- don't feel guilty about enlisting the aid of family or friends to help with chores or shopping
• don't feel guilty about having the baby sleep in a separate room if it is more restful for you

Mention must be made of a more serious condition that is rare but dangerous -- a few women (estimated to be 2 in 1,000 based on admission to psychiatric hospitals) suffer from postpartum psychosis in which suicidal thoughts or even thoughts of infanticide are considered. A severe psychosis occurs usually within the first 2 weeks, presenting with symptoms of agitation and confusion followed by delusions, hallucinations and behavioral disturbances. Women whose first degree relatives are manic-depressive have a 1 in 3 risk for postpartum psychosis. Should this condition occur, the patient should be hospitalized immediately and sedated with antipsychotic and antidepressant medication followed by psychiatric treatment.

If you are pregnant and would like to know about postpartum depression or if you are having an episode of postpartum depression, please see your health care provider promptly.