Postpartum depression

Postpartum depression is a form of depression a mother experiences after the birth of her child. It is a complex mixture of physical, emotional, and behavioral changes and can be divided into three categories: postpartum blues, postpartum depression, and postpartum psychosis.

What Is It?

Having a baby can be both elating and exhausting. During the first few weeks after giving birth you may feel fatigue and some pain as your body heals. If you're like most women, you may also experience "maternity" blues (postpartum blues), a very mild form of depression. It begins three to six days after childbirth and lasts for up to two to six weeks. Experts believe these feelings are caused by hormonal changes (especially low estrogen levels or thyroid abnormalities), fatigue, and interrupted sleep. Symptoms can include feeling overwhelmed, confused, and nervous. The postpartum woman with the "blues" will frequently cry and do so for long periods of time. Patients describe having their feelings hurt rather easily, an irritability triggered by the most minor incidents, and most troubling, a lack of feeling for the baby.

Postpartum depression (PPD), a more serious condition, is experienced by 8% to 15% of women. It usually begins around two weeks after childbirth, but sometimes may not appear until three to six months after giving birth. It can last for several months, and if left untreated, for several years. If you've experienced postpartum depression before, you have a 70% chance of getting it again. Women who have had major complications during pregnancy are twice as likely to have it than women who've had a relatively easy pregnancy. There is a 15% to 25% risk of PPD in women with previous depressive reaction that was not associated with pregnancy.

Symptoms of PPD are: feelings of inadequacy; inability to cope; impaired concentration or memory; despondency or despair; thoughts of suicide; no feelings for the baby, or over-concern for the baby's health; guilt; panic attacks; feeling "out of control" or like you are "going crazy"; headaches; chest pains; heart palpitations; or hyperventilation. Other factors that can contribute to postpartum depression include: having other children at home; giving birth to twins; ambivalence about being pregnant; and having a previous history of depression.

Postpartum psychosis is a relatively rare occurrence (1 in 1,000 births) the onset is usually within the first three months of the postpartum period and tends to be severe and quick. A wide range of symptoms includes: lack of appetite, hyperactivity, confusion, fatigue, mood swings, memory loss, and delusions or hallucinations both auditory and visual. These women are often overcome by an overwhelming sense of shame or hopelessness.

How Do I Know I Have It?

Symptoms of maternity blues include weepiness, anxiety, insomnia, mood swings, difficulty concentrating, fatigue, and loss of interest in sex. While some of these symptoms are similar to postpartum depression, keep in mind that maternity blues is milder and shorter-lasting. Call your health-care provider if you have any concerns.

Postpartum depression comes in two forms: major and minor. Major depression is diagnosed when five or more of the below symptoms are present for at least a two-week period. Minor depression is diagnosed when fewer than five of the below symptoms are present for at least a two-week period. In both cases, at least one of the symptoms must include being in a depressed mood for most of the day or having a decreased interest in activities almost every day. Call your health-care provider if you are experiencing any of these symptoms:

• Depressed mood most of the day.
• Noticeably decreased interest or pleasure in activities almost every day.
• Noticeable weight loss or gain.
• Decreased or increased appetite.
• Insomnia or sleeping too much.
• Fatigue.
• Agitation or apathy.
• Guilt.
• Feelings of worthlessness.
• Inability to concentrate.
• Headaches.
• Panic attacks.
• Lack of feeling for the baby.
• Recurring thoughts of death or suicide.

How Can I Treat It?

There are many things you can do on your own to help ease maternity blues or postpartum depression. The most important thing to do is take a step back and allow yourself some time to adjust to your new life. Here are some other tips:

• Ask for help with daily activities.
• Keep visits short with friends and family if you're feeling overwhelmed.
• Get as much rest as possible.
• Get out of the house whenever you have a chance.
• Get together with other new moms.
• Spend some time alone.
• Make time for moderate aerobic exercise, like walking.

Psychopharmacologic treatment is also available. There are numerous support and self-help groups, which can be an invaluable resource during this difficult and confusing time. In an attempt to prevent postpartum depression from occurring, several prenatal interventions have been proposed. The purpose is to provide a smooth transition into parenthood. These interventions address a wide variety of efforts to prevent the depressive episodes. They include prenatal classes to teach parenting skills, reliance on assistance from support personnel including spouses, family members, friends, and neighbors. Mothers-to-be are encouraged to verbalize their fears and anxieties well before the baby arrives and to continue these discussions even after delivery. This type of educational approach with specific attention to the psycho-social aspect of the pregnancy holds great promise.

If these suggestions don't help, talk to your health-care provider. Women with mild depression are usually referred to a therapist to talk about their fears and concerns. In some cases, women with moderate depression are given estrogen treatments. For major depression, antidepressants and/or anti-anxiety agents are usually prescribed. Tell your health-care provider if you are breast-feeding before he recommends any medication.

How Can I Prevent It?

Unfortunately, postpartum depression cannot be prevented, but planning ahead can help. While you are pregnant, try to mentally prepare for the numerous lifestyle changes that will soon take place. Find someone who will help with household chores and the baby during your first week home from the hospital; choose child care so that you can get a break on an ongoing basis; and decide ahead of time what you need to have on hand when the baby arrives. Having these things worked out before you give birth will provide some stability during a very unpredictable time.

Frequently Asked Questions

Q: I've been feeling wonderful ever since I brought my baby home a month ago. Is this good feeling going to go away and lead to depression?

A: Most likely, no. While maternity blues are common, and some women get postpartum depression, that doesn't necessarily mean you will. Since the majority of maternity blues starts the first week after giving birth and postpartum depression sets in after the second week, it's safe to assume that you've escaped both conditions.

Q: What about the baby's dad? Can he get postpartum depression, too?

A: New fathers, especially first-timers, may also have feelings of sadness or anxiety, especially about feeling left out when all of the attention is focused on the mother and baby. Now is a good time to talk to each other about being new parents. Try to spend some time alone together, even if it's just for an hour. Many parents try to plan a regular date night so they can be together without the baby.

Q: Is it safe to take antidepressants while breast-feeding?

A: Unfortunately, experts don't know much about the effects of antidepressants on nursing newborns. Because most medicines that moms take do show up in their breast milk, it is advisable to avoid taking antidepressants while breast-feeding. If your postpartum depression is severe, you may want to consider bottle-feeding so that you can safely take the medication without passing it to your baby. It is a good idea to address these concerns with your health-care provider.

Review Date: June 29, 2001
Reviewed By: Peter Chen, M.D., Obstetrics and Gynecology, University of Pennsylvania School of Medicine. Review provided by VeriMed Healthcare Network.

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