Depression

Postpartum Depression

Postpartum Depression Overview Postpartum Depression

Postpartum Depression Overview

You’ve just had a baby, one of the most important and happiest events in your life. “What could make a woman happier than a new baby?” you wonder. So why are you so sad?

We don’t know for sure, but you are not alone. As many as 80% of women experience some mood disturbances after pregnancy (“postpartum”). They feel upset, alone, afraid, or unloving toward their baby, and guilt for having these feelings.

For most women, the symptoms are mild and go away on their own. But 10-20% of women develop a more disabling form of mood disorder called postpartum depression.

* The “baby blues” are a passing state of heightened emotions that occurs in about half of women who have recently given birth.

o This state peaks 3-5 days after delivery and lasts from several days to 2 weeks.

o A woman with the blues may cry more easily than usual and may have trouble sleeping or feel irritable, sad, and “on edge” emotionally.

o Because baby blues are so common and expected, they are not considered an illness.

o Postpartum blues do not interfere with a woman’s ability to care for her baby.

o The tendency to develop postpartum blues is unrelated to a previous mental illness and is not caused by stress. However, stress and a history of depression may influence whether the blues go on to become major depression.

* Postpartum depression is depression that occurs soon after having a baby. Some health professionals call it postpartum nonpsychotic depression.

o This condition occurs in about 10-20% of women, usually within a few months of delivery.

o Risk factors include previous major depression, psychosocial stress, inadequate social support, and previous premenstrual dysphoric disorder (see premenstrual syndrome for more information).

o Symptoms include depressed mood, tearfulness, inability to enjoy pleasurable activities, trouble sleeping, fatigue, appetite problems, suicidal thoughts, feelings of inadequacy as a parent, and impaired concentration.

o If you experience postpartum depression, you may worry about the baby’s health and well-being. You may have negative thoughts about the baby and fears about harming the infant (although women who have these thoughts rarely act on them).

o Postpartum depression interferes with a woman’s ability to care for her baby.

o When a woman with severe postpartum depression becomes suicidal, she may consider killing her infant and young children, not from anger, but from a desire not to abandon them.

* Postpartum (puerperal) psychosis is the most serious postpartum disorder. It requires immediate treatment.

o This condition is rare. A woman with this condition experiences psychotic symptoms within 3 weeks of giving birth. These include false beliefs (delusions), hallucinations (seeing or hearing things that are not there), or both.

o This condition is associated with mood disorders such as depression, bipolar disorder, or psychosis.

o Symptoms can include inability to sleep, agitation, and mood swings.

o A woman experiencing psychosis can appear well temporarily, fooling health professionals and caregivers into thinking that she has recovered, but she can continue to be severely depressed and ill even after brief periods of seeming well.

o Women who harbor thoughts of hurting their infants are more likely to act on them if they have postpartum psychosis.

o If untreated, postpartum psychotic depression has a high likelihood of coming back after the postpartum period and also after the birth of other children.

Postpartum Depression Causes

No specific cause of postpartum depression has been found.

* Hormone imbalance is thought to play a role.

o Levels of the hormones estrogen, progesterone, and cortisol fall dramatically within 48 hours after delivery.

o Women who go on to develop postpartum depression may be more sensitive to these hormonal changes.

* Other known risk factors

o Mental illness before pregnancy

o Mental illness, including postpartum depression, in the family

o Postpartum mental disorder after an earlier pregnancy

o Conflict in the marriage, loss of employment, or poor social support from friends and family

o Pregnancy loss such as miscarriage or stillbirth

+ The risk of major depression after miscarriage is high for women who are childless. It occurs even in women who were unhappy about being pregnant.

+ The risk for developing depression after miscarriage is highest within the first few months after the loss.

* Childbirth is a time of great change for a woman. The adjustment to these changes can contribute to depression.

o Physical changes after delivery

+ Many changes occur after delivery, including changes in muscle tone and difficulty losing weight.

+ Many new mothers are very tired after giving birth and in the weeks afterwards.

+ Soreness and pain in your perineal area (area around the birth canal) makes many women uncomfortable. Physical recovery after cesarean delivery may take even longer than after vaginal delivery.

+ Changes in hormones can affect mood.

o Common emotional changes after delivery

+ Feelings of loss of an old identity, feeling trapped at home

+ Feeling overwhelmed with responsibilities of motherhood

+ Feeling stress from changes in routine

+ Feeling fatigue because of broken sleep patterns

+ Feeling less attractive physically and sexually

* A mother’s age and the number of children she has had do not relate to her likelihood of getting postpartum depression.

Postpartum Depression Symptoms

Symptoms usually appear any time from 24 hours to a few months after delivery.

* If you have these, it is important to see a health care provider, who will look for other conditions that can cause similar symptoms.

o Sad mood, frequent crying

o Lack of pleasure or interest in activities that once gave pleasure

o Sleep disturbance

o Weight loss

o Loss of energy

o Agitation or anxiety

o Feelings of worthlessness or guilt

o Trouble concentrating or making decisions

o Thoughts of death or suicide

o Decreased interest in sex

o Feelings of rejection

* Physical symptoms such as frequent headaches, chest pain, rapid heart beat, numbness, shakiness or dizziness, and mild shortness of breath suggest anxiety. Postpartum anxiety disorder is a separate disorder from postpartum depression, but the two often occur together.

* See the introduction to this article for symptoms specific to each type of postpartum depression.

When to Seek Medical Care

Call your health care provider in any of the following situations:

* When you have mood swings or feel depressed for more than a few days after the birth of your baby

* When you feel you are unable to cope with the daily activities in your life, including caring for your newborn or your other children

* When you have strong feelings of depression or anger 1-2 months after childbirth

Call a neighbor, friend, or loved one who is nearby AND 911 right away if you are experiencing any of the following:

* Inability to sleep more than 2 hours per night

* Thoughts of hurting or killing yourself

* Thoughts of hurting your baby or other children

* Hearing voices or seeing things

* Thoughts that your baby is evil

Exams and Tests

The diagnosis of postpartum depression can be missed because the symptoms are so common after childbirth. The symptoms are the same as those of many other mental illnesses, especially depression. Here is what to expect during an evaluation.

* Your health care provider will ask you about your symptoms: what they are, how bad they are, and how long they have lasted.

* He or she will also ask whether you have ever had similar symptoms before.

* You will also be asked about risk factors for depression, such as family or marital problems, other stresses, mental illness in family members, and drug and alcohol use.

* Your health care provider may use the questions of the Edinburgh Postnatal Depression Scale. You answer 10 questions, and your answers indicate your probability of having postpartum depression. Depending on your score, you may be referred for further evaluation.

Postpartum Depression Treatment

While self-care cannot take the place of medical care in depression, there are things you can do to improve your mood and your ability to function at home.

Self-Care at Home

* Surround yourself with supportive family members and friends, and ask for their help in caring for the baby.

* Take care of yourself. Get as much rest as you can. Nap when the baby naps.

* Try not to spend much time alone.

* Spend some time alone with your husband or partner.

* Take a shower and get dressed every day.

* Get out of the house. Take a walk, see a friend, do something you enjoy. Get someone to take care of the baby if you can; if you can’t, take the baby with you.

* Don’t expect too much from yourself. Don’t worry too much about the housework. Ask friends and family for help.

* Talk to other mothers. You can learn from each other, and their experiences can be reassuring.

* If the depression persists for longer than 2 weeks or is very deep, talk to your health care provider. Self-care alone is not recommended.

Medical Treatment

Treatment for postpartum depression depends on the form and how severe it is.

* Your health care provider may refer you for psychological help and individual or group therapy.

* Support groups are helpful.

* Marriage counseling may be part of your treatment plan.

* It’s important for friends and family to understand the illness so they can help.

* Medications can be helpful.

For postpartum blues, no specific treatment may be necessary because the condition goes away by itself. If symptoms don’t go away within 2 weeks, call your health care provider.

For postpartum depression, the severity of the illness will guide the health care provider in choosing treatment. Milder forms may be treated with psychological therapy. More severe forms may require medication. A combination is sometimes helpful.

Medications

Vitamins: While postpartum depression in the United States is rarely related to nutritional problems, it is probably a good idea to continue to take prenatal vitamins and iron after delivery.

Antidepressants: Drugs such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), or venlafaxine (Effexor) may be given for as long as a year (possibly longer). Other medications that might be used include lithium or valproic acid (Depakote).

Hormone therapy: Estrogen, often in combination with an antidepressant, sometimes helps with postpartum depression. Some women also need thyroid treatment.

Other still unproven therapies include the use of bright light and nutritional therapy (especially increasing omega-3 free fatty acids).

If you are breastfeeding, medicine you take can be passed to your baby. Some antidepressants can be used safely with little risk to your baby.

Other Therapy

Generally, psychotherapy and medications are used together. Psychotherapy alone may be effective in mild cases.

Interpersonal psychotherapy (IPT) is an alternative to medication that may be appropriate for some women. IPT assists with social adjustments. It usually consists of 12 one-hour long sessions with a therapist. IPT has been shown to improve measures of depression in some women.

Teaching mothers skills such as controlling the baby’s crying often reduces depressive symptoms during the first 2-4 months after delivery.

If your symptoms can’t be controlled with counseling or medicine, and you are thinking about hurting yourself or your baby, then your doctor may consider putting you in the hospital.

Next Steps

Follow-up

Follow the recommendations of your health care provider. If he or she prescribes medication and/or counseling, be sure to follow through.

If you are given medication, take it as directed. Do not stop taking your medication until you have talked to your health care provider.

Prevention

Too often, depressive symptoms are dismissed as normal for a woman who has just experienced childbirth.

If you have had depression in the past, or have risk factors for depression, talk with your doctor before getting pregnant or early in your pregnancy.

All new mothers should be screened for depressive disorders.

Outlook

Postpartum depression usually goes away during the months after delivery. Some women have symptoms for months or years.

If untreated, the illness can cause prolonged misery for the mother and her family.

* It can hurt the mother-baby relationship.

* It could even be dangerous if the mother considers hurting her child or herself.

Support Groups and Counseling

A support group can help you cope with your illness.

* Depression After Delivery – (800) 944-4PPD

* National Women’s Health Information Center – (800) 994-9662

* Postpartum Support International (PSI) – (805) 967-7636

-www.emedicinehealth.com

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