Postpartum Depression

Postpartum depression

Definition

Postpartum depression is a mood disorder that begins after childbirth and usually lasts at least six weeks.

Description

Postpartum depression, or PPD, affects approximately 15% of all childbearing women. The onset of postpartum depression tends to be gradual and may persist for many months, or develop into a second bout following a subsequent pregnancy . Mild to moderate cases are sometimes unrecognized by women themselves. Many women feel ashamed and may conceal their difficulties. This is a serious problem that disrupts women's lives and can have effects on the baby, other children, her partner, and other relationships. Levels of depression for fathers can also increase significantly.

Postpartum depression is often divided into two types: early onset and late onset. Early-onset PPD most often seems like the "blues," a mild brief experience during the first days or weeks after birth. During the first week after the birth, up to 80% of mothers will experience the "baby blues." This period is usually a time of extra sensitivity; symptoms include tearfulness, irritability, anxiety , and mood changes, which tend to peak between three to five days after childbirth. The symptoms normally disappear within two weeks without requiring specific treatment apart from understanding, support, skills, and practice. In short, some depression, fatigue , and anxiety may fall within the "normal" range of reactions to giving birth.

Late-onset PPD appears several weeks after birth. It involves slowly growing feelings of sadness, depression, lack of energy, chronic fatigue, inability to sleep, change in appetite, significant weight loss or gain, and difficulty caring for the baby.

Causes & symptoms

At present, experts cannot always say what causes postpartum depression. Most likely, it is caused by a combination of factors that vary from person to person. Some researchers think that women are vulnerable to depression at all major turning points in their reproductive cycle, childbirth being only one of these markers. Factors before the baby's birth that are associated with a higher risk of PPD include severe vomiting (hyperemesis), premature labor contractions, and psychiatric disorders in the mother. In addition, new mothers commonly experience some degree of depression during the first weeks after birth. Pregnancy and birth are accompanied by sudden hormonal changes that affect emotions. Additionally, the 24-hour responsibility for a newborn infant represents a major psychological and lifestyle adjustment for most mothers, even after the first child. These physical and emotional stresses are usually accompanied by inadequate rest until the baby's routine stabilizes, so fatigue and depression are not unusual.

In addition to hormonal changes and disrupted sleep, certain cultural expectations appear to place women from those cultures at increased risk of postpartum depression. For example, women who bear daughters in societies with a strong preference for sons are at increased risk of postpartum depression. In other cultures, a strained relationship with the husband's family is a risk factor. In Western countries, domestic violence is associated with a higher rate of PPD.

Experiences of PPD vary considerably but usually include several symptoms.

Feelings:

• persistent low mood
• inadequacy, failure, hopelessness, helplessness
• exhaustion, emptiness, sadness, tearfulness
• guilt, shame, worthlessness
• confusion, anxiety, and panic
• fear for the baby and of the baby
• fear of being alone or going out

Behaviors:

• lack of interest or pleasure in usual activities
• insomnia or excessive sleep, nightmares
• not eating or overeating
• decreased energy and motivation
• withdrawal from social contact
• poor self-care
• inability to cope with routine tasks

Thoughts:

• inability to think clearly and make decisions
• lack of concentration and poor memory
• running away from everything
• fear of being rejected by partner
• worry about harm or death to partner or baby
• ideas about suicide

Some symptoms may not indicate a severe problem. However, persistent low mood or loss of interest or pleasure in activities, along with four other symptoms occurring together for a period of at least two weeks, indicate clinical depression, and require adequate treatment.

There are several important risk factors for postpartum depression, including:

• stress
• lack of sleep
• poor nutrition
• lack of support from one's partner, family, or friends
• family history of depression
• labor/delivery complications for mother or baby
• premature or postmature delivery
• problems with the baby's health
• separation of mother and baby
• a difficult baby (temperament, feeding, sleeping problems)
• pre-existing neurosis or psychosis

Diagnosis

Diagnosis of postpartum depression can be made through a clinical interview with the patient to assess symptoms.

Treatment

Postpartum depression can be effectively alleviated through counseling and support groups, so that the mother does not feel she is alone in her feelings. Acupuncture , Chinese herbs, and Western herbs can all help the mother suffering from postpartum depression return to a state of balance.

Recommended herbal remedies to ease depressive episodes may include damiana (Turnera diffusa ), ginseng (Panax ginseng ), lady's slipper (Cypripedium calceolus ), lavender (Lavandula angustifolia ), oats (Avena sativa ), rosemary (Rosmarinus officinalis ), skullcap (Scutellaria laterifolia ), St. John's wort (Hypericum perforatum ), and vervain (Verbena officinalis ). Women who are breastfeeding or are suffering from a chronic medical condition should consult a healthcare professional before taking any herbal remedies.

Some strategies that may help new mothers cope with the stress of becoming a parent include:

• Valuing her role as a mother and trusting her own judgment.
• Making each day as simple as possible.
• Avoiding extra pressures or unnecessary tasks.
• Trying to involve her partner more in the care of the baby from the beginning.
• Discussing with her partner how both can share the household chores and responsibilities.
• Scheduling frequent outings, such as walks and short visits with friends.
• Sharing her feelings with her partner or a friend who is a good listener.
• Talking with other mothers to help keep problems in perspective.
• Trying to sleep or rest when the baby is sleeping.
• Taking care of her health and well being.

Allopathic treatment

Several treatment options exist, including medication, psychotherapy , counseling, and group treatment and support strategies, depending on the woman's needs. One effective treatment combines antidepressant medication and psychotherapy. These types of medication are often effective when used for three to four weeks. Any medication use must be carefully considered if the woman is breastfeeding, but with some medications, continuing breastfeeding is safe. Nevertheless, medication alone is never sufficient and should always be accompanied by counseling or other support services.

Expected results

With support from friends and family, mild postpartum depression usually disappears quickly. If depression becomes severe, a mother cannot care for herself and the baby, and in rare cases, hospitalization may be necessary. However, medication, counseling, and support from others usually work to cure even severe depression in three to six months.

Prevention

Exercise can help enhance a new mother's emotional well-being. New mothers should also try to cultivate good sleeping habits and learn to rest when they feel physically or emotionally tired. It is important for a woman to learn to recognize her own warning signs of fatigue and respond to them by taking a break.

Resources

BOOKS

Murray, Lynne, and Peter J. Cooper, eds. Postpartum Depression and Child Development. New York: Guilford Press, 1999.

Sebastian, Linda. Overcoming Postpartum Depression and Anxiety. LPC, 1998.

PERIODICALS

Burt, V. K., and K. Stein. "Epidemiology of Depression Throughout the Female Life Cycle." Journal of Clinical Psychiatry 63 (2002, Supplement 7): 9–15.

Danaci, A. E., G. Dinc, A. Deveci, et al. "Postnatal Depression in Turkey: Epidemiological and Cultural Aspects." Social Psychiatry and Psychiatric Epidemiology 37 (March 2002): 125–129.

Josefsson, A., L. Angelsioo, G. Berg, et al. "Obstetric, Somatic, and Demographic Risk Factors for Postpartum Depressive Symptoms." Obstetrics and Gynecology 99 (February 2002): 223–228.

Patel, V., M. Rodrigues, and N. DeSouza. "Gender, Poverty, and Postnatal Depression: A Study of Mothers in Goa, India." American Journal of Psychiatry 159 (January 2002): 43–47.

ORGANIZATIONS

Depression After Delivery (D.A.D.). P.O. Box 1282, Morrisville, PA 19067. (800) 944-4773. <http://www.depressionafterdelivery.com>.

Postpartum Support International. 927 North Kellog Avenue, Santa Barbara, CA 93111. (805) 967-7636. <http://www.postpartum.net>.

Paula Ford-Martin

Rebecca J. Frey, PhD