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Postpartum Depression

Postpartum Depression


There has been considerable clinical and research interest in postpartum depression. This has been largely provoked by the accumulating evidence that postpartum depression is associated with disturbances in child socioemotional development. This evidence has renewed concern about the epidemiology of postnatal depression, its etiology, methods of prediction and detection, and the most appropriate form of management.

The Nature of Postpartum Depression

Postpartum depression must be distinguished from two other mood disorders which occur after the birth of a child. The first is the maternity blues, a common disturbance in mood, which arises in the first few days following delivery and usually remits within a week or two, and is characterised by marked swings in mood (lability). It is not, in itself, of psychiatric significance. The second category of disorder is the postpartum psychoses which arise in the early weeks following delivery. These disorders affect around one in one thousand postpartum women. They cover a wide spectrum of psychiatric conditions, the most common being manic in form. They are of major psychiatric significance and frequently require hospital admission. In terms of severity, postpartum depression lies between these two classes of disturbance. The clinical profile is the same as depressions arising at other times (Cooper et al. 1988; O'Hara 1997). Thus, central to the depression is a protracted period of low mood accompanied, in varying combinations and to varying degrees, by a loss of interest and pleasure, sleep and appetite disturbance, concentration problems, irritability, feelings of guilt and worthlessness, anxiety symptoms, and, on occasion, suicidal thoughts.


Epidemiology and Course

Epidemiological studies of postpartum samples have consistently revealed that approximately 10 percent of women experience a non-psychotic major depressive disorder in the early weeks following delivery (O'Hara 1997). Although this does not represent an increase over the non-postpartum rate (Cooper et al. 1988; O'Hara et al. 1990), the inception rate for depression in the first three months postpartum does appear to be elevated compared to the succeeding nine months. The duration of postpartum depression is similar to that of depressions arising at other times; in other words, episodes typically remit spontaneously within two to six months. Some residual depressive symptoms are, however, not uncommon, and can persist up to a year following delivery (O'Hara et al. 1990; Cooper et al. 1988). Some cultural variation in the rate of postpartum depression is apparent. Thus, although a rate similar to that found in Western groups has been reported for a Chinese sample (Lee et al. 2001) and for a Nigerian sample (Aderbrigbe, Gureje, and Omigbodun 1993), a substantially lower rate has been found in a Malaysian sample (Grace et al. 2001), and in an indigent urban South African postpartum sample the rate was found to be as high as 34 percent (Cooper et al. 1999). The high prevalence in the latter sample probably reflects a response to the endemic levels of extreme socioeconomic adversity.


Etiology

There is little evidence to support a biological cause for postpartum depression (O'Hara 1997). Despite extensive research on steroid hormones in women after birth, no firm evidence has emerged linking these hormones to the development of postpartum depression

Several studies have found that the presence of maternity blues in the immediate postpartum period is related to the subsequent development of postpartum depression, but no hormonal basis to this association has been identified (O'Hara 1997). Obstetric factors are important in a vulnerable subgroup of women: amongst those with a previous history of depressive disorder, delivery complications are associated with a raised rate of postpartum depression (Murray and Cartwright 1993; O'Hara 1997).

Epidemiological studies have consistently shown that the major factors of etiological importance are largely psychosocial (O'Hara 1997). Thus, the occurrence of stressful life events, including unemployment, a dysfunctional marital relationship, and the absence of support from family and friends, has been found to raise the risk of postpartum depression. A psychiatric history is also commonly reported to be a risk factor for postnatal depression, especially a history of depressive disorder. The importance of this latter association was clarified in a five-year follow-up study of two subgroups of primiparous women who had had a postpartum depression: those for whom the postpartum depression was a recurrence of previous non-postpartum mood disorder, and those for whom the postpartum depression was their first experience of affective disturbance (Cooper and Murray 1995). The former group was found to be at raised risk for subsequent non-postpartum depression, but not to be at risk for depression following a subsequent delivery. Conversely, the latter group was found to be at raised risk for subsequent postpartum depression but not for subsequent non-postpartum depression. This suggests that for a subgroup of those with postpartum depression the birth of a child carries specific biological or psychological risks.

Prediction

Although a number of studies have reported on antenatal factors associated with postpartum depression, the samples used have usually been too small to derive a reliable predictive index. By the end of the twentieth century the only large-scale predictive study conducted revealed that the most reliable predictors of postpartum depression—such factors as the absence of social support or a previous history of depression—each approximately doubled the odds over the base rate risk (Cooper et al. 1996). The predictive index derived from this study is somewhat useful: at a cutoff score of twenty-six about a third of those who will develop postpartum depression are identified, and about a third of those scoring above this cutoff become depressed. It is unlikely, given the modest elevation of odds conferred by all antenatal risk factors identified to date, that an antenatal predictive index could be produced with substantially better predictive power.

The prediction of postpartum depression could probably be improved if account were taken of certain postpartum factors. For example, a study that examined the impact of early postpartum factors on the course of maternal mood (Murray et al. 1996b) found that, beyond the predictive contribution of antenatal factors, both a high maternity blues score and certain neonatal factors (infant irritability and poor motor control) were significantly related to the onset of postnatal depression. Because both the maternity blues and the neonatal infant factors contribute predictively over and above antenatal variables, the predictive value of critical antenatal factors could be improved by taking account of these postpartum variables.


Detection

Although postpartum depression is frequently missed by the primary care team (Seeley, Murray, and Cooper 1996), its detection does not present any special clinical problem. As noted above, the disorder's symptoms are not distinctive and its assessment is straightforward. Indeed, a simple self-report measure, the Edinburgh Postnatal Depression Scale (EPDS), has been developed as a screening device (Cox, Holden, and Sagovsky 1987). The questionnaire has sound psychometric properties (Murray and Carothers 1990), is easy to administer and simple to interpret, and could readily be incorporated within the routine services provided to all postpartum women. Sensitive clinical inquiry with those who have high EPDS scores would be sufficient to confirm the presence of a depressive disorder.


Impact on Family Life, Parenting, and Child Outcome

Little research has been conducted on the impact of postpartum depression on family life. However, in a study of a non-postpartum group of depressed patients, the impact on partners was found to be considerable and far-reaching, including restrictions in social and leisure activities (going out less frequently, seeing people less often), a fall in family income, and a considerable strain on the marital relationship (Fadden, Bebbington, and Kuipers 1987). A questionnaire study of a small sample found the same adverse impact in the case of postpartum depression (Boath, Pryce, and Cox 1998). Interestingly, the partners of women with postpartum depression have been found to have a significantly elevated rate of depression themselves (Ballard et al. 1994).

There have been a number studies on the impact of postpartum depression on the early mother-infant relationship. These have consistently shown difficulties in the interactions between depressed mothers and their infants, most notably either withdrawn and disengaged behavior in the mother, or intrusive and hostile mother-infant communication (Field et al. 1990). These difficulties are most apparent in groups with high adversity levels, but even in low risk samples depressed mothers have been found to respond less sensitively to their infants than well mothers (Murray et al. 1993; Murray et al. 1996a), particularly when the mood disturbance persists (Campbell, Cohn, and Meyers 1995). Follow-up studies also indicate an association between the maternal mood disorder and aspects of child development. Thus, one study conducted in Cambridge, U.K., found an adverse effect on child cognitive performance among eighteen-month-old infants of mothers who had had a postpartum depression (Murray 1992; Murray et al. 1996b). Although cognitive disturbance was not found to persist in this study, two London studies found cognitive deficit persisting in boys of mothers with postpartum depression when the children were aged four to five (Cogill et al. 1986; Sharp et al. 1995). Poor emotional adjustment in children has reliably been shown to be associated with postpartum depression. Thus, the majority of studies which have systematically examined infant attachment in the context of postpartum depression have found an elevated rate of insecure attachments (Martins and Gaffan 2001). There is evidence that these emotional problems persist into later childhood. A follow-up study of the Cambridge cohort found that the five-year-old children of mothers who had had postpartum depression were significantly more likely than controls to be rated—by both their teachers and their mothers—as behaviorally disturbed (Sinclair and Murray 1998; Murray et al. 1999). One major conclusion from these studies is that the mechanism mediating the association between postpartum depression and adverse child developmental outcome is the impaired pattern of communication between the mother and her infant.

Treatment

There has been little systematic research on pharmacological treatment of postnatal depression. Although progesterone treatment has been enthusiastically advocated (Lawrie, Herxheimer, and Dalton 2000), there has been no systematic evaluation of its clinical utility. By the end of the twentieth century, there has been only one controlled trial of an antidepressant medication, and it showed significant antidepressant effect for both the active drug and the comparison psychological treatment (Appleby et al. 1997). However, there was no additive effect of the two treatments, and the drug treatment was not found to be superior to the psychological treatment. It should be noted that less than half of those invited to take part in the study agreed, mainly because of reluctance to take the medication. This suggests that this line of treatment is not appropriate as a first line treatment, especially in view of the positive results obtained using other forms of intervention which are highly acceptable to women, and that pharmacological treatment should be reserved for those with particularly severe depression or those whose mood disturbance fails to respond to other measures.

There have been a number of controlled trials of psychological treatment of postpartum depression. In an early study, whose findings were later replicated, Holden and her colleagues (Holden, Sagovsky, and Cox 1989) found that improvement in maternal mood in women visited an average of nine times in thirteen weeks by Health Visitors trained in non-directive counselling was substantially greater than in the control group who received routine primary care. Similar positive benefits to maternal mood have been reported for other forms of psychological intervention, such as cognitive behavior therapy, psychodynamic therapy (Cooper and Murray 1997; Cooper and Murray 2001), and interpersonal psychotherapy (O'Hara et al. 2000).

Few studies have examined the impact of treating postpartum depression on the quality of the mother-infant relationship and child development. One controlled psychological treatment trial found that intervention was associated with significant improvement in maternal reports of infant problems, both immediately after treatment (4 to 5 months postpartum) and at a follow-up at eighteen months postpartum; these benefits were confirmed by independent teacher reports of behavior problems at age five (Cooper and Murray 1997; Murray and Cooper 2001). Moreover, early remission from depression, itself significantly associated with treatment, was related to a reduced rate of insecure infant attachment at eighteen months. Similar benefits have been reported in a study of Health Visitor practice (Seeley, Murray, and Cooper 1996). Training was provided to all the Health Visitors working in one National Health Service sector and a cohort study was conducted to assess Health Visitors' clientele before their training and then during a post-training period. Again, significant benefits were apparent in terms of both maternal mood and maternal reports of the quality of the mother-infant relationship.

Marital therapy has been proposed as a treatment for postpartum depression (Apfel and Handel 1999) and as "the treatment of choice" in cases where the marital relationship is in crisis because of the partner's inability to respond empathically to their spouse's distress (Whiffen and Johnson 1998). However, there is no reliable evidence to support such a proposal. Indeed, such an approach is likely to be appropriate only in a selected subgroup of those with postpartum depression where the spouse is available and willing to engage in a therapeutic process of this sort.


Conclusion

Postpartum depression has a significant adverse impact, not just on the affected woman, but on her partner and the family as a whole. This is of special importance to the infant who is so dependent on the mother for its care. It is of great concern that follow-up studies of the children of mothers who have experienced postpartum depression reveal an enduring adverse impact on the child's socioemotional development. It appears that these adverse child outcomes are driven by disturbances in the mother-child relationship which begin in the early postpartum period. This highlights the importance of early detection and treatment by the primary care health team. It also suggests that efforts should be directed to the identification of high risk samples and to the development and evaluation of preventive interventions.


See also:Attachment: Parent-Child Relationships; Depression: Adults; Loneliness


Bibliography

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cooper, p. j., and murray, l. (2001). "a controlled trial of the long term effect of psychological treatment of postpartum depression: impact on maternal mood." british journal of psychiatry. forthcoming.

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cox, j. l.; holden, j. m.; and sagovsky, r. (1987) "detection of postnatal depression: development of the 10-item edinburgh postnatal depression scale." british journal of psychiatry 150:782–786.

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peter j. cooper lynne murray

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"Postpartum Depression." International Encyclopedia of Marriage and Family. 2003. Encyclopedia.com. 28 Jul. 2016 <http://www.encyclopedia.com>.

"Postpartum Depression." International Encyclopedia of Marriage and Family. 2003. Encyclopedia.com. (July 28, 2016). http://www.encyclopedia.com/doc/1G2-3406900332.html

"Postpartum Depression." International Encyclopedia of Marriage and Family. 2003. Retrieved July 28, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3406900332.html

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): 915.

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): 125129.

Josefsson, A., L. Angelsioo, G. Berg, et al. "Obstetric, Somatic, and Demographic Risk Factors for Postpartum Depressive Symptoms." Obstetrics and Gynecology 99 (February 2002): 223228.

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): 4347.

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

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Ford-Martin, Paula; Frey, Rebecca. "Postpartum Depression." Gale Encyclopedia of Alternative Medicine. 2005. Encyclopedia.com. 28 Jul. 2016 <http://www.encyclopedia.com>.

Ford-Martin, Paula; Frey, Rebecca. "Postpartum Depression." Gale Encyclopedia of Alternative Medicine. 2005. Encyclopedia.com. (July 28, 2016). http://www.encyclopedia.com/doc/1G2-3435100621.html

Ford-Martin, Paula; Frey, Rebecca. "Postpartum Depression." Gale Encyclopedia of Alternative Medicine. 2005. Retrieved July 28, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3435100621.html

Postpartum depression

Postpartum depression

Definition

Postpartum depression is a depression that can range from mild to suicidal and can occur anytime after delivery up to one year later.

Description

Postpartum depression is an affective disorder (any mental disorder characterized by a consistent change in mood that affects thoughts and behaviors) that can occur after pregnancies of all duration, from spontaneous (not induced) abortions, also called miscarriages, to full-term deliveries. The depression can take a mild clinical course or it can range to suicidal ideations (thoughts). The depression can occur anytime post-delivery to one year after delivery. Symptoms commonly start within four to six weeks after delivery. Differentiating postpartum depression from "maternity blues" or the stress from the pregnancy and delivery can be difficult. Postpartum depression can be differentiated from other types of depression if the mother exhibits signs of ambivalence to the infant and neglect of other family members.

Causes and symptoms

Causes

The cause of postpartum depression has been extensively studied. Alterations of hormone levels for prolactin, progesterone, estrogen, and cortisol are not significantly different from those of patients who do not suffer from postpartum depression. However, some research indicates a change in a brain chemical that controls the release of cortisol.

Research seems to indicate that postpartum depression is unlikely to occur in a patient with an otherwise psychologically uncomplicated pregnancy and past history. There is no association of postpartum depression with marital status, social class, or the number of live children born to the mother. However, there seems to be an increased chance to develop this disorder after pregnancy loss.

Certain characteristics have been associated with increased risk of developing postpartum depression. These risk factors include:

  • medical indigence being in need of health care and not being able to receive it, possibly due to lack of medical insurance
  • being younger than 20 years old at time of delivery
  • being unmarried
  • having been separated from one or both parents in childhood or adolescence
  • receiving poor parental support and attention in childhood
  • having had limited parental support in adulthood
  • poor relationship with husband or boyfriend
  • economic problem with housing or income
  • dissatisfaction with amount of education
  • low self-esteem
  • past or current emotional problem(s)
  • family history of depression

Symptoms

The symptoms can range from mild depression to a severe depression with thoughts of ending one's life (suicide ). The disorder should be suspected during its peak (four to six weeks after delivery) in a patient who demonstrates signs and symptoms of clinical depression (feelings of worthlessness and hopelessness, changes in eating and sleeping patterns, irritability, difficulty with motivation, and difficulty getting out of bed in the morning). Additionally, patients may be emotionally detached from the infant and unable to display loving affection towards family members. Physical and emotional stress during delivery in conjunction with great demands for infant care may cause the patient to neglect other family members, increasing the woman's feelings of self-worthlessness, isolation, and being trapped. Patients may also feel as if they are inadequate mothers, causing them guilt and embarrassment.

Demographics

There is a 20% to 30% risk of postpartum depression for women who had a previous depressive episode that was not associated with pregnancy. Additionally, there is an increased risk of recurrence in subsequent pregnancies since 50100% of patients will have more than one episode.

Diagnosis

Patients should undergo careful clinical assessment from a psychologist or psychiatrist , who can determine the risk factors and diagnose the condition. A careful, comprehensive psychological assessment interview could reveal a previous depressive cycle or a family history of depressionimportant risk factors. The most widely used standard for diagnosis is the Edinburgh Postnatal Depression Scale (EPDS). This is a simple and short 10-question scale. A score of 12 or greater on the EPDS is considered high risk for postpartum depression.

Treatments

Treatment should begin as soon as the diagnosis is established. A typical treatment plan includes psychotherapy and medications. Recent studies have found that a group of medications known as the selective serotonin reuptake inhibitors (SSRIs) are effective in treating postpartum depression. These antidepressants have fewer side effects than other antidepressants and can be taken by breast-feeding mothers. SSRIs are secreted into breast milk, however, in varying amounts. Some studies indicate that paroxetine secretes the least amount of medication into breast milk. Breast-feeding women considering taking an antidepressant should discuss medication choices with their doctor. SSRIs can be given two to three weeks before delivery to patients who had a previous episode to avoid recurrence. Some SSRIs include: fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and citalopram (Celexa).

When medications are combined with psychological therapy, the rates for successful treatment are increased. Interpersonal therapy and cognitive-behavioral therapy have been found to be effective.

Prognosis

The prognosis for postpartum depression varies because this disorder is usually implicated with difficult social factors, a personal history of emotional problems, and adverse pregnancy outcomes, such as miscarriage. The prognosis is better if depression is detected early during its clinical course and a combination of SSRIs and psychotherapy is available and inititated.

Prevention

The best method to prevent the disorder is through education. Mothers should be advised prior to hospital discharge that if the "maternity blues" last longer than two weeks or pose tough difficulties with family interactions, they should call the hospital where their baby was delivered and pursue a referral for a psychological evaluation. Education concerning risk factors and reduction of these is important. Prophylactic (preventive) use of SSRIs is indicated two to three weeks before delivery to prevent the disorder in a patient with a past history of depression, since recurrence rates are high if the mother had a previous depressive episode.

Resources

BOOKS

Gabbe, Steven, Jennifer R. Niebyl, Joe Leigh Simpson. Obstetrics: Normal & Problem Pregnancies. 4th ed. Philadelphia : W. B. Saunders Company, 2002.

Ryan, Kenneth J., Ross S. Berkowitz, Robert L. Barbieri, and others. Kistner's Gynecology & Women's Health. 7th ed. Saint Louis: Mosby, Incorporated, 1999.

PERIODICALS

Evins, G. G., J. P. Theofrastous, and S. L. Galvin. "Postpartum Depression: a comparison of screening and routine clinical evaluation." American Journal of Obstetrics and Gynecology 182, no. 5 (May 2000).

ORGANIZATIONS

Online PPD Support Group. <http://www.ppdsupportpage.com>.

Laith Farid Gulli, M.D.

Nicole Mallory, M.S., PA-C

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Gulli, Laith Farid; Mallory, Nicole. "Postpartum depression." Gale Encyclopedia of Mental Disorders. 2003. Encyclopedia.com. 28 Jul. 2016 <http://www.encyclopedia.com>.

Gulli, Laith Farid; Mallory, Nicole. "Postpartum depression." Gale Encyclopedia of Mental Disorders. 2003. Encyclopedia.com. (July 28, 2016). http://www.encyclopedia.com/doc/1G2-3405700307.html

Gulli, Laith Farid; Mallory, Nicole. "Postpartum depression." Gale Encyclopedia of Mental Disorders. 2003. Retrieved July 28, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3405700307.html

Postpartum Depression

Postpartum Depression

Definition

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

Description

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. Postpartum depression affects approximately 15% of all childbearing women. Mild to moderate cases are sometimes unrecognized by women themselves. Many women feel ashamed if they are not coping and so 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 also increase significantly.

Postpartum depression is often divided into two types: early onset and late onset. An early onset 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 is usually a time of extra sensitivity and 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, skill, and practice. In short, some depression, tiredness, and anxiety may fall within the "normal" range of reactions to giving birth.

Late onset appears several weeks after the birth. This involves a slowly growing feeling of sadness, depression, lack of energy, chronic tiredness, inability to sleep, change in appetite, significant weight loss or gain, and difficulty caring for the baby.

Causes and symptoms

As of 2006, experts cannot say what causes postpartum depression. Most likely, it is caused by many factors that vary from individual to individual. 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.

Experiences 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, settling problems)
  • preexisting neurosis or psychosis

Diagnosis

There is no diagnostic test for postpartum depression. However, it is important to understand that it is, nonetheless, a real illness, and like a physical ailment, it has specific symptoms.

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 3 to 4 weeks. Any medication use must be carefully considered if the woman are breast-feeding, but with some medications, continuing breast-feeding is safe. Nevertheless, medication alone is never sufficient and should always be accompanied by counseling or other support services.

Alternative treatment

Postpartum depression can be effectively alleviated through counseling and support groups, so that the mother doesn't feel she is alone in her feelings. Constitutional homeopathy can be the most effective treatment of the alternative therapies because it acts on the emotional level where postpartum depression is felt. Acupuncture, Chinese herbs, and Western herbs can all help the mother suffering from postpartum depression come back to a state of balance. Seeking help from a practitioner allows the new mother to feel supported and cared for and allows for more effective treatment.

A new mother also should remember that this time of stress does not last forever. In addition, there are useful things she can do for herself, including:

  • 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
  • having the baby sleep in a separate room so she sleeps more restfully
  • 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.
  • not losing her sense of humor

Prognosis

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. Yet, medication, counseling, and support from others usually cures even severe depression in 3-6 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's important for a woman to learn to recognize her own warning signs of fatigue, respond to them by taking a break.

Resources

ORGANIZATIONS

Depression After Delivery (D.A.D.). P.O. Box 1282, Morrisville, PA 19067. (800) 944-4773.

Postpartum Support International. 927 North Kellog Ave., Santa Barbara, CA 93111. (805) 967-7636.

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Doermann, David. "Postpartum Depression." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Encyclopedia.com. 28 Jul. 2016 <http://www.encyclopedia.com>.

Doermann, David. "Postpartum Depression." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Encyclopedia.com. (July 28, 2016). http://www.encyclopedia.com/doc/1G2-3451601299.html

Doermann, David. "Postpartum Depression." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Retrieved July 28, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3451601299.html

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