Introduction
Postpartum depression (PPD) has been a focus of research since 1970.
Approximately 12 to 15 percent of mothers suffer from PPD. The disorder is defined
as the onset of depression occurring within days or weeks after childbirth.
Symptoms include sadness, frequent crying or tearfulness, loss of interest or
pleasure in life, loss of appetite, loss of motivation,
irritability, fatigue, anxiety, poor sleep, and feelings of
hopelessness and guilt. PPD can arise days, weeks, or even months after
childbirth. The most common onset is within a few days of delivery, perhaps due to
the hormonal changes that the body experiences. Some women acquire PPD two to six
weeks postpartum due to neuroendocrine changes and lifestyle changes that
accompany caring for the infant. No one theory accounts for all cases of PPD, but
almost all researchers in this area agree on the importance of biological and
psychosocial factors in the development of PPD.
Related Postpartum Emotional Disorders
In addition to PPD, there are other forms of psychiatric illness that can arise
following childbirth. Maternity blues or "baby blues" affects 50 to 80 percent of mothers after delivery. The symptoms,
which begin on the second or third day after childbirth, include anxiety, mood
swings from joyfulness to tearfulness, irritability, and sleep difficulties, all
of which typically remit within four weeks. However, 25 percent of these women go
on to suffer a more long-term and severe form of depression known as postpartum
depression. A related disorder is postpartum psychosis, a
serious psychiatric disorder that occurs two to four weeks postpartum and requires
immediate professional attention. Symptoms of postpartum psychosis include
hallucinations (such as hearing voices), delusions
(bizarre false beliefs), and mania (hyperactivity, increased energy levels, rapid
speech, and destructive impulsive behavior). A small number of women with
postpartum psychosis experience obsessions having to do with harming
themselves or their babies following delivery. In this instance, a differential
diagnosis is important to assess the risk of harm to the mother and child.
Who Suffers?
The strongest predictor of PPD is any form of depression
during pregnancy, but any previous history of mood
disorders elevates the risk of PPD. In addition, a lack of
social support,
mixed feelings about the pregnancy, an unplanned pregnancy, marital problems, or
giving birth to a temperamentally difficult child all increase the chances of PPD.
Furthermore, pregnant adolescents have a 30 percent chance of developing PPD. The
majority of patients with PPD have a family history of mood or anxiety disorders.
In general, stressful events that occur during pregnancy or delivery (such as
illness during pregnancy, pregnancy complications, or a premature
birth) increase the risk for developing postpartum
depression. The risk of postpartum psychosis is higher for mothers who have
bipolar
disorder.
Causes of PPD
Theories about the causes of PPD stress the importance of biological and
psychological influences, although no single agreed-on theory has emerged. One
biological theory of the cause of PPD is that hormonal changes in the woman’s body
after childbirth affect her mood. Three days after childbirth, the
hormones estrogen and progesterone show a sharp drop from
their previously high levels during pregnancy, and these changes may induce
chemical changes in the brain that play a role in causing depression.
Some psychosocial factors (such as ambivalence about the pregnancy or low social support) can serve to increase stress and undermine coping resources. The fact that a family history of mood disorders is predictive of PPD might suggest that certain women are biologically vulnerable, and the addition of negative psychosocial factors interacts with this vulnerability to produce PPD.
Treatment Options
There are several treatment options for PPD and its variations, and the
treatment for PPD is similar to the treatment for any other forms of depression.
Most women who suffer from postpartum “blues” are advised to seek social
support from their spouses, family, friends, and doctors.
Other recommendations for new mothers experiencing the "baby blues" are to stay
physically active, to take time to relax, and to pursue activities that are
enjoyable to them. However, because 25 percent of women with maternal blues will
develop PPD, physicians should advise and monitor those patients in case their
symptoms become more severe or last longer than a few weeks. If the symptoms
persist for an extended period of time, usually more than five weeks following
delivery, women are generally encouraged to seek psychotherapy
or counseling. Through therapy, patients can explore their thoughts and feelings,
receive help for interpersonal problems, set realistic goals and expectations, and
learn strategies
for coping with stress. Oftentimes the therapy continues
after the PPD is no longer present. With severe cases of postpartum depression, an
antidepressant may be used to complement psychotherapy.
Nursing mothers should discuss the risks of taking an antidepressant while
breastfeeding with their doctor. Postpartum psychosis requires immediate
treatment. If the person with PPD experiences a psychotic reaction, then an
antipsychotic
medication is often warranted in addition to antidepressant
drugs. Electroconvulsive therapy has also been recommended as an effective
treatment for severe postpartum psychosis.
Bibliography
"Depression During and After Pregnancy Fact
Sheet." WomensHealth.gov. US Department of Health and Human
Services, 16 July 2012. Web. 21 July 2014.
Dunnewold, Ann, and
Diane G. Sanford. Postpartum Survival Guide. Oakland: New
Harbinger, 1994. Print.
Kleiman, Karen.
Therapy and the Postpartum Woman: Notes on Healing Postpartum
Depression for Clinicians and the Women Who Seek Their Help. New
York: Routledge, 2009. Print.
Kleiman, Karen R., and Valerie Davis
Raskin. This Isn't What I Expected: Overcoming Postpartum
Depression. 2nd ed. Philadelphia: De Capo, 2013.
Print.
"Postpartum Depression." Mayo
Clinic. Mayo Foundation for Medical Education and Research, 11
Sept. 2012. Web. 21 July 2014.
"Postpartum Depression." The American
College of Obstetricians and Gynecologists. American College of
Obstetricians and Gynecologists, Dec. 2013. Web. 21 July 2014.
Steiner, Meir,
Kimberly A. Yonkers, and E. Eriksson, eds. Mood Disorders in
Women. Malden: Blackwell Science, 2000. Print.
Twomey, Teresa
M. Understanding Postpartum Psychosis: A Temporary
Madness. Westport: Praeger, 2009. Print.
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