What is postpartum depression?

Causes and Symptoms

For most women, the symptoms of depression are fairly common in the first week after childbirth. According to the American Pregnancy Association's 2014 statistics, approximately 70 to 80 percent of women who have given birth experience what are often called the “baby blues” or the “fourth-day blues.” These symptoms often disappear or lessen without medical intervention within one or two weeks following birth. In contrast, postpartum depression (PPD) is more severe and longer lasting. According to the American Psychological Association in 2015, approximately one in seven women who have given birth experience PPD. Additionally, an important distinction between baby blues and PPD is that the blues typically do not interfere with the mother’s ability to care for a baby, whereas PPD can affect the ability of the mother to care for her child and herself.

PPD symptoms often include sadness, restlessness, guilt, unexplained weight changes, insomnia, frequent crying, irrational fears, irritability, decreased energy and motivation, and even lessened feelings of self-worth. Doctors also look for the presence of a depressed mood or a significantly diminished interest or pleasure in nearly all activities. Postpartum depression also commonly interferes with a mother’s ability to care for the baby.

A personal or family history of depression, bipolar disorders, or other mental illnesses puts one at higher risk for PPD. Other factors that seem to play a role are an unwanted pregnancy, a complicated or difficult labor, a fetal anomaly, a lack of social support, and a temporary upheaval, such as a recent move, death of a loved one, or job change. Women who have previously suffered from depression following the birth of a child have an increased risk of becoming depressed following a subsequent delivery.

PPD is best understood as resulting from several causes. One factor is that the sudden change in body hormones caused by childbirth can affect the mother’s mood. There is also a psychological sense of anticlimax after an event that has been anticipated for many months. Many new mothers are very tired, and some are a little apprehensive and lacking confidence about the challenges of motherhood. Another factor is the sudden change that may occur in lifestyle and an associated feeling of shrunken horizons, especially if the mother had been working before the birth. Additionally, environmental, social, and sexual difficulties can predispose some women to develop PPD.

PPD may be accompanied by a rare but very severe symptom known as postpartum psychosis.
Symptoms may include dramatic mood swings, delusional thoughts about the baby, hallucinations, and severe sleep disturbances. Often a danger with this condition is that the mother contemplates or fears that she will kill her child. When such symptoms develop, immediate care is vital, as it will protect both the mother and the child. Additionally, immediate care will help to reduce the distress of the mother, which will in turn help her to regain her health more quickly and return to healthy mothering after treatment.

Some concerns have been raised over the fact that the Diagnostic and Statistical Manual of Mental Disorders, which lists PPD as a subtype of major depression, maintains that diagnosis is dependent upon symptoms appearing within the first four to six weeks after giving birth—though many women may not develop symptoms until months later. Meanwhile, studies have continued to investigate this complicated illness and any possiblities of prevention, researching whether the administration of an epidural and other pain management strategies during birthing might have an effect in reducing occurrence. Katherine Stone, a mother who had suffered from PPD herself, started a blog in 2004 to offer support to other women struggling with the illness that has become a leading source of information on the topic. The blog also led to the creation of Postpartum Progress, a nonprofit organization dedicated to raising awareness about PPD.

Treatment and Therapy

It is important for all new mothers to be aware of the baby blues and the more serious problem of PPD. Awareness of the possibility of PPD may encourage expectant mothers to better care for themselves psychologically and to prepare in advance for what may be a psychologically and physically challenging first few weeks of motherhood. In terms of prevention, it is important for new mothers to avoid becoming too tired and to obtain assistance in baby and household care as much as possible. The loving support of a husband or significant other, relatives, and close friends is extremely helpful. The baby’s father can take turns caring for the baby when the baby is unsettled or distressed. During the day, friends or family can help with shopping or looking after the baby while the mother rests.

If the depression develops and persists, a physician should be consulted for an evaluation of PPD. Antidepressant medication, such as sertraline hydrochloride (Zoloft), is usually effective if administered in the early stages of depression. Counseling is also beneficial to PPD sufferers. In severe cases, in which postpartum psychosis develops or the level of depression becomes life-threatening, admission to a psychiatric hospital for treatment may be necessary. Finally, it is important to note that anyone receiving medications, especially antidepressants, should be in regular contact with their physicians. Side effects, such as increased thoughts of suicide, may be an associated risk.

Bibliography

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Lundberg-Love, Paula K., Kevin L. Nadal, and Michele Antoinette Paludi. Women and Mental Disorders. Santa Barbara: Praeger, 2012. Print.

Nason, Juliana K., Patricia Spach, and Anna Gruen. Beyond the Birth: A Family's Guide to Postpartum Mood Disorders. Seattle: Postpartum Support Intl. of Washington, 2012. Print.

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