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Women and Postpartum Depression

Having a baby is one of the most exciting and joyous events in a woman's life. Life with a new baby can be thrilling and rewarding, but it can also be stressful and difficult for the new mother. The physical and emotional turmoil associated with pregnancy and childbirth leaves many new mothers feeling sad, anxious, afraid, or confused after delivery. These feelings are common and are often dismissed as "normal." However, many women who are experiencing these emotions have postpartum depression, and they need medical treatment. (1)

What is Postpartum Depression?

The term postpartum depression describes the range of physical, emotional, and behavioral changes that many new mothers experience following the delivery of their babies. Symptoms of this condition can range from mild to severe. A new mother's depression may be a mild, brief bout of "baby blues"; or she may suffer from postpartum depression, a much more serious condition. In some cases, new mothers may have postpartum psychosis, a relatively rare but severe and incapacitating illness. (2)

The Range of Postpartum Conditions

The "baby blues." This condition occurs in many new mothers in the days immediately following childbirth (3). It is characterized by sudden mood swings, which range from euphoria to intense sadness. Symptoms may include crying for no apparent reason; impatience; irritability; restlessness; anxiety; feelings of loneliness, sadness, and low self-esteem; increased sensitivity; and heightened feelings of vulnerability. The "baby blues" may last only a few hours or as long as one to two weeks after delivery. The condition may disappear as quickly and as suddenly as it appeared, without medical treatment. (4)

Postpartum depression (PPD). Roughly 10% of pregnancies result in postpartum depression (5), which can occur a few days or even months after delivery. Postpartum depression can occur after the birth of any child, not just the first (6). This condition is characterized by more intense feelings of sadness, despair, anxiety, and irritability. It often disrupts a woman's ability to function, which is the key sign that medical attention is necessary.

Left untreated, symptoms may worsen and linger for as long as a year. This physical disorder, however, can be diagnosed and its symptoms alleviated (7).

Postpartum psychosis. This serious mental illness affects approximately 1 in 500-1,000 new mothers (8). Onset is severe and quick, usually within the first three months after delivery. Women who suffer from postpartum psychosis may completely lose touch with reality, often experiencing hallucinations and delusions (9). Other symptoms may include insomnia, agitation, and bizarre feelings and behavior (10).

Postpartum psychosis should be treated as a medical emergency. Patients need immediate medical assistance, which almost always includes medication. In many cases, women who are suffering from this condition are hospitalized (11).

Who is At Risk for Postpartum Depression?

Any woman who is pregnant, had a baby within the past several months, miscarried, or recently weaned a child from breastfeeding can suffer from postpartum depression. A woman can have this condition regardless of her age, socioeconomic status, or the number of children she has borne (12).

Postpartum depression is more likely to occur if a woman had any of the following:

  • previous postpartum depression
  • depression not related to pregnancy
  • severe premenstrual syndrome (PMS)
  • a non-supportive partner; and stress related to family, marriage, occupation, housing, and other events during pregnancy or after childbirth (13).

Symptoms of Postpartum Depression

Symptoms of postpartum depression include

  • restlessness, irritability, or excessive crying; headaches, chest pains, heart palpitations, numbness,
  • hyperventilation;
  • an inability to sleep or extreme exhaustion or both;
  • loss of appetite and weight loss, or, conversely, overeating and weight gain;
  • difficulty concentrating, remembering, or making decisions;
  • an excessive amount of concern or disinterest in the baby;
  • feelings of inadequacy, guilt, and worthlessness;
  • a fear of harming the baby or one's self;
  • a loss of interest or pleasure in activities, including sex (14).

Women who have a previous history of mood disorders, such as depression, are at an increased risk of relapse after delivery (15). At least 33% of women who have had postpartum depression have a recurrence of symptoms after a subsequent delivery (16). As many as 60% of women with the psychiatric condition known as bipolar disorder have a relapse after childbirth (17). Fortunately, prenatal screening can identify these women during their pregnancy (18).

Some women may not be depressed, but they may feel very anxious. These women might suffer from postpartum anxiety or panic disorder. Symptoms can include intense anxiety and fear, rapid breathing, an accelerated heart rate, hot or cold flashes, chest pain, and shaking or dizziness (19).

Factors Associated with Postpartum Depression

Postpartum depression is a complex mixture of biological, emotional, and behavioral changes. The exact cause of this condition is still unknown (20).

A variety of hormonal changes may trigger its symptoms. Estrogen and progesterone levels-which increase tenfold during pregnancy to accommodate the growing fetus-suddenly and rapidly drop in the first 24 hours after childbirth. After delivery, these hormones fall to even lower levels, to pre-pregnancy levels (21). These decreases may trigger depression, just as smaller hormonal changes can affect a woman's moods before menstruation (22).

Thyroid levels may also drop sharply after birth. A thyroid deficiency can produce symptoms that mimic depression, such as mood swings, severe agitation, fatigue, insomnia, and anxiety. Simple thyroid tests can determine if this condition is causing a woman's postpartum depression (23).

Aside from biological changes, a variety of physical, psychological, and environmental factors can lead to postpartum depression.

  • Feelings of fatigue following delivery, broken sleep patterns, and insufficient rest often prevent a new mother from regaining her full strength for weeks, especially if she has had a cesarean delivery (24).
  • Taking responsibility for an expanding family can be overwhelming. Some new mothers have feelings of self-doubt and inadequacy. They may doubt their ability to be a good mother (25).
  • Many new mothers suffer from stress, which can be caused by changes in work and home routines. Stress can also be caused by the pressure a woman places on herself to be the "perfect mother," a highly unrealistic goal (26).
  • New mothers often experience feelings of loss. After the birth of a baby, many women feel a loss of identity, a loss of control, a loss of a slim figure, and a perceived loss of physical attractiveness (27).
  • In addition, their free time is suddenly restricted, they are confined indoors for long periods of time, and they have less time to spend with their baby's father (28).

Treating Postpartum Depression

Postpartum depression is treated much like other types of depression. The most common treatments for depression are antidepressant medication, psychotherapy, participation in a support group, or a combination of these treatments. However, some antidepressants can contaminate breast milk. Women who breastfeed should talk to their doctors to determine the most suitable treatment option (30).

The most appropriate treatment depends on the nature and severity of the postpartum depression and, to some extent, on individual preference. It is important to recognize that postpartum depression is both temporary and treatable.

New mothers with postpartum depression can practice a number of self-care strategies.

  • Good, old-fashioned rest is important. Always try to nap during the baby's nap time.
  • Relieve some of the pressure you may be feeling. Do as much as you can, and leave the rest. If possible, ask your husband or partner to share night-time feeding duties and household chores.
  • To help you through the readjustment process, seek out emotional support from your husband or partner, family, and friends.
  • Isolation often perpetuates the depression. Get dressed and leave the house for at least a short time each day.
  • Make an effort to spend time alone with your partner.
  • Ask your physician to advise you on possible medical treatments.
  • Be assertive about your concerns. Not all health care professionals recognize the symptoms or seriousness of postpartum depression. Get a referral to a mental health professional who specializes in treating depression (31).
  • Talk with other mothers, so you can learn from their experiences.
  • Join one of the many support groups that are now available to help women who suffer from postpartum depression. Call a hotline to access information and services.

For further information...

National Women's Health Information Center (NWHIC)
Toll-free: 1-800-994-WOMAN (1-800-994-9662)
Toll-free TDD: 1-888-220-5446
http://www.4woman.gov/

Office on Women's Health (OWH)
Office of the Secretary Department of Health and Human Services
200 Independence Avenue, S.W.,
Rm 730B
Washington, DC 20201
Phone (202) 690-7650
Fax (202) 690-7172
http://www.4woman.gov/owh/about/index.htm

American College of Obstetricians and Gynecologists (ACOG)
409 12th Street, SW
Washington, DC 20024-2188
Phone (202) 484-3321
Fax (202) 479-6826
http://www.acog.com

American Psychological Association (APA)
750 First Street, N.E.
Washington, DC 20002-4242
Phone (202) 336-5500
Toll-free: 1-800-374-2721
http://www.apa.org/

American Academy of Family Physicians (AAFP)
11400 Tomahawk Creek Parkway
Leawood, KS 66211-2672
Phone (913) 906-6000
http://www.aafp.org/

Depression After Delivery
P.O. Box 278
Belle Mead, NJ 08502
Phone (908) 575-9121
(215) 295-3994 (Professional Inquiries)
Toll-free: 1-800-944-4PPD (Information Requests)
http://www.behavenet.com/dadinc/

Postpartum Education for Parents
P.O. Box 6154
Santa Barbara, CA 93160
http://www.sbpep.org/

Postpartum Support International
927 North Kellogg Avenue
Santa Barbara, CA 93111
Phone (805) 967-7636
Fax (805) 967-0608
http://www.chss.iup.edu/postpartum

Footnotes:

1. Depression After Delivery, http://www.behavenet.com/dadinc/
2. Ibid.
3. The American College of Obstetricians and Gynecologists, Labor, Delivery, and Postpartum Care, (AP091), Postpartum Depression, ACOG Patient Education Pamphlet, August 1990, Reviewed June 1995, http://www.acog.com/
4. Ibid.
5. National Institute of Mental Health, Office of Communications and Public Liaison, fax communication to OWH, 6/22/01.
6. ACOG, Postpartum Depression.
7. Ibid.
8. National Institute of Mental Health, Office of Communications and Public Liaison, fax communication to OWH, 6/22/01 and Kruckman, L., and Smith, Susan. An Introduction to Postpartum Illness. In Postpartum Depression Resource Guide. http://www.chss.iup.edu/anthropology/projects/depression/postpart.html, p. 7.
9. Ibid.
10. Depression After Delivery, p. 2.
11. Ibid.
12. Ibid, p. 3.
13. Postpartum Depression and the "Baby Blues", American Family Physician, April 15, 1999. http://www.aafp.org/afp/990415ap/990415e.html, p. 2.
14. An Introduction to Postpartum Illness, p.6.
15. Epperson, C. Neill. Postpartum Major Depression: Detection and Treatment. In American Family Physician, April 15, 1999, p. 4. http://www.aafp.org/afp/990415ap/2247.html
16. Ibid.
17. Ibid.
18. Postpartum Depression and the "Baby Blues," p. 4.
19. Depression After Delivery, p. 2.
20. An Introduction to Postpartum Illness, p. 7.
21. Ibid.
22. ACOG, Postpartum Depression.
23. Ibid.
24. Ibid.
25. Ibid.
26. Ibid.
27. Ibid.
28. Ibid.
29. Postpartum Depression and the "Baby Blues," p. 2.
30. Ibid.
31. Ibid.

Information provided by: The Office on Women's Health - Department of Health and Human Services

www.4woman.gov -- 800-994-9662 (800-994-WOMAN) -- 888-220-5446 (TDD)