Postpartum Depression Health Article

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 2001, 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 three to four 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.