Living With: Postpartum Depression

What is Postpartum Depression?

There are two forms of postpartum depression. The first form is postpartum or maternity blues, which is a mild mood condition that lasts for a short time. A more severe form, called postpartum major depression, is a serious, potentially life-threatening condition.

How Can I Recognize Postpartum Blues?

The postpartum blues have symptoms that usually occur within three or four days of giving birth. Family members or new mothers may recognize the symptoms, including mood swings, tearfulness, irritability, anxiousness, and sleeping difficulties, among others. These symptoms affect 50 to 80 percent of new mothers, so it’s important to monitor a new mother’s condition. If she shows signs and symptoms of postpartum depression for longer than two weeks, seek medical attention. One in five women with this condition develops postpartum major depression.

How Can I Recognize Postpartum Major Depression?

If a family member or friend has recently given birth, there are a few things that can tell you that she has developed postpartum major depression. This type of depression may begin immediately after birth or weeks later, and it is very serious. A major symptom is that the mother is depressed the majority of every day for at least two weeks. She will also show signs of losing interest in activities she once enjoyed. Some other symptoms include difficulty concentrating, feelings of worthlessness, guilt, insomnia, and recurring thoughts of death or suicide. About 10 to 15 percent of new mothers develop this form of depression, although it sometimes goes unrecognized for months after birth. It is important for new mothers to get professional help if these symptoms arise.

What Can I Expect from Treatment?

Treatment for postpartum depression depends on the severity of the patient’s symptoms. If the patient has the postpartum blues, these will only last for about two weeks. After this time, the depression tends to resolve on its own. When the depression becomes deeper and persists, the mother needs a different treatment. Some types of treatment include psychotherapy and antidepressant medications. Psychotherapy usually involves counseling sessions. Antidepressants come in different forms, and there has been no evidence of these medications causing problems for nursing infants. If the depression is severe, medical professionals may urge a new mother to take medications to help treat the chemical imbalance in her brain.
If a woman has become severely depressed and is having thoughts of suicide or psychotic thoughts, a doctor may want to keep her hospitalized to ensure her and her baby’s health and safety. Another rare type of treatment is electroconvulsive therapy, which doctors sometimes use when mothers do not want to take drugs or medications.
Antidepressant medications come in different chemical forms that have different types of side effects. Serotonin reuptake inhibitors, or SSRIs, are normally recommended for breast-feeding mothers. Some of these include:

• Sertraline
• Paroxetine
• Fluoxetine
• Citalopram

Breast-feeding mothers can also use an older type of treatment that uses tricyclic antidepressants. Some of these include:

• Imipramine
• Nortriptyline

For extremely severe depression with psychotic symptoms such as hallucinations or delusions, an antidepressant may be combined with an antipsychotic like Haldol, Risperdal, or Zyprexa.

Why Do I Have Postpartum Depression?

Experts don’t know exactly what causes postpartum depression. They believe it could be caused by hormones in a woman’s body that change during pregnancy and affect her brain’s chemistry. After she gives birth, the amount of estrogen and progesterone in her body is dramatically reduced, which may cause sensitive individuals to react by developing postpartum depression. Another possibility is that women with postpartum depression may have an underlying problem with an underactive thyroid gland after delivery. This issue is easy to treat if it is detected.
Currently, researchers are studying other biological or social problems that may cause postpartum depression. This type of depression is most likely linked to other forms of depression, since women who have suffered previously from depression of any kind are more likely to develop depression after giving birth. Women with relatives who have had depression also have a higher risk of developing postpartum depression.

Am I at Risk?

You may be at risk for postpartum depression if you have had a similar episode before. If you suffered from postpartum depression with the birth of your first child, for example, it is more likely that you will have postpartum depression again after the birth of your second child. If a woman has ever been depressed, her risk of developing postpartum depression increases from approximately 10 percent (women with no history of depression) to 25 percent. Women who suffer from manic-depressive illness or bipolar disorder also may need to be more careful after giving birth. These women have a very high risk of developing postpartum major depression.
Other factors might indicate a risk for postpartum depression. Some of these include depression during pregnancy, significant premenstrual symptoms prior to pregnancy, and relatives with bipolar disorder or depression. Stressful situations can also put a woman at a higher risk of developing postpartum major depression after she gives birth.

What Happens if a Woman Is Not Treated for Postpartum Depression?

Women who aren’t treated for postpartum depression can have a negative effect on their children. Studies have shown that depressed mothers interact less with their children, which can impact the children’s later behavior. Children might also have problems performing as well on developmental tasks when compared to children of mothers who are not depressed.

How Can Counseling Help?

Counseling and support can help women work through some of the mental aspects of postpartum depression. If the depression is severe, a mother may need a family member to stay with her at all times to offer support, reassurance, and validation of her abilities as a mother. Some of the common issues mothers face with postpartum depression include overwhelming fears about their new responsibilities and guilt about becoming depressed at what is supposed to be a happy time. Interpersonal and cognitive-behavioral therapies may help these mothers work through these feelings and put the problems into the proper perspective.

For more on the topic of Living With Postpartum Depression, we’ve included the following expert consensus documents as reference materials:

• Postpartum Depression: A Guide for Patients and Families

View Resources

• Health Utah – PPD: A cause for concern
• MayoClinic – information about Postpartum Depression
• Wisconsin – information about Postpartum Depression
• CDC – other PPD publications
• PubMed Health – general information about Postpartum Depression