What causes postpartum depression?
How can I recognize postpartum depression?
How is postpartum depression treated?
What support services are available for new mothers?
Research has shown that 50-75% of women will experience some form of the
"baby blues" in the period following the birth of a child. For most women the
symptoms are mild and transient, characterized by a brief period of emotional
instability that may manifest itself with episodes of unexplained crying and
mood swings.
For about 10-15% of new mothers the period of "baby
blues" becomes quite severe and disabling, resulting in a full blown illness
that only recently has been recognized by the medial community and subsequently
been termed "post partum depression."
Are you at risk for postpartum
depression
Answer the questions below, then read on to
learn more about this often hidden disease.
- Are you experiencing
difficulty sleeping?
- Do you feel anxious, tense
or panicked much of the day?
- Do you find yourself crying
uncontrollably for unexplained reasons?
- Is it difficult for you to
concentrate?
- Are you filled with
self-doubt and lacking in self-esteem?
- Have you experienced sudden
changes in appetite?
- Are you feeling totally
exhausted and lacking in enthusiasm for things that once seemed pleasurable?
- Do you feel more distant
from your spouse or partner?
- Do you often feel helpless,
hopeless and unable to cope?
- Are you over concerned about
the health of your baby, constantly worrying about what could go wrong?
- Do you feel like most days
you are "out of control" or "going crazy"?
- Do you ever think of hurting
yourself or your baby?
This questionnaire has no right
or wrong answers. The truth is that there is no one tool that can be used to
diagnose postpartum depression. If you answered yes to any of these questions,
you could be experiencing a characteristic or behavior that has been associated
with post partum depression.
If you think you may be suffering from postpartum
depression consult with your health care provider at once. Recognizing the
disease is the first step in treating this disorder.
What causes
postpartum depression?
Postpartum depression has been
recognized since ancient times. In 700 BC Hippocrates described in great detail
the emotional problems of women associated with child bearing. Unfortunately,
the medical community has for many years failed to acknowledge and formally
recognize the existence of a depressive disorder related directly to
childbearing. Even today controversy exists about how to define and classify
depression which occurs in the post partum period.
Current research has still not
determined the exact cause of postpartum depression. What is known is that
pregnancy and the postpartum period which follows the delivery are times of
great biochemical upheaval that can be complicated by increasing social and
psychological changes, all of which create an environment for post partum
depression.
The following risk factors have been identified for postpartum depression:
- Marital problems
- Poor or lacking social
support systems
- Stress or negative life
events occurring during pregnancy such as the death of a parent or close
relative or move to a new location Previous post partum depression or mood
disorder
- Traumatic birth experience
- Early hospital discharge
following childbirth
- History of severe
Premenstrual Syndrome (PMS)
Other factors have been implicated as
contributors to the development of postpartum depression.
Hormones
During pregnancy the levels of the female hormone
estrogen and progesterone increase up to ten fold. After delivery these hormone
levels decline rapidly, reaching pre-pregnancy levels in about 72 hours. Some
researchers have demonstrated a link between rapidly declining hormone levels
and the appearance of symptoms associated with depression in the post partum
period.
More recent research is focusing
on the relationship between prolactin levels and symptoms of depression.
Prolactin levels are lower at the time of delivery but begin to rise sharply in
the first week following delivery.
Changes in the blood levels of
adrenal steroids like cortisol and aldosterone occur in the post partum period
and researchers believe there could be a link between these changes and the
frequency with which women experience mood changes in the post partum period.
Some of the current research indicates that a
relationship exists between premenstrual syndrome (PMS) and post partum
depression, with higher rates of depression being experienced by women who
suffer from PMS.
Stress
Having a baby is supposed to be a time of great joy and
excitement for new mothers. No new mother can fully comprehend the enormous
amount of work that is involved in caring for a newborn child until she actually
begins to meet the everyday challenges of motherhood. The initial period
following the birth of a child is often filled with a multitude of emotions. One
moment you may be feeling exhilarated and on top of the world and the next
moment you may feel frustrated, inadequate and totally incapable of meeting the
newest challenges that motherhood has delivered to your doorstep.
Physical exhaustion, sleep
deprivation, a colicky baby, unrealistic role expectations and the social
isolation that follow childbirth can all contribute to the depth of depression
that might occur following delivery. Although none of these factors alone have
been seen as the sole cause of post partum depression, it appears that
psychosocial factors play a role in post partumdepression.
Prior history of a mood disorder
A prior history of
depression increases the risk that a woman will experience postpartum
depression. Studies show that one-third of women with a previous depression
experience will relapse in the post partum period and half of women who become
depressed after one delivery will experience depression after subsequent
deliveries.
Even though the exact causes of post partum depression
have yet to be pinpointed, current research appears to link this disorder to the
brain's neurotransmitters, which are directly responsible for how we feel and
are influenced by hormonal and situational factors.
How can I recognize
postpartum depression?
Since most women experience some
form of the "baby blues" it is easy to see how worsening symptoms could go
untreated and unrecognized as a form of real illness. Post partum depression is
not just a "funk" that will go away. It is a serious illness, like diabetes,
high blood pressure and other ailments that require medical intervention for
successful management.
Increasing awareness about post
partum depression is an important first step in treating the disorder. Post
partum illness can be divided into three categories although the symptoms may
overlap form one category to another.
Baby blues
The "baby blues" are
different than post partum depression in that the blues usually subside in a few
weeks and they do not lead to a crisis situation in which the woman's ability to
function is greatly impaired or lost. The "baby blues" usually occur during the
first week after birth and are characterized by feelings of sadness in the new
mother, emotional instability, crying, and fatigue. The symptoms are usually
explained as the "let down" that follows the emotionally charged experience of
childbirth. The "baby blues" are self-limiting and resolve spontaneously.
Postpartum Depression
Although most women report
a period where emotions fluctuate after childbirth, some women go on to develop
more severe symptoms that can become quite disabling, leading to an inability to
function and perform the activities of daily living. Post partum depression can
begin at any time during the first year after childbirth and left untreated it
can linger for several years.
Several self-assessment tools
are available to screen for post partum depression. The tools are designed to
help a woman recognize signs and symptoms that may indicate a more serious mood
disorder. Women who experience postpartum depression often describe the
following feelings or symptoms:
- Extreme fatigue,
sluggishness, exhaustion
- Feelings of sadness,
hopelessness and misery
- Appetite disturbances
- Feeling extremely anxious,
scared, and panicked for much of the day
- Thoughts of harming oneself
or the baby
Postpartum Psychosis
This is a relatively rare disorder that occurs in the
first few weeks following childbirth. It is characterized by extreme confusion,
agitation, and the general the inability to care for one's self or baby and it
requires immediate medical intervention.
How is postpartum
depression treated?
Treatment for postpartum depression is variable,
depending on the type and severity of symptoms that a woman may experience. All
of the symptoms, whether mild or severe are temporary and treatable with the
support of a skilled professional.
Medical evaluation by a
counselor or physician who is familiar with postpartum depression is an
important first step in the treatment process. Tests to rule out the presence of
other illnesses like thyroid disease or anemia are often performed as part of
the initial evaluation.
Psychotherapy can be an
important tool in helping the woman to identify factors that may be contributing
to her depression. Individual or family counseling, along with participation in
a support group involving other women who have experienced this disorder may
prove beneficial.
Treatment with antidepressant
and anti-anxiety medications is case-specific and based on a risk-benefit ratio.
Factors such as the mother's symptoms, the decision whether or not to
breast-feed and the side effects of the medication all play a role in deciding
if and what medications should be used.
Overall it is widely accepted
that the treatment for post partum depression can be widely enhanced by
preventative efforts. In a recent prenatal prevention study (Herz 1992:73-37)
the following strategies were seen as successful in reducing the incidence of
emotional upheaval following childbirth:
- The responsibilities of
motherhood are learned, get as much information as possible beforehand
- Enlist the help of your
spouse, partner, friends and relatives. Social support is an important factor
in the period after childbirth.
- Interact with other couples who are experienced
parents.
- Get as much rest and sleep as possible. Don't
overload yourself with tasks that are unimportant. Relax your standards of
housekeeping and meal preparation if needed.
- Don't give up all of your outside activities and
interests. Stay connected with your friends and colleagues.
- Take care of yourself. Don't try to be a nurse
to relatives and others at this time.
- Discuss your worries and feeling with your mate.
- Don't plan on making major life changes soon
after the baby is born (i.e. Moving, career change).
- Arrange for babysitters early on. Time away from
the baby is necessary.
- Have a relationship with a medical professional
early on and don't be reluctant to seek help when needed.
What support services are available for new
mothers?
Many new parents find it beneficial to join a new mother or
parent's group after the birth of their child. Interaction with other new
parents who are experiencing the same circumstances has been shown to ease the
transition into parenthood for many participants. Your obstetrician, family
practice physician or pediatrician can most likely refer you to a support group
in your local area.
Courtesy Health AtoZReferences
Herz, E.K. (1992). Prediction,
Recognition, and Prevention. In J.A. Hamilton and P.N. Harberger, Postpartum
Psychiatric Illness: A picture puzzle. Philadelphia: University of Pennsylvania
Press.
Stowe Z.N. and Nemeroff CB.
Women at Risk for Postpartum onset major depression. AJOG 173 (2) 639-5. August
1995.
An Introduction To Postpartum Illness by Laurence
Kruckman and Susan Smith