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