July 5, 2005
PostPartum Blues and Depression
Dr. Amy Mouvius, MD
Celebrity antics aside, postpartum depression is unequivocally real. It may be found in the Diagnostic and Statistic Manual of Mental Disorders, under mood disorders with a “postpartum onset specifier”. This reference, called the DSM for short, is the ultimate dictionary of mental illness used by medical and mental health professionals.
Postpartum depression is not the same as having the “baby blues”. Post partum blues describe a temporary, generally mild condition of mood swings, irritability, anxiety, insomnia and crying spells that occurs in 40-80% of women after giving birth. The symptoms generally start 2-3 days after giving birth and are (thankfully) resolved in about 2 weeks. These “blues” are attributed to the dramatic hormonal shifts that occur immediately after having a baby. Treatment for this condition consists of providing support and reassurance to the family and ensuring that the new mother has time to sleep and rest.
Postpartum depression is a condition with more severe and prolonged symptoms. The reported incidence varies but is estimated to be greater than 10% of new mothers. It recurs in 50% of these women with future pregnancies. The symptoms of postpartum depression, or PPD, typically begin within 4 weeks of giving birth. There is no single cause of postpartum depression. Rather, the development of PPD is likely due to a combination of genetic susceptibility, hormonal changes, and major life events. As such, there are many risk factors for PPD. Some of these include personal or family history of depression, being single or having marriage problems, lack of social/emotional/financial support, having an unplanned pregnancy or previous miscarriage, stressful events occurring in the previous year, concerns about childcare, and having a child born with medical problems.
The symptoms of PPD are the same as for other forms of depression, but may be more challenging to identify because of the “normal” rigors of new parenthood. These include oversleeping or insomnia, a profound lack of energy, appetite and weight changes and lack of sex drive. Other symptoms include anxiety/panic attacks, intense irritability or anger, guilt, feeling overwhelmed and unable to care for the child, feeling a failure as a mother, and not bonding with the new baby. Some women with PPD will also have obsessive thoughts of hurting themselves or their baby.
Postpartum depression is underreported. Many women feel isolated, ashamed and guilty and will conceal their symptoms. New mothers are more likely to admit symptoms if directly asked. The first line treatment of PPD includes psychosocial therapies which can take the form of individual, family or group counseling. Light therapy has also shown promise in women with PPD. Medications, such as antidepressants, may also be used with good results. The most important step is to identify the condition. Identifying PPD promptly and providing treatment improves the long-term outcome for mother, baby and the whole family.