Postpartum Depression

Introduction

Postpartum Depression (PPD) affects an estimated 10% of all mothers of newborn babies. Often confused with the "baby blues," PPD is a diagnosable medical condition requiring psychiatric care and pharmaceutical therapy. In contrast, the "baby blues" is a short-term condition (typically lasting about two weeks) that affects approximately 80% of women where the new mom feels overwhelmed, moody, prone to tears and may have trouble sleeping. Such symptoms are not initially cause for concern; however, prolonged bouts of symptoms could indicate PPD and medical attention should be sought. Because PPD can affect relationships between mothers and their newborns it is imperative that warning signals be addressed by a medical professional.

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Symptoms

Dangerous Signs in the Postpartum Period

  • Sleep problems that increase, especially problems returning to sleep after feeding the baby.
  • Eating problems – eating too much or too little.
  • An increase in depression or irritability, especially:
    • Self-deprecating thoughts or self-doubt.
    • Increasing discomfort with being a mother.
    • Fears for the child, infanticidal fantasies.
    • Death wish, suicide thoughts.
  • Lack of steps to counteract fatigue (i.e., not napping).
  • Avoiding people, becoming withdrawn, socially isolated.
  • Difficulty interacting with the baby.
  • Panic attacks.
  • Inability to reason; hallucinations, delusions.
  • Mania – feeling speedy, a decreased need to sleep, being distractible, irritable, excitable, and exhibiting pressured speech.

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Diagnosis

It is extremely important that a new mom be aware of the signs and symptoms of PPD and, if the signs are observed, seeks help immediately. It is also imperative that if she confesses her concern to her partner or a friend that she be taken seriously. It is better to be overcautious than let the woman suffer silently. Partners and doctors should also be aware of any changes in the new mother that may signal PPD, as she may not be aware of them herself.

If one displays any of the symptoms of PPD for more than two weeks it is advisable to see a doctor. A medical professional will listen to a description of the symptoms and ask several questions about the patient’s overall mood. The most commonly used resource for this is called the Edinburgh Postnatal Depression Scale. This short questionnaire determines your depression level. Blood work may be ordered to rule out any physical conditions such as a thyroid disorder or anemia.

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Causes

There is no one single cause of PPD, however many factors contribute to the onset of it. Physical, emotional and lifestyle changes all play a part in developing PPD.

Physical Changes:
A dramatic drop in hormones, specifically estrogen and progesterone, can contribute. Hormones produce by the thyroid gland may also drop sharply, resulting in feeling tired, sluggish and depressed. Changes in your blood volume, blood pressure, immune system and metabolism can lead to fatigue and mood swings.
Emotional Factors:
Sleep deprivation and a feeling of being overwhelmed can make it difficult to handle even minor problems. Feeling anxious about your ability to care for a newborn, the feeling that you have lost control of your life and feeling less attractive or struggling with your sense of identity can all play a part in developing PPD.
Lifestyle Influences:
Many different lifestyle factors can lead to the development of PPD. Lack of support from a spouse or partner, exhaustion, financial difficulties, other children to care for in addition to your newborn or trouble with breastfeeding are all factors.
Risk Factors:
While it is impossible to say for certain who will develop PPD, there are certain risk factors that may increase an individual’s chances. These include:
  1. History of depression.
  2. Previously suffering from PPD during a prior pregnancy.
  3. Stressful events occurring in the past year, including illness, job loss or pregnancy complications.
  4. Marriage trouble.
  5. Having a weak support system.
  6. If the pregnancy was unplanned or unwanted.
  7. Depression during the pregnancy.
  8. Formula feeding rather than breastfeeding.
  9. Infant temperament problems/colic.
  10. Single parenthood.

Every pregnancy and birth is different so while a person may have never previously suffered from PPD, they can still develop it with subsequent births.

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Effect of PPD on Infants

PPD has a negative effect on women who suffer from it, but it also impacts their newborn negatively. Studies have shown that women who suffer from PPD have trouble bonding with their baby, have an overall lack of interest in their baby, and less physical contact with their baby. Because the mother is depressed and detached, she may have trouble responding to her baby’s needs and her changing moods may cause the baby to mirror the mother’s emotions. There is evidence to indicate that at three months, children of depressed mothers smile less than average, turn their heads away from adults and seem more upset when they look at their mother’s face than when she leaves the room.

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Treatment

Many women are hesitant to begin taking medications for PPD because they are breastfeeding. There are, however, some non-medical options for treating PPD such as counseling or attending support groups.

If it is determined that psychological treatment alone is not enough, or the case of PPD is severe, medical intervention may be necessary. Antidepressants are most commonly prescribed to treat PPD. While studies have shown that all antidepressants secrete into breast milk, there are some that can be used while breastfeeding with minimal risk of side effects to your baby. All medications have an FDA drug risk category that indicates the safety of use when pregnant or breastfeeding. The categories range from A (safest) to X (known danger, do not use).

FDA Drug Use Categories
Category Description
A Controlled studies show no risk-Adequate, well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester of pregnancy.
B No evidence of risk in humans-Adequate, well controlled studies in pregnant women have not shown increased risk of fetal abnormalities despite adverse findings in animals.
Or
In the absence of adequate human studies, animal studies show no fetal risk. The chance of fetal harm is remote, but remains a possibility.
C Risk cannot be ruled out—Adequate, well-controlled human studies are lacking, and animal studies have shown a risk to the fetus or are lacking as well.
There is a chance of fetal harm if the drug is administered during pregnancy; but the potential benefits may outweigh the potential risk.
D Positive evidence of Risk-Studies in humans, or investigational or post marketing data, has demonstrated fetal risk. Nevertheless, potential benefits from the use of the drug may outweigh the potential risk. For example, the drug may be acceptable if needed in a life threatening situation or serious disease for which safer drugs cannot be used or are ineffective.
X Contraindicated in Pregnancy—Studies in animals or humans, or investigational or post-marketing reports, have demonstrated positive evidence of fetal abnormalities or risk which clearly outweighs any possible benefit to the patient.

Because 50% of women who have suffered from PPD will develop it again in subsequent pregnancies, it is recommended that they begin a course of antidepressants immediately following the birth of their next child as a preventative measure.

With treatment, the prognosis for women suffering from PPD is good. Most women will recover completely within a matter of months.

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Conclusion

Postpartum Depression is a treatable condition that should not be confused with the more common baby blues. It is important for mothers of newborns to have a good support system and be aware of how they are feeling, seeking medical attention immediately if they display any of the warning signs of PPD. With proper diagnosis and early treatment, PPD is an entirely treatable condition.

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References

Bennett, S. S., Ph.D., & Indman, P., Ed.D., MFT. (2003). Beyond the blues: A guide to understanding and treating prenatal and postpartum depression. San Jose, CA: Moodswings press.

Dunnewold, A., Ph.D., & Sanford, D. G., Ph.D. (1994). Postpartum survival guide. Oakland, CA: New harbinger publications.

Epperson, C. N., M.D. (n.d.). Postpartum major depression: Detection and treatment. In American family physician. Retrieved April 15, 1999, from http://www.aafp.org/‌afp/‌990415ap/‌2247.html

Federal drug administration. (n.d.). Retrieved May 27, 2009, from http://www.fda.gov/‌fdac/‌features/‌2001/‌301_preg.html#categories

Huysman, A., Ph.D. (1998). A mother’s tears: Understanding the mood swings that follow childbirth. New York: Seven Stories Press.

Misri, S., M.D., F.R.C.P.C. (2005). Pregnancy blues: What every woman needs to know about depression during pregnancy. New York: Bantam dell.

Wikipedia. (n.d.). Retrieved May 27, 2009, from http://en.wikipedia.org/‌wiki/‌Post_partum_depression

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