Postpartum Depression


Research has shown that 50 percent to 75 percent 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.

In about 10 percent to 15 percent of new mothers, the period of “baby blues” becomes quite severe and disabling, resulting in a full-blown illness. Only relatively recently the medical community recognized how frequently the disorder occurs, and it has subsequently been termed “postpartum 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 overly 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 postpartum depression.

If you think you may be suffering from postpartum depression, consult your health care provider at once. Recognizing the disease is the first step in treating it.

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 the depression that occurs in the postpartum period.

Current research still has not determined the exact cause of postpartum depression. What is known is that pregnancy and the postpartum period following the delivery are times of great biochemical upheaval, complicated by increasing social and psychological changes. These can create an environment for postpartum depression.

The following risk factors have been identified for postpartum depression:

  • Marital problems
  • Depression/anxiety during pregnancy
  • Lack of or poor social support systems
  • Stress or negative life events occurring during pregnancy, such as the death of a parent or close relative or a move to a new location; previous postpartum depression or mood disorder
  • Traumatic birth experience
  • Early hospital discharge following childbirth
  • History of severe premenstrual syndrome (PMS)
  • Previous postpartum depression or mood disorder

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 tenfold. 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 of postpartum depression.

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 such as cortisol and aldosterone occur in the postpartum period. Researchers believe there could be a link between these changes and the frequency with which women experience mood changes in the postpartum period. Some current research indicates a relationship between PMS and postpartum depression. Women who suffer from PMS have higher rates of depression.

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 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. 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 all can contribute to the depth of depression that might occur following delivery. Although none of these factors alone is seen as the sole cause of postpartum depression, it appears that psychosocial factors play an important role in postpartum depression.

Prior history of depression A prior history of depression increases the risk that a woman will experience postpartum depression. Studies show that one-third of women with previous depression will relapse in the postpartum period. In addition, half of women who become depressed after one delivery will experience depression after subsequent deliveries.

Even though the causes of postpartum 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 to 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. Postpartum depression is not just a “funk” that will go away. It is a serious illness, such as diabetes, high blood pressure and other ailments that require medical intervention for successful management.

Increasing awareness about postpartum depression is an important first step in treating the disorder. Postpartum illness can be divided into three categories, although the symptoms may overlap from one category to another.

Baby blues The “baby blues” is different than postpartum depression in that the blues usually subside in a few weeks and do not lead to a crisis situation in which the woman’s ability to function is greatly impaired or lost. The “baby blues” usually occurs during the first week after birth and is characterized by feelings of sadness in the new mother, emotional instability, crying and fatigue. The symptoms are usually explained as the “letdown” that follows the emotionally charged experience of childbirth. “Baby blues” is self-limiting and resolves spontaneously.

Postpartum depression. Although most women report a period when emotions fluctuate after childbirth, some women develop more severe symptoms that can become quite disabling, leading to an inability to function and perform daily activities. Postpartum depression can begin at any time during the first year after childbirth. Left untreated, it can linger for several years.

Several self-assessment tools are available to screen for postpartum 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:

Several self-assessment tools are available to screen for postpartum 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 and exhaustion
  • Feelings of sadness, hopelessness and misery
  • Difficulty sleeping
  • Appetite disturbances
  • Feeling extremely anxious, scared and panicked for much of the day
  • Inability to cope with every day situations
  • Unrealistic concerns for the baby’s well-being
  • Thoughts of harming oneself or the baby

Postpartum psychosis This relatively rare disorder occurs in the first few weeks following childbirth. It is characterized by extreme confusion, agitation and the general inability to care for oneself or the baby. It requires immediate medical intervention.

How is postpartum depression treated?

Treatment for postpartum depression varies, depending on the type and severity of symptoms that a woman is experiencing. 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, such as thyroid disease or anemia, are often performed as part of the initial evaluation.

Psychotherapy can be an important tool in helping a woman identify factors that may be contributing to her depression. Individual or family counseling along with participation in a support group with 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 breastfeed and the side effects of the medication all play a role in deciding if medications should be used.

Overall, it is widely accepted that the treatment for postpartum depression can be greatly enhanced by preventative efforts. In a recent prenatal prevention study, 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 feelings with your mate.
  • Don’t plan on making major life changes soon after the baby is born, such as moving or a career change.
  • Arrange for babysitters as soon as possible. Time away from the baby is necessary.
  • Have a relationship with a medical professional ,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 mothers or parents 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 or pediatrician can most likely refer you to a support group in your local area.