Postpartum Depression

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Definition

Postpartum depression is a mood disorder that begins after childbirth and usually lasts beyond six weeks.

Description

The onset of postpartum depression tends to be gradual and may persist for many months, or develop into a second bout following a subsequent pregnancy. Postpartum depression affects approximately 15% of all childbearing women. Mild to moderate cases are sometimes unrecognized by women themselves. Many women feel ashamed if they are not coping and so may conceal their difficulties. This is a serious problem that disrupts women's lives and can have effects on the baby, other children, her partner, and other relationships. Levels of depression for fathers also increase significantly.

Postpartum depression is often divided into two types: early onset and late onset. An early onset most often seems like the "blues," a mild brief experience during the first days or weeks after birth. During the first week after the birth up to 80% of mothers will experience the "baby blues." This is usually a time of extra sensitivity and symptoms include tearfulness, irritability, anxiety, and mood changes, which tend to peak between three to five days after childbirth. The symptoms normally disappear within two weeks without requiring specific treatment apart from understanding, support, skill, and practice. In short, some depression, tiredness, and anxiety may fall within the "normal" range of reactions to giving birth.

Late onset appears several weeks after the birth. This involves a slowly growing feeling of sadness, depression, lack of energy, chronic tiredness, inability to sleep, change in appetite, significant weight loss or gain, and difficulty caring for the baby.

— David James Doermann

(psychology) Any acute depression occurring within approximately 3 months following childbirth.

"I'm going to take a wild guess and say that Mr. Cruise has never suffered from postpartum depression."

Thus began Brooke Shields's response to Tom Cruise's broadside against psychiatry, particularly psychiatric drugs. Ms. Shields is the author of Down Came the Rain: My Journey Through Postpartum Depression.

Link: War of Words

Posted July 3, 2005.

See our Word Overheard blog to see interesting uses of strange words.

A moderate to severe form of depression which occurs in women beginning approximately 2 to 3 weeks after childbirth as a result of physical and psychological factors. Symptoms include fatigue, loss of appetite, and lack of enthusiasm for everyday activities.

Definition

Postpartum depression is a mood disorder that begins after childbirth and usually lasts at least six weeks.

Description

Postpartum depression, or PPD, affects approximately 15% of all childbearing women. The onset of postpartum depression tends to be gradual and may persist for many months, or develop into a second bout following a subsequent pregnancy. Mild to moderate cases are sometimes unrecognized by women themselves. Many women feel ashamed and may conceal their difficulties. This is a serious problem that disrupts women's lives and can have effects on the baby, other children, her partner, and other relationships. Levels of depression for fathers can also increase significantly.

Postpartum depression is often divided into two types: early onset and late onset. Early-onset PPD most often seems like the "blues," a mild brief experience during the first days or weeks after birth. During the first week after the birth, up to 80% of mothers will experience the "baby blues." This period is usually a time of extra sensitivity; symptoms include tearfulness, irritability, anxiety, and mood changes, which tend to peak between three to five days after childbirth. The symptoms normally disappear within two weeks without requiring specific treatment apart from understanding, support, skills, and practice. In short, some depression, fatigue, and anxiety may fall within the "normal" range of reactions to giving birth.

Late-onset PPD appears several weeks after birth. It involves slowly growing feelings of sadness, depression, lack of energy, chronic fatigue, inability to sleep, change in appetite, significant weight loss or gain, and difficulty caring for the baby.

Causes & Symptoms

At present, experts cannot always say what causes postpartum depression. Most likely, it is caused by a combination of factors that vary from person to person. Some researchers think that women are vulnerable to depression at all major turning points in their reproductive cycle, childbirth being only one of these markers. Factors before the baby's birth that are associated with a higher risk of PPD include severe vomiting (hyperemesis), premature labor contractions, and psychiatric disorders in the mother. In addition, new mothers commonly experience some degree of depression during the first weeks after birth. Pregnancy and birth are accompanied by sudden hormonal changes that affect emotions. Additionally, the 24-hour responsibility for a newborn infant represents a major psychological and lifestyle adjustment for most mothers, even after the first child. These physical and emotional stresses are usually accompanied by inadequate rest until the baby's routine stabilizes, so fatigue and depression are not unusual.

In addition to hormonal changes and disrupted sleep, certain cultural expectations appear to place women from those cultures at increased risk of postpartum depression. For example, women who bear daughters in societies with a strong preference for sons are at increased risk of postpartum depression. In other cultures, a strained relationship with the husband's family is a risk factor. In Western countries, domestic violence is associated with a higher rate of PPD.

Experiences of PPD vary considerably but usually include several symptoms.

Feelings:

• persistent low mood
• inadequacy, failure, hopelessness, helplessness
• exhaustion, emptiness, sadness, tearfulness
• guilt, shame, worthlessness
• confusion, anxiety, and panic
• fear for the baby and of the baby
• fear of being alone or going out

Behaviors:

• lack of interest or pleasure in usual activities
• insomnia or excessive sleep, nightmares
• not eating or overeating
• decreased energy and motivation
• withdrawal from social contact
• poor self-care
• inability to cope with routine tasks

Thoughts:

• inability to think clearly and make decisions
• lack of concentration and poor memory
• running away from everything
• fear of being rejected by partner
• worry about harm or death to partner or baby
• ideas about suicide

Some symptoms may not indicate a severe problem. However, persistent low mood or loss of interest or pleasure in activities, along with four other symptoms occurring together for a period of at least two weeks, indicate clinical depression, and require adequate treatment.

There are several important risk factors for postpartum depression, including:

• stress
• lack of sleep
• poor nutrition
• lack of support from one's partner, family, or friends
• family history of depression
• labor/delivery complications for mother or baby
• premature or postmature delivery
• problems with the baby's health
• separation of mother and baby
• a difficult baby (temperament, feeding, sleeping problems)
• pre-existing neurosis or psychosis

Diagnosis

Diagnosis of postpartum depression can be made through a clinical interview with the patient to assess symptoms.

Treatment

Postpartum depression can be effectively alleviated through counseling and support groups, so that the mother does not feel she is alone in her feelings. Acupuncture, Chinese herbs, and Western herbs can all help the mother suffering from postpartum depression return to a state of balance.

Recommended herbal remedies to ease depressive episodes may include damiana (Turnera diffusa), ginseng (Panax ginseng), lady's slipper (Cypripedium calceolus), lavender (Lavandula angustifolia), oats (Avena sativa), rosemary (Rosmarinus officinalis), skullcap (Scutellaria laterifolia), St. John's wort (Hypericum perforatum), and vervain (Verbena officinalis). Women who are breastfeeding or are suffering from a chronic medical condition should consult a healthcare professional before taking any herbal remedies.

Some strategies that may help new mothers cope with the stress of becoming a parent include:

• Valuing her role as a mother and trusting her own judgment.
• Making each day as simple as possible.
• Avoiding extra pressures or unnecessary tasks.
• Trying to involve her partner more in the care of the baby from the beginning.
• Discussing with her partner how both can share the household chores and responsibilities.
• Scheduling frequent outings, such as walks and short visits with friends.
• Sharing her feelings with her partner or a friend who is a good listener.
• Talking with other mothers to help keep problems in perspective.
• Trying to sleep or rest when the baby is sleeping.
• Taking care of her health and well being.

Allopathic Treatment

Several treatment options exist, including medication, psychotherapy, counseling, and group treatment and support strategies, depending on the woman's needs. One effective treatment combines antidepressant medication and psychotherapy. These types of medication are often effective when used for three to four weeks. Any medication use must be carefully considered if the woman is breastfeeding, but with some medications, continuing breastfeeding is safe. Nevertheless, medication alone is never sufficient and should always be accompanied by counseling or other support services.

Expected Results

With support from friends and family, mild postpartum depression usually disappears quickly. If depression becomes severe, a mother cannot care for herself and the baby, and in rare cases, hospitalization may be necessary. However, medication, counseling, and support from others usually work to cure even severe depression in three to six months.

Prevention

Exercise can help enhance a new mother's emotional well-being. New mothers should also try to cultivate good sleeping habits and learn to rest when they feel physically or emotionally tired. It is important for a woman to learn to recognize her own warning signs of fatigue and respond to them by taking a break.

Resources

Books

Murray, Lynne, and Peter J. Cooper, eds. Postpartum Depression and Child Development. New York: Guilford Press, 1999.

Sebastian, Linda. Overcoming Postpartum Depression and Anxiety. LPC, 1998.

Periodicals

Burt, V. K., and K. Stein. "Epidemiology of Depression Throughout the Female Life Cycle." Journal of Clinical Psychiatry 63 (2002, Supplement 7): 9–15.

Danaci, A. E., G. Dinc, A. Deveci, et al. "Postnatal Depression in Turkey: Epidemiological and Cultural Aspects." Social Psychiatry and Psychiatric Epidemiology 37 (March 2002): 125–129.

Josefsson, A., L. Angelsioo, G. Berg, et al. "Obstetric, Somatic, and Demographic Risk Factors for Postpartum Depressive Symptoms." Obstetrics and Gynecology 99 (February 2002): 223–228.

Patel, V., M. Rodrigues, and N. DeSouza. "Gender, Poverty, and Postnatal Depression: A Study of Mothers in Goa, India." American Journal of Psychiatry 159 (January 2002): 43–47.

Organizations

Depression After Delivery (D.A.D.). P.O. Box 1282, Morrisville, PA 19067. (800) 944-4773. .

Postpartum Support International. 927 North Kellog Avenue, Santa Barbara, CA 93111. (805) 967-7636. .

[Article by: Paula Ford-Martin; Rebecca J. Frey, PhD]

The term postnatal (or postpartum) depression describes a condition occurring in a woman after giving birth to her child. The symptoms are depression, anxiety, lack of interest in the baby, and feelings of inadequacy and incompetence as a mother. It occurs among 10 to 15 percent of mothers after delivery, with onset at five to eight weeks after delivery. It is underestimated by professionals and often denied by women, who usually do not seek medical advice. It commonly lasts six months to a year or longer. It causes a lack of attunement in the mother and infant dyad and can lead to early developmental and psychosomatic problems in the baby, making diagnosis and treatment essential (Murray, L., et al., 1991; Mazet, P., 1997). Jeni Holden et al. (1989) demonstrated the therapeutic efficacy of nondirective psychological interviews; A. F. Henderson et al. (1991) note the positive effects of estrogen therapy; R. Channi Kumar et al. (1984) and Donald Meltzer emphasize the need for professionals to coordinate their efforts in treating this pathology, which is still poorly understood and is situated at the intersection of obstetrics, pediatrics, and health services.

B. Pitt (1968) gave the first description of an "atypical postnatal depression" that affected a minority of women, but occurred at a rate of 10.8 percent in a sample of 305 women after delivery. The Edinburgh Postnatal Depression Scale (EPDS), a questionnaire for mothers developed and validated by John Cox et al. (1987), John Cox and Jeni Holden (1994), and Nicole Guedeney et al. in France (1995), makes it possible to diagnose postnatal depression from the sixth week after delivery (when the postnatal obstetrical visit is usually scheduled).

Postnatal depression can be classed among other postnatal psychiatric conditions, ranging from the blues to postpartum traumatic neuroses (Bydlowski and Raoul-Duval, 1978) and the acute postpartum psychoses that have been described since the nineteenth century (Marcé, L.-V., 1858). In a psychodynamic study, Paul-Claude Racamier et al. (1961) developed the concept of "maternality." The event of childbirth occasions reversible changes in the psyche whose transparency has been described by Monique Bydlowski (1997). This involves, on the one hand, a reactivation of the themes of the young woman's infantile neuroses, namely castration anxiety and the avatars of her pre-oedipal links to her own mother, and, on the other hand, a particular capacity for regression that enables her to achieve a psychic functioning that is more in tune with her newborn, as Donald Winnicott showed (1956). The conflicted development of this maternality is theorized as being the origin of some psychopathologies.

Postnatal depression differs from a depressive state in the strict sense, in that anxiety and the mother's feelings of inadequacy it produces often dominate the picture. It should also be distinguished from postpartum blues (Yalom, I., et al., 1968; Kennerley, H., et al., 1989), a reaction whose peak frequency occurs on the third day after delivery and which affects half of all women; it is characterized by irritability, mood swings, and crying spells, with spontaneous resolution in one to ten days. A particularly lasting or intense case of the blues may be an indicator of the subsequent likelihood of true postnatal depression (Fossey, L., et al., 1997).

Bibliography

Bydlowski, Monique. (1997). La dette de vie: itinéraire psychanalytique de la maternité. Paris: Presses Universitaires de France.

Bydlowski, Monique, and Raoul-Duval, Anne. Un avatar psychique méconnu de la puerpuéralité: la névrose traumatique post-obstétricale. Perspectives psychiatriques, 68, 321-328.

Cox, John, and Holden, Jeni (eds.). (1994). Perinatal psychiatry: Use and misuse of the Edinburgh Postnatal Depression Scale. London: Gaskell.

Cox, John L., Holden, Jeni M., and Sagovsky, R. (1987). Detection of postnatal depression. British Journal of Psychotherapy, 150, 782-786.

Fossey Luc, Papiernik, E., and Bydlowsky Monique. (1997). Postpartum blues: A clinical syndrome and predictor of postnatal depression. Journal of Psychosomatic Obstetric Gynecology, 18, 17-21.

Guedeney, Nicole, Fermanian, J., Guelfi, J.D., Delour, M. (1995). Premiers résultats de la traduction de l'Edinburgh post-natal depression scale sur une population parisienne. Devenir, 7 (2), 69-90.

Henderson, A F, Gregoire, A J, Kumar, RD, Studd, JW. (1991). Treatment of severe postnatal depression with oestradiol skin patches. Lancet, 338, 816-17.

Holden, Jeni, Sagovsky R, and Cox, John L. (1989). Counselling in a General Practice Setting: A controlled study of health visitor intervention in treatment of postnatal depression. British Medical Journal, 298, 223-226.

Kennerley, H, Gath, D. (1989, Sept.). Maternity blues I. Detection and measurement by questionnaire. British Journal of Psychotherapy, 155, 356-62

Kumar R. Channi, Robson KM. (1984). A prospective study of emotional disorders in childbearing women. British Journal of Psychotherapy, 144, 35-47.

Marcé, Louis-Victor. (1958). Traité de la folie des femmes enceintes, des nouvelles accouchées et des nourrices et considérations médico-légales qui se rattachentà ce sujet. Paris: Bailliére.

Mazet, Philippe. (1997). Quels sont les particularités cliniques des troubles dépressifs chez le nourrisson? In Les troubles dépressifs chez l'enfant: reconnaître, soigner, prévenir, devenir (pp. 25-32). Paris: Frison-Roche.

Murray, L., Cooper, PJ., and Stein, A. (1991). Postnatal depression and infant development. British Medical Journal, 302, 978-979.

Pitt, B. (1968). "Atypical" Depression Following Childbirth. British Journal of Psychotherapy. 114, 1325-1335.

Racamier, Paul-Claude. La mère et l'enfant dans les psychoses du post-partum. Evolution Psychiatrique 1961, 26, 4: 526-570.

Winnicott, Donald W. (1956). Primary maternal preoccupation. Collected papers, Through paediatrics to psychoanalysis (pp. 300-305). London: Tavistock, 1958.

Yalom, Irwin D, Lunde, T, Moos, RH and Hamburg, DA. (1968). "Postpartum Blues" syndrome. Arch Gen Psychiat, 18: 16-27.

—MONIQUE BYDLOWSKI