Postpartum depression

The "baby blues" have always been viewed as a normal part of the postpartum period. Usually starting between the third and fifth day after delivery, feelings of mild depression, crying spells, anxiety, irritability, and mood swings occur in as many as 85% of women. Because this expected phase of mothering is so common, and usually resolves after a few days without any intervention, health care professionals often ignored these symptoms, and left the new mothers and families to deal with it on their own.
In the past few years, mothers and doctors have become more aware of the high incidence of postpartum blues. They are realizing that often the "blues" are much more than a temporary normal phase that "every mother goes through." Some mothers will continue into a more severe depression that, if ignored and untreated, can have severe consequences for the new mother and baby.
Postpartum Depression occurs in 10 to 15 percent of deliveries. It is much more than the standard "baby blues" discussed above. Most cases begin within the first few weeks after delivery, but onset can be delayed for several months. Symptoms include:

• Depressed mood
• Agitation
• Fatigue
• Lack of interest in pleasurable activities
• Poor concentration and decision making
• Poor appetite
• Insomnia
• Feelings of failure as a mother
• Guilt
• Unusual worry over infant's health
• Suicidal thoughts

How can you distinguish the difference between routine baby blues and postpartum depression? To diagnose postpartum depression, the following criteria must be met:

• Symptoms persist for more than 2 weeks
• Depressed mood or lack of interest in pleasurable activities must occur much of the day, almost every day
• At least four of the remaining symptoms must be present

Other characteristics of postpartum depression that emphasize the importance of prevention and treatment for this disorder include:

• It affects 30 percent of adolescent deliveries.
• Many cases last more than six months, and untreated, can persist for over a year.
• Many women will go on to have recurrent psychiatric disorders year after the postpartum depression resolves.
• In moderate to severe cases, some women will refuse to have any more children.
• Children of mothers with postpartum depression have a higher risk of behavioral problems and show lower scores on intellectual testing.
• Untreated, postpartum depression can have a devastating impact on the mother/infant relationship.

Because the ramifications of this disorder are so widespread, it is extremely important to identify prenatally those women who are at higher risk. Factors include:

• History of a mood disorder prior to pregnancy. One half of women with postpartum depression will have such a prior history.
• Postpartum depression with a previous child. There is a 30 percent chance of having the disorder with subsequent children.

Education about this disorder during prenatal classes can make families more aware of the risk factors and signs to watch for during the early postpartum weeks.
It is unclear exactly what causes postpartum depression, but research has shown that genetic risk, situational stresses, changes in a variety of hormones, and changes in certain chemicals in the brain may all play a roll in triggering this disorder.

Treating postpartum depression

Most uncomplicated cases can be managed by an OB/GYN with antidepressant medications. The two most common types are tricyclic antidepressants (TCA's) and serotonin reuptake inhibitors (SRI's). Counseling and support groups are an important part of treatment, as are regular exercise, good nutrition, and a supportive family.

Antidepressant medications and breastfeeding

Physicians sometimes recommend weaning while taking antidepressants or other psychiatric medications because it seems to them the safest and simplest alternative. Antidepressant medications have been researched and found to be safe during breastfeeding. You may have to be the one who seeks out additional information or who presses your physician to learn more about medications and breastfeeding. Impress upon the prescribing physician that you wish to continue breastfeeding and that this is an important part of how you care for and mother your baby. Abrupt weaning in itself can cause depression, so the effects of weaning on your feelings should not be taken lightly.
The most commonly used and safest medications during breastfeeding are the SRI's, which include Zoloft (sertraline) and Paxil (paroxetine). Prozac (fluoxetine) is and SRI, but side effects have been observed in infants, so it is a less preferable choice. In studies of many breastfeeding infants whose mothers were taking Zoloft, the drug has either been undetectable in the infant's blood or is present in insignificant amounts. Paxil would be the next choice.
St. John's Wort is also used for depression, however, there is conflicting research regarding its safety during breastfeeding. Some experts feel it is safe, while others do not. Until we know for sure, it is safer not to use it unless your doctor advises you to.

POSTPARTUM PSYCHOSIS

It is this extreme form of postpartum depression that has made the medical community and the general public more aware of postpartum mood disorders. Symptoms include (in addition to those above) delusions, hallucinations of the infant suffering from illness or even dying, severely impaired day-to-day functioning, and suicidal or homicidal thoughts. This severe disorder affects one or two per thousand deliveries. This is about 12 times the occurrence of psychosis in non-pregnant women. It usually begins during the first month, but can be delayed for 3 months. It is extremely important for the family and the doctor to recognize these symptoms so that immediate treatment and safeguards can be initiated.