What Is Postpartum Depression?
Terminology: Also known as postnatal depression, postpartum nonpsychotic depression (PND) and postpartum neurotic depression.
Postpartum depression (PPD) is a form of moderate to severe depression that can occur after childbirth. It affects between 10 and 20 percent of women after delivery. Depression is more than just a feeling of being ‘down’ for a few days. It is a serious illness that involves chemical reactions in the brain that interfere with a person's ability to lead a normal life. Typically PPD does not develop straight away - it takes at least a week, or up to 6 to 8 weeks after delivery for symptoms to occur. In some cases it can even take up to a year before PPD starts, but doctors disagree about whether depression that develops months after delivery should be termed 'postpartum'.
How Long Does Postpartum Depression Last?
PPD can last well over a year, in fact two or three years is not uncommon. Additionally, symptoms may be particularly worse just before a period is due. PDD can also recur with future pregnancies. Generally speaking women in their childbearing years are particularly prone to depression and anxiety disorders. Mental disorders seem to be linked to hormone changes that peak in menarche, pregnancy and menopause. It is estimated that at least 50 percent of PPD cases go undetected and women just struggle through.
What Are The Symptoms?
Symptoms of postpartum depression: Initially the woman may feel quite happy after delivery, even elated and slightly ‘high’ before symptoms kick-in (this contrasts to the baby-blues, which appears almost immediately). What symptoms you then experience can vary greatly from woman to woman - in other words, one size does not fit all. However, whatever you feel, you should feel it everyday for at least 2 weeks for it to be considered true depression. The following is a list of some of the most common emotions reported:
• Anger, irritability, rage.
• Feeling overwhelmed and anxious.
• Sleeping too much or too little.
• Worrying about everything, all the time.
• Problems concentrating.
• Guilty feelings.
• Loss of libido.
• Reduced appetite, although occasionally increased.
• Feeling worthless and low self esteem.
• Backaches and other physical symptoms with no obvious cause.
• Sadness. Read more about the effects of depression.
What Are The Risk Factors?
Data from the latest Pregnancy Risk Assessment Monitoring System (PRAMS*) report the following as the top 5 risk factors:
1. Smoking during pregnancy, particularly in the third trimester.
2. Physical abuse before or during pregnancy.
3. Partner related stress during pregnancy.
4. Experiencing a stressful event during pregnancy, such as death of a loved one, premature delivery or illness.
5. Financial stress during pregnancy.
Other risks include:
• Being under the age of 20.
• Having a history of severe premenstrual syndrome (PMS).
• Suffering depression or an anxiety disorder before pregnancy.
• Having a family history of depression.
*PRAMS, run by the CDC, studies women in the United States who have given birth within the last 2 to 6 months.
What Causes It?
Causes of postpartum depression: There is no single cause of depression - it is usually a combination of factors:
Genetics: Depression is a mental illness which tends to run in families.
Chemicals: A chemical imbalance in the brain is believed to play a big role.
Hormones: Hormones appear to play a major role, we know for example that hormones directly affect the brain chemicals that control mood. Women are more prone to developing depression in puberty, during and after pregnancy and during perimenopause when their hormone balance is most changeable. Symptoms of PPD can worsen in the days approaching a period.
Trauma: Death of a loved one, being the victim of a violent crime or accident, abuse and poverty.
Thyroid Hormones: Levels of thyroid hormones can cause depression, so it is worth asking your doctor to perform a simple blood test to check for thyroid disease.
Other factors include:
• Changes in social relationships and work patterns.
• Having less time and freedom for yourself.
• Not getting enough sleep.
• Being worried about your ability as a mother.
Is It The Same As 'Baby Blues?'
No, baby blues is much milder and shorter form of depression - in fact, it is not considered 'depression' in the medical sense, but rather a temporary mood change (as PMS is) caused by hormone changes. It does not require treatment. Research shows that between 50 and 85 percent of new moms get the baby blues.
• Appears out of the blue, typically between days 3 and 5 after childbirth.
• Lasts a few days but can linger for 2 to 3 weeks.
• Lack of concentration.
• Stress. Take our online stress test to check if you are stressed.
• Feeling vulnerable.
If your symptoms do not disappear after 2 weeks or if they become more severe and intense, talk to your doctor. The baby blues may have developed into PPD.
How Is It Diagnosed?
Postpartum depression diagnosis: There is no one test that can diagnose PPD. Primarily your physician will diagnose based on your symptoms, how severe they are, when they started and how long they have lasted. It is important not to feel embarrassed and say if things are not great. Your doctor may also:
1. Ask you to complete a questionnaire such as the Edinburgh Postnatal Depression Scale (EPDS) to assess your likelihood of being depressed.
2. Perform a blood test. Between 2 and 4 percent of women who appear to have postpartum depression in fact have thyroid problems. The symptoms can be similar (see signs of thyroid disease).
It should be noted that many family doctors and Ob/gyn now only perform the above tests to screen for signs of depression; preferring to refer patients to a mental health worker for a more professional assessment and diagnosis.
How Is Postpartum Depression Treated?
There are two main types of treatment for postpartum depression: talk therapy and medications, a combination of which can cure the condition.
Talking To An Expert
This involves talking to a psychologist, therapist or social worker to help change the way you think, feel and act. A therapist will help you draw up a wellness action plan which may involve dietary advice and group therapy.
Depending on your symptoms, you may be prescribed antidepressants for postpartum depression. These are usually taken for a year and then reduced gradually to avoid a relapse. Selecting the right drug or drug combination will involve some trial-and-error. Ideally dosages should be kept as low as possible to allow the mother to care for herself and her baby. If you plan on breastfeeding, talk to your doctor about the specific side-effects of your medications. There are two main types of medications prescribed to women with postpartum depression. These are tricyclics (TCAs) including Norpramin, Pamelor, Elavil and Tofranil; and selective serotonin reuptake inhibitors (SSRIs) including Paxil, Prozac, Lexapro and Zoloft.
See also: Natural treatment for postpartum depression for advice on supplements, herbs and alternative therapies.
What If It's Not Treated?
Women who are untreated run the risk of:
• Eating poorly.
• Becoming exhausted through lack of sleep.
• Missing postnatal doctor visits.
• Seeking 'feel good' fixes from smoking cigarettes or drinking alcohol.
• Untreated depression turning to chronic depression. This means you develop relapses for the rest of your life. 25 percent of women with untreated PPD still have it after 1 year.
• Not being able to meet their child's needs.
They are less likely to breastfeed, sing to their baby or implement child safety practices. This can ruin the mother's confidence, so she becomes even more depressed. Research also shows that her baby is likely to be affected and have behavioral problems (like crying more and have difficulties socially interacting with people later in life).
Is PDD preventable? Read more about prevention of postpartum depression.