CNN - Postpartum depression: More than the 'baby blues'

May 20, 1999
Web posted at: 11:04 AM EDT (1504 GMT)

By Pat Carolan

(WebMD) -- Having the blues after giving birth isn't all that unusual. As many as 50 percent to 80 percent of women experience the "baby blues": feelings of anxiety, sadness or crying spells, irritability, disturbed sleep (apart from baby interruptions) or change in appetite. Women and their families may be distressed by the experience, but it doesn't last long.

The baby blues usually arrive two to three days after delivery. And with lots of loving support, new moms are pretty much back to normal within two weeks. But not all feelings of sadness after the birth of a child are the baby blues. They may be symptomatic of a postpartum depression.

What's postpartum depression?

"Postpartum depression is a common, but frequently unrecognized, devastating mood disorder," says Kathryn Leopold, M.D., assistant professor of obstetrics at Albany Medical Center in New York. Most women who develop postpartum depression experience symptoms within six weeks of delivery, but not within the first two weeks. While similar to the baby blues, postpartum depression is more severe and longer-lasting, with symptoms including:

Anxiety, sadness or despair

Feelings of worthlessness or guilt, especially failure at motherhood

Loss of interest in usually pleasurable activities

Difficulty concentrating or making decisions

Fatigue

Changes in appetite or sleep

Recurrent thoughts of death or suicide

What's the risk of having a postpartum depression?

Approximately 10 to 15 percent of all new mothers and 25 to 30 percent of teen-age mothers experience a postpartum depression. All women are at risk. However, certain factors increase the risk:

History of psychiatric illness -- especially depression, substance abuse or eating disorder

Family history of depression or anxiety disorder

Poor marital relationship, especially an abusive relationship

Lack of social supports such as family and friends

Stress of caring for other children

What causes postpartum depression?

As with other types of depression, the cause of postpartum depression is unknown. However, research suggests a probable combination of factors may be responsible, says Leopold. A woman experiences a dramatic change in her body chemistry after giving birth as a result of the sudden drop in estrogen and progesterone. She also experiences increased stress with an equally sudden change in role and responsibility. Add a biological or genetic predisposition to depression and/or a psychological predisposition (such as pessimism or low self-esteem), and you may have the basis for a postpartum depression.

How successful is treatment?

Most women make a full recovery, says Marlene Casiano, M.D., a Chicago-based psychiatrist with a subspecialty in postpartum depression. But they are at risk of recurrent episodes of depression with subsequent pregnancies, at menopause, or during times of high stress.

As in other types of depression, early identification and treatment are the keys to successful recovery. Unlike the baby blues, postpartum depression doesn't disappear spontaneously.

The treatment for postpartum depression is the same as for other major depressions: antidepressant medication, often in conjunction with psychotherapy. As with any other medication, special attention must be paid if a woman is breast-feeding -- it may limit the choice of antidepressant medication, but it doesn't rule it out. Electroconvulsive therapy may be used in situations when the depression is resistant to medication.

"With psychotherapy," continues Casiano, "instead of just individual therapy, we try to involve the husband and/or other support people in a woman's life -- those who can give her some help. And we encourage the woman to take time to take care of her own needs." Support groups for postpartum depression are also beneficial. Belonging to a group lets a woman know that she isn't alone in her experience, and that she will recover.

But first it's necessary to get treatment. Women experiencing symptoms of postpartum depression should talk with their obstetrician or a mental-health practitioner.

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