Postpartum Depression

What is postpartum depression?

Giving birth to a lovely bouncing baby is one of the most joyous moments in a woman’s life. Still, it is not uncommon for new mothers to feel down and depressed. The way you feel may have nothing to do with your character strength or your family concerns as you may be suffering from a common post-pregnancy complication called postnatal or postpartum depression (PPD) ^[1]. It is recommended to consult your health care provider regarding any necessary treatment options as PPD can become quite serious if left untreated.

What are the types of postnatal depression?

It can be classified in the following manner ^[2] depending on the severity of the symptoms:

Baby Blues (the least severe form of PPD)
Postpartum Depression (the moderate form)
Postpartum or Puerperal Psychosis (comparatively rare; causes severe depression) ^[3]

When does postpartum depression start?

The least severe form (baby blues) often starts within 1-3 days after childbirth ^[3] while both postnatal depression and psychosis can develop anytime from a few days to 6 months following delivery ^[4].

What are the signs and symptoms of postpartum depression?

Baby Blues Symptoms

Mood swings
Over-anxiety for your baby’s wellbeing
Sadness
Irritability ^[5]
Impatience
Trouble sleeping despite considerable tiredness ^[6]
Lack of concentration

Postpartum Depression Symptoms

The signs and symptoms are similar to those of baby blues, but are relatively intense, often interfering with the care of the child:

Insomnia (inability to sleep) or hypersomnia (excessive sleepiness)
Appetite loss ^[1]
Unexplained crying spells
Intense anger or irritability
Overwhelming fatigue
Severe mood swings
Feeling hopeless and helpless ^[7]
Feelings of guilt, shame or inadequacy
Difficulty or inability to bond with your child
Withdrawal from friends and family
Decreased libido

Postpartum Psychosis Symptoms

Confusion (inability to recognize family members and friends) ^[8]
Disorientation
Paranoia and suspicion ^[4]
Hallucinations and delusions
Attempting to harm your baby or yourself (risk of suicide or killing the baby) ^[9]
Restlessness
Racing thoughts
Frequent tearfulness

What causes postpartum depression?

Researches are being carried out to determine the exact causes responsible for PPD while the following factors are believed to play a significant role: Physical Changes

Sudden drop in the estrogen and progesterone levels after childbirth combined with lack of sleep ^[10]
The reduced levels of hormones produced by the thyroid gland
Rapid changes in the blood pressure, metabolism and immune system following childbirth ^[1]

Emotional Causes It is quite normal for you to feel anxious about your baby’s health and your ability to take care of the child. You may struggle with the changes in your daily routine or even feel like you are losing control over your own life. These factors may collectively lead to your depression and mood swings. Other Factors Social and financial factors like lack of support from your family or having a demanding job are considered possible contributing factors as well ^[11]. Having older children who have further demand on your time or inability or difficulty to breastfeed your baby may also make you depressed.

PPD after a Miscarriage or Stillbirth

It is quite common to have postnatal depression after suffering a miscarriage or stillbirth as all the normal physical changes responsible for PPD after childbirth (lowering hormone levels etc.) take place after these events as well ^[22]

Are there any risk factors for postpartum depression?

Having a family history of postpartum depression, bipolar disorder or any other mental disease
Experiencing stressful events in the past year ^[1]
Having twins or triplets^[39]
Problems in the family
Having financial problems
Unplanned or unwanted pregnancy
Smoking or drinking alcohol ^[13]
Being a teenage mother

How to prevent postpartum depression?

Here are some tips that may prevent or reduce the severity of PPD, helping to achieve a smoother recovery, especially in women at risk:

Doing some research on PPD so that you can recognize the earliest symptoms and seek immediate expert advice
Following a daily light exercise schedule (e.g. walking for 15 minutes) ^[14]
Following a nutritious diet
Taking a nap when the baby is sleeping
Practicing relaxation techniques like meditating and deep breathing or taking a warm bath everyday ^[15]
Avoiding making any major changes in your life right after childbirth
Trying not to have unrealistic expectations regarding childbirth and motherhood as movies and TV shows can be highly misleading when it comes to pregnancy and delivery^[12]
Interacting with your partner, family and friends as well as asking for their help to carry out everyday chores like cleaning and laundry
Talking with other new mothers, as it helps you realize that you are not alone in this
Finding some time for yourself, going out to visit your friends and spending time with your partner
Eating well and taking lots of rest to avoid stress during your pregnancy also goes a long way in avoiding postpartum depression ^[16]

Postnatal Depression Diagnosis

The diagnosis is done depending on the DSM (Diagnostic and Statistical Manual of Mental Disorders) published by the APA (American Psychiatric Association), which considered PPD to be a form of major depression^[1]. There are no tests or medical exams that can detect the problem at once. The diagnosis depends on your medical, mental and family history as well the results of physical exams and lab tests performed to rule out any other health condition that might lead to mental symptoms ^[17]. The criteria used for confirming the diagnosis generally include:

Severe depression that remains throughout the day, continuing for over 1-2 weeks
Significant change in appetite and/or body weight ^[1].
Insomnia or hypersomnia

Screening tools like Edinburgh postnatal depression scale, a questionnaire containing ten items for detecting and determining the severity of PPD, also helps with the diagnosis^[18].

Postpartum Depression Treatment

The treatment measures used for managing different types of PPD often varies from one another.

Dealing with the Baby Blues

It usually goes away on its own without any special treatment or medicines. Relaxing, taking lots of rest and eating healthy foods can help to speed up the recovery process. Avoiding alcohol is advisable as it may worsen the mood swings ^[1]. Your doctor may also prescribe a thyroid medication in case the symptoms are resulting from an underactive thyroid gland ^[19].

Treatment for Postpartum Depression

Psychological treatment

Counseling: Talking to a professional mental health care provider about your doubts and fears regarding the change in your role can help you better cope with your problems and depression ^[1]. Cognitive behaviour therapy (CBT): CBT helps to manage your feelings and disappointments by helping you to think positive and set realistic goals ^[20]. Interpersonal therapy (IPT): The principal object of this non-drug therapy is finding out if your relationship with family and friends is contributing to your depressive state. The therapy takes four to six sessions per week and is based on the belief that being able to interact better with those important to you (including your baby) makes you less likely to get depressed ^[21].

Antidepressant Medications

Antidepressants are sometimes used for treating severe cases with common drugs used for the purpose including selective-serotonin reuptake inhibitors (SSRIs) ^[22] like fluoxetine (Prozac), paroxetine (Paxil), citalopram (Celexa), sertraline (Zoloft) and nortriptyline (Pamelor) ^[23] as well as tri-cyclic antidepressants ^[24] like imipramine (Imavate) and lofepramine (Emdalen). Dummy tablets or placebos (pills containing no substances with medical value) have been found to help in reducing the psychological symptoms in women with mild PPD ^[24].

Hormone Therapy

Estrogen replacement therapy may help to balance the lowering estrogen levels after childbirth, managing the symptoms of PPD in some cases. However, the efficacy of this hormone therapy is still under research ^[25].

Postpartum Psychosis Treatment

A combination of psychotherapy and medication is necessary for treating postnatal psychosis. A woman suffering from puerperal psychosis should be kept under close observation at all times, especially if she is likely to harm herself or the baby. Admitting her to a psychiatric hospital may also be necessary for better monitoring and treatment. Electroconvulsive therapy or ECT performed by mental health professionals in a controlled hospital setting can successfully treat the symptoms of depression and acute mania ^[26].

Natural Remedies for Postpartum Depression

A few home remedies like St. John’s Wort have been found effective for reducing the symptoms of depression in those with mild PPD. However, there is a lack of adequate medical research regarding the potential side effects of these treatments in nursing mothers and their babies ^[27]. Essential oils like bergamot, grapefruit and wild orange are also believed to help with the baby blues ^[38]. Fish oil supplements are also believed to be useful for this purpose ^[28] as omega-3 fatty acids are known to have a positive effect against depression. Consult your doctor regarding the dosage as it if often recommended for PPD patients to take a higher EPA (omega-3 fatty acids eicosapentaenoic acid) dosage than DHA (docosahexaenoic acid) ^[29]. You may also benefit from alternative treatments like acupuncture, but their efficacy is still being studied ^[30].

What is the prognosis for postpartum depression?

Baby blues has an excellent recovery rate with most women getting better within a few weeks or months. Around 5 to 7 out of every 10 women with moderate to severe depression start getting better within weeks of starting antidepressant treatment ^[24]. Postpartum psychosis has a relatively negative prognosis as the symptoms often persist for years ^[31]. But, most women recover fully over time ^[4].

Postpartum Depression and Breastfeeding

Some antidepressants are likely to leak into breast milk; however, in small amounts that is not likely to harm the baby ^[24]. Make sure to talk to your doctor about breastfeeding while on medication. There are various antidepressants that allow you to breastfeed your baby without any adverse effects ^[32].

How long does postpartum depression last?

Baby blues do not last for any longer than a few days to weeks ^[35] while the moderate postpartum depression may last for months ^[1]. Postpartum psychosis, the most severe form of PPD, can persist for years with the condition even becoming permanent in some rare cases.

Postpartum Depression Recurrence Risk

Statistics show the recurrence risk for PPD to range from 10% to 35% in a subsequent pregnancy ^[2]. If you have already suffered from PPD in a previous pregnancy, it is advisable to consult your doctor before conceiving again to reduce the risks of developing the symptoms again ^[33].

Postpartum Depression Incidence Statistics

Baby blues is the most prevalent form, affecting most new mothers with studies showing postpartum depression to occur in 10%-15% mothers within one year of giving birth ^[34].

Postpartum Depression ICD-9 and ICD-10 Codes

The ICD-9 code used for indicating PPD is 648.4 ^[36] while it ICD-10 code is F53.0 ^[37].

Postpartum Depression Support Group

Postpartum Support International 6706 SW 54th Avenue Portland,Oregon 97219

United States Telephone: 503-894-9453

Fax: 503-894-9452

Support Helpline: 800.944.4PPD (4773)

Website: http://www.postpartum.net/

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