Postpartum depression manifests as extreme feelings of sadness, tearfulness and apathy that can occur after giving birth to a child. This response can interfere with mother-child bonding. Many women feel a more mild form of this known as the "baby blues," which often resolves spontaneously. Treatment options are similar to other forms of major depression.
Basics
Postpartum depression constitutes one form of major depressive disorder, according to the "Diagnostic and Statistical Manual" of the American Psychiatric Association. This type of depression occurs within four weeks of giving birth. The symptoms are similar to other forms of major depression but can also include fluctuations in mood and preoccupation with infant well-being. Postpartum depression presents with symptoms severe enough to impair a woman's functioning.
It is important to distinguish postpartum depression from "baby blues," in which transient feelings of depression or anxiety occur and do not interfere with functioning. Postpartum depression must also be distinguished from postpartum psychosis, characterized by sleep disturbance, depersonalization, hallucinations and delusions within two weeks of childbirth, according to the Primary Psychiatry website.
Causes
Postpartum depression emerges from multiple causal factors. First, the hormonal changes that occur after giving birth result in a dramatic drop in estrogen and progesterone, as well as drops in thyroid hormones and blood flow, all of which can lead to feelings of sluggishness and mood swings. Second, the emotional factors associated with giving birth impact functioning, due to the mother's lack of sleep, body image issues, and most importantly, the tremendous new responsibility to the newborn child, according to the Mayo Clinic. Some individuals may be more susceptible to the impact of these variables than others.
Risk Factors
Women who have previously experienced any kind of major depressive episode present with increased risk for postpartum depression, according to the American Psychiatric Association. A family history of mood disorders, whether depression, bipolar or dysthymia, also increases a woman's risk.
Other risk factors include a poor support system, recent life stressors and an unplanned or unwanted pregnancy, according to the Mayo Clinic.
Epidemiology
It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth, according to the National Institute of Mental Health. A much larger proportion may experience baby blues, estimated to occur in 50 to 80 percent of women, according to the Primary Psychiatry website. Without treatment, the baby blues may quickly disappear, but the depression can last for months or, rarely, years.
Treatments
Many psychiatrists believe that postpartum depression often warrants treatment with antidepressant medication. According to the Primary Psychiatry website, careful consideration of the potential effects of the medication on the breastfeeding child should be considered through consultation between physician and patient. However, the debilitating depression of the mother must be treated proactively to facilitate bonding between mother and child. Antidepressants are excreted in breast milk and may be harmless in the short term, but the long-term effects of exposure on the child remain unclear.
Hormonal therapy to counteract the postnatal drop in estrogen and psychotherapy may also be considered.
References
- National Institute of Mental Health: What are the Different Forms of Depression?
- Primary Psychiatry: Treatment of Postpartum Depression
- "Diagnostic and Statistical Manual of Mental Disorders"; American Psychiatric Association; 2000.
- Mayo Clinic: Postpartum Depression Risk Factors
