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Postpartum Depression

Alternate Names

  • baby blues

Definition

Postpartum depression is a form of depression that occurs in some women within the first 6 weeks after childbirth. Depression is a medical condition that leads to intense feelings of sadness or despair. These feelings don't go away on their own. Depression in the post-partum period can be life-threatening to both mother and baby.

What is going on in the body?

Depression is a disorder of the brain. Researchers believe that chemicals called neurotransmitters are involved in depression. Nerve impulses cause the release of neurotransmitters from one nerve cell, or neuron, to the next. This release allows cells to communicate with one another. Too little or too much of these important neurotransmitters may be released and cause or contribute to depression. Some of the neurotransmitters believed to be linked to depression are serotonin, norepinephrine, and dopamine.
Pregnancy and childbirth are accompanied by hormonal changes that can affect emotions. The round-the-clock job of caring for a new baby can seem overwhelming at times. Too little rest usually accompanies these physical and emotional stresses.

Risks

What are the causes and risks of the condition?

The hormonal changes of pregnancy and childbirth contribute to a woman's risk for postpartum depression. Caring for a newborn can be overwhelming. Physical exhaustion, lack of sleep, unrealistic role expectations, and social isolation can all play a role in postpartum depression.
The following increase the risk for developing postpartum depression:
  • early hospital discharge after childbirth
  • history of severe premenstrual syndrome
  • lack of support system
  • marital problems
  • previous history of depression
  • traumatic birth experience

Prevention

What can be done to prevent the condition?

There is no prevention for postpartum depression. However, there are things a woman can do to minimize the problem. These include the following steps.
  • Ask family and friends to help with cooking or housework.
  • Get adequate rest, nutrition, and emotional support.
  • Get regular exercise.
  • Set aside some personal time.
  • Sleep when the baby sleeps.

Diagnosed

How is the condition diagnosed?

There are several tools a woman can use to screen for postpartum depression. These are designed to help her recognize the signs and symptoms of the problem so she can seek help. This may include a list of questions such as:
  • Are you experiencing difficulty sleeping?
  • Do you feel anxious, tense, or panicked much of the day?
  • Do you find yourself crying uncontrollably for unexplained reasons?
  • Is it difficult for you to concentrate?
  • Are you filled with self-doubt and lacking in self-esteem?
  • Have you experienced sudden changes in appetite?
  • Are you feeling totally exhausted and lacking in enthusiasm for things that once seemed pleasurable?
  • Do you feel more distant from your spouse or partner?
  • Do you often feel helpless, hopeless, and unable to cope?
  • Are you overly concerned about the health of your baby, constantly worrying about what could go wrong?
  • Do you feel like most days you are out of control or going crazy?
  • Do you ever think of hurting yourself or your baby?
If a woman answers yes to any of these questions, she may be at risk for postpartum depression. The woman should have a comprehensive evaluation for depression. The evaluation may include a medical history, physical exam, and lab tests.

Long Term Effects

What are the long-term effects of the condition?

Untreated, postpartum depression interferes with bonding between mother and infant. Serious depression may be accompanied by:
  • aggressive feelings toward the baby
  • loss of appetite
  • loss of pride in personal appearance and home
  • suicidal tendencies
  • withdrawal from others

Other Risks

What are the risks to others?

Depression is not contagious. However, a mother who is severely depressed may neglect or abuse her baby.

Treatments

What are the treatments for the condition?

The two most common ways of treating depression are with antidepressant medications and psychotherapy. Often a combination is used. Occasionally a woman must be hospitalized for intense treatment or for her own safety.
Antidepressant medications are effective in the following ways:
  • increasing the woman's ability to function in daily life
  • lowering the risk of suicide
  • making the woman feel better

The following types of medications are used to treat depression:

  • selective serotonin reuptake inhibitors (SSRIs), including paroxetine HCl (i.e., Paxil, Pexeva) and fluoxetine HCl (i.e., Prozac, Serafem)
  • monoamine oxidase inhibitors (MAOIs), such as phenelzine sulfate (i.e., Nardil) and tranylcypromine sulfate (i.e., Parnate)
  • other antidepressants, such as nefazodone (i.e., Serzone) and venlafaxine (i.e., Effexor)
  • tetracyclic antidepressants, such as maprotiline HCl and mirtazapine (i.e., Remeron)
  • tricyclic antidepressants (TCAs), including amitriptyline, nortriptyline HCl (i.e., Aventyl, Pamelor) and desipramine HCl (i.e., Norpramin).
A woman with postpartum depression can also benefit from learning about the following coping mechanisms:
  • accepting help when it is offered and designating where help is needed
  • arranging for relaxation time
  • decreasing concern with appearances, such as a tidy house
  • getting plenty of sleep and rest
  • including others in care of the newborn when possible
  • setting priorities for task, such as household tasks

Side Effects

What are the side effects of the treatments?

Antidepressants may cause mild and usually temporary side effects in some people. The most common side effects are as follows:
  • agitation
  • constipation
  • dizziness
  • drowsiness
  • dry mouth
  • nausea
Some antidepressants may be excreted in the breast milk and affect the baby, so be sure to consult a physician or pharmacist before taking any antidepressant medications while breastfeeding.

After Treatment

What happens after treatment for the condition?

With medication, counseling and support, most cases of postpartum depression improve within 3 to 4 weeks, although may take up to 8 to 12 weeks to improve.

Monitor

How is the condition monitored?

A woman taking an antidepressant medication needs to have blood levels of the drug monitored frequently. She may have regular visits with the healthcare provider until the depression is gone. Any new or worsening symptoms should be reported to the healthcare provider.

Sources

"Depression: What Every Woman Should Know", [hyperLink url="http://www.nimh.nih.gov/publicat/depwomenknows.cfm" linkTitle="www.nimh.nih.gov/publicat/depwomenknows.cfm"]www.nimh.nih.gov/publicat/depwomenknows.cfm[/hyperLink]

"Post Partum Depression", [hyperLink url="http://www.depression.com/health_library/types/types_03_postpartum.html" linkTitle="www.depression.com/health_library/types/types_03_postpartum.html"]www.depression.com/health_library/types/types_03_postpartum.html[/hyperLink]

"I Don't Feel Like Myself Since the Baby Was Born", [hyperLink url="http://homearts.com/depts/health/37drb2.htm" linkTitle="homearts.com/depts/health/37drb2.htm"]homearts.com/depts/health/37drb2.htm[/hyperLink]

Professional Guide to Diseases, Sixth Edition. Springhouse: Springhouse Corporation, 1998

Tierney, Lawrence, editor, "Current Medical Diagnosis and Treatment, 39th edition", 2000

Griffith, H. Winter. Instructions for Patients. Philadelphia:W.B. Saunders company, 1994

Thompson, Eleanor, Introduction to Maternity and Pediatric Nursing: 2nd edition, 1995

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