Is It More Than the Baby Blues?
Author: Dr. Anna Kaplan
Postpartum depression is a mood disorder that comes on after having a baby. It is not just the "baby blues" but is a much more serious problem While as many as 80% of women have the baby blues, only 10% to 20% of women experience postpartum depression.
Postpartum depression has essentially the same symptoms as serious depression in anyone. These include:
- Sadness, depressed mood and tearfulness
- Difficulty concentrating
- Fatigue and trouble sleeping
- Feel of worthlessness, inadequacy as a parent
- Decreased appetite.
- Inability to enjoy pleasurable activities
- Thoughts of suicide
Women who have had a previous depression at any time, or a previous postpartum depression, are more at risk for postpartum depression. The same is true for women who have exaggerated premenstrual symptoms, called premenstrual dysphoric disorder. Women under stress and without enough support from family or friends are also at risk.
It is very important to distinguish this from baby blues, because a woman with postpartum depression may have impaired ability to take care of her baby and herself.
Doctors should be screening women for depression when they come in for postpartum checkups. If you are concerned about your mood, you should tell your obstetrician, family doctor or internist. If you have concerns about someone else with postpartum depression, you need to encourage them to seek medical help.
Sometimes individual therapy with a counselor, and also group therapy, can help women who are not severely depressed. This may also be useful for women who don't want to take medication because they are breast feeding.
However, if the depression is severe, they have to be treated as any other depressed person would be treated, with appropriate medication. SSRIs (selective serotonin reuptake inhibitors) are the first choice. These include Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Celexa (citalopram), and Lexapro (escitalopram). Dosage must be adequate, and varies from one medication to the other. Side effects are usually mild, and go away with time. They can include insomnia, jitteriness, nausea, loss of appetite, headache and sexual dysfunction. Most women will do well with one or another of these medicines. Alternatively, there are older antidepressants that can be used. There are a couple of medications that are secreted very little if at all into breast milk. This should be considered when deciding on the use of medicine.
It usually takes two to four weeks for symptoms to improve. Women can also be receiving psychotherapy (counseling) at the same time. They should be followed closely, and observed for any evidence that they are suicidal or psychotic.
Postpartum psychosis is much rarer. Perhaps one or two women out of a thousand experience psychosis after childbirth. They may have a history of psychiatric illness before this particular period. They may have had postpartum depression with other pregnancies, or without being pregnant. They may be bipolar. The onset of the psychosis is more sudden than postpartum depression. The mother may act like someone with mania. That means she may be irritable and restless, with constantly changing mood and behavior. She may have delusional beliefs about her baby. Of course, this puts the baby at risk, and other children, as well as the mother.
But for the vast majority of women with postpartum depression, treatment with antidepressant medication, therapy, and the support of their family and friends, will help them and they will recover. Therapy usually needs to be continued for nine to twelve months, depending on the specific situation. It is important for a woman with postpartum depression to be identified and treated. It is even better to try and prevent it. Any woman with a history of postpartum depression, or serious depression at any time, or manic-depressive illness (bipolar affective disorder) should be watched closely during and after pregnancy. For some women, the best choice is to start antidepressant medication immediately after delivery.
