Postpartum depression is a mood disorder that begins after childbirth
and usually lasts beyond six weeks.
The onset of postpartum depression tends to be gradual and may persist for many months, or develop into a second bout following a subsequent pregnancy. Postpartum depression affects approximately 15% of all childbearing women. Mild to moderate cases are sometimes unrecognized by women themselves. Many women feel ashamed if they are not coping and so may conceal their difficulties. This is a serious problem that disrupts women's lives and can have effects on the baby, other children, her partner, and other relationships. Levels of depression for fathers also increase significantly.
Postpartum depression is often divided into two types: early onset and late onset. An early onset most often seems like the "blues," a mild brief experience during the first days or weeks after birth. During the first week after the birth up to 80% of mothers will experience the "baby blues." This is usually a time of extra sensitivity and symptoms include tearfulness, irritability, anxiety
, and mood changes, which tend to peak between three to five days after childbirth. The symptoms normally disappear within two weeks without requiring specific treatment apart from understanding, support, skill, and practice. In short, some depression, tiredness, and anxiety may fall within the "normal" range of reactions to giving birth.
Late onset appears several weeks after the birth. This involves a slowly growing feeling of sadness, depression, lack of energy, chronic tiredness, inability to sleep, change in appetite, significant weight loss or gain, and difficulty caring for the baby.
Causes and symptoms
As of 2006, experts cannot say what causes postpartum depression. Most likely, it is caused by many factors that vary from individual to individual. Mothers commonly experience some degree of depression during the first weeks after birth. Pregnancy
and birth are accompanied by sudden hormonal changes that affect emotions. Additionally, the 24-hour responsibility for a newborn infant represents a major psychological and lifestyle adjustment for most mothers, even after the first child. These physical and emotional stresses are usually accompanied by inadequate rest until the baby's routine stabilizes, so fatigue
and depression are not unusual.
Experiences vary considerably but usually include several symptoms.
- persistent low mood
- inadequacy, failure, hopelessness, helplessness
- exhaustion, emptiness, sadness, tearfulness
- guilt, shame, worthlessness
- confusion, anxiety, and panic
- fear for the baby and of the baby
- fear of being alone or going out
- lack of interest or pleasure in usual activities
- insomnia or excessive sleep, nightmares
- not eating or overeating
- decreased energy and motivation
- withdrawal from social contact
- poor self-care
- inability to cope with routine tasks
- inability to think clearly and make decisions
- lack of concentration and poor memory
- running away from everything
- fear of being rejected by partner
- worry about harm or death to partner or baby
- ideas about suicide
Some symptoms may not indicate a severe problem. However, persistent low mood or loss of interest or pleasure in activities, along with four other symptoms occurring together for a period of at least two weeks, indicate clinical depression, and require adequate treatment.
There are several important risk factors for postpartum depression, including:
- lack of sleep
- poor nutrition
- lack of support from one's partner, family or friends
- family history of depression
- labor/delivery complications for mother or baby
- premature or postmature delivery
- problems with the baby's health
- separation of mother and baby
- A difficult baby (temperament, feeding, sleeping, settling problems)
- preexisting neurosis or psychosis
There is no diagnostic test for postpartum depression. However, it is important to understand that it is, nonetheless, a real illness, and like a physical ailment, it has specific symptoms.
Several treatment options exist, including medication, psychotherapy, counseling, and group treatment and support strategies, depending on the woman's needs. One effective treatment combines antidepressant medication and psychotherapy. These types of medication are often effective when used for 3 to 4 weeks. Any medication use must be carefully considered if the woman are breast-feeding, but with some medications, continuing breast-feeding is safe. Nevertheless, medication alone is never sufficient and should always be accompanied by counseling or other support services.
Postpartum depression can be effectively alleviated through counseling and support groups, so that the mother doesn't feel she is alone in her feelings. Constitutional homeopathy can be the most effective treatment of the alternative therapies because it acts on the emotional level where postpartum depression is felt. Acupuncture
, Chinese herbs, and Western herbs can all help the mother suffering from postpartum depression come back to a state of balance. Seeking help from a practitioner allows the new mother to feel supported and cared for and allows for more effective treatment.
A new mother also should remember that this time of stress does not last forever. In addition, there are useful things she can do for herself, including:
- valuing her role as a mother and trusting her own judgment
- making each day as simple as possible
- avoiding extra pressures or unnecessary tasks
- trying to involve her partner more in the care of the baby from the beginning
- discussing with her partner how both can share the household chores and responsibilities
- scheduling frequent outings, such as walks and short visits with friends
- having the baby sleep in a separate room so she sleeps more restfully
- sharing her feelings with her partner or a friend who is a good listener
- talking with other mothers to help keep problems in perspective
- trying to sleep or rest when the baby is sleeping
- taking care of her health and well-being.
- not losing her sense of humor
With support from friends and family, mild postpartum depression usually disappears quickly. If depression becomes severe, a mother cannot care for herself and the baby, and in rare cases, hospitalization may be necessary. Yet, medication, counseling, and support from others usually cures even severe depression in 3-6 months.
can help enhance a new mother's emotional well-being. New mothers should also try to cultivate good sleeping habits and learn to rest when they feel physically or emotionally tired. It's important for a woman to learn to recognize her own warning signs of fatigue, respond to them by taking a break.
Depression After Delivery (D.A.D.). P.O. Box 1282, Morrisville, PA 19067. (800) 944-4773.
Postpartum Support International. 927 North Kellog Ave., Santa Barbara, CA 93111. (805) 967-7636.
1. a hollow or depressed area.
2. a lowering or decrease of functional activity.
in psychiatry, a mental state of altered mood characterized by feelings of sadness, despair, and discouragement; distinguished from grief, which is realistic and proportionate to a personal loss. Profound depression may be an illness itself, such as major depressive disorder
(see also mood disorders
), or it may be symptomatic of another psychiatric disorder, such as schizophrenia
. adj., adj
Depression is closely associated with a lack of confidence and self-esteem and with an inability to express strong feelings. Repressed anger is thought to be a powerful contributor to depression. The person feels inadequate to cope with the situations that arise in everyday life and so feels insecure.
Treatment of profound and chronic depression is often very difficult, requiring in most cases intensive psychotherapy to help the patient understand the underlying cause of the depression. antidepressant
drugs such as imipramine
) and amitriptyline (Elavil)
are often used in the treatment of profound depression. They are not true stimulants of the central nervous system, but they do block the reuptake of neurotransmitter substances, which may potentiate the action of norepinephrine and serotonin. monoamine oxidase (MAO) inhibitors
are also used. When antidepressants fail, a different technique such as electroconvulsive therapy
may be used in conjunction with the psychotherapy.
. Mild, sporadic depression is a relatively common phenomenon experienced by almost everyone at some time, but hospitalized patients are particularly susceptible to feelings of depression and a sense of loss and despair. Early signs of depression of this kind include pessimistic statements about one's illness and its prognosis, refusal to eat, diminished concern about personal appearance, and reluctance to make decisions. When depression is noted in a patient, it should be listed on the treatment plan along with suggestions for resolving it.
When patients are depressed, they are likely to isolate themselves and avoid social contact even with those who are trying to help them. Since loss of contact with others contributes to depression, members of the health care team should persist in attempts to talk with these patients, by asking them questions, and actively listening when they attempt to express their feelings. One should be especially careful to avoid being judgmental when the patient does express despair, anger, hostility, or some negative feeling. Above all, it is important not to be condescending or to respond to statements with a meaningless cliché such as “Don't worry,” or “I'm sure everything will turn out okay.” These responses convey a lack of empathy with the patient's suffering and are an unrealistic approach to a problem that is very real.
Physical contact and touching may be misunderstood by depressed patients. Sometimes, it is better just to sit with them and calmly observe them without making them feel uncomfortable. Honest dialogue and expressions of support and concern can often improve their mood and sense of self worth.
Severely depressed patients usually express three basic feelings associated with their mental state. These are a lack of desire for socializing or physical activity, feelings of worthlessness and loss of self esteem, and thoughts of self-injury or destruction. In planning the care of the depressed patient, one must always consider these feelings and strive for some understanding of the reasons for the patient's behavior. Only by gradually gaining their attention and pointing out encouraging signs of progress can they be helped in their early attempts to return to reality and socialize with others.
Physical inactivity will require attention to adequate nutrition, a normal balance of fluid intake and output, proper elimination, and good skin care. Patients will need help in maintaining good personal hygiene. Severely depressed patients may be totally out of touch with reality and completely unresponsive to anyone else's presence. In such instances the health care provider may be able to do little more than demonstrate caring and empathy by remaining with the patient.
Consistency of care is helpful to depressed patients. They know what to expect, and thus are not repeatedly disappointed when their expectations are not met. An example is consistency in scheduling and carrying out treatments and routine care at the same time each day. A supportive family and interested friends should be involved in choosing and planning activities that are helpful.
Constant vigilance must be maintained to prevent the profoundly depressed patient from injuring himself or committing suicide
. Self-destructive behavior is a manifestation of the patient's feeling of worthlessness and loss of self esteem. An awareness of the potential dangers in such a situation should help the provider plan and provide a safe and congenial atmosphere, remaining alert to the early signs of a patient's intention to harm or destroy himself. In most cases suicide is most likely to occur when the patient is recovering from severe depression.
agitated depression major depressive disorder characterized by signs and symptoms of agitation, such as restlessness, racing thoughts, pacing, hand-wringing, sighing, or moaning.
congenital chondrosternal depression a congenital, deep, funnel-shaped depression in the anterior chest wall.
a type of depression caused by somatic or biological factors rather than environmental influences, in contrast to a reactive depression
. It is often identified with a specific symptom complex—psychomotor retardation, early morning awakening, weight loss, excessive guilt, and lack of reactivity to the environment—that is roughly equivalent to the symptoms of major depressive disorder.
one that is not a psychotic depression
. The term is now little used but has been used sometimes broadly to indicate any depression without psychotic features and sometimes more narrowly to denote only milder forms of depression (dysthymic disorder
moderate to severe depression beginning slowly and sometimes undetectably during the second to third week post partum, increasing steadily for weeks to months and usually resolving spontaneously within a year. Somatic complaints such as fatigue are common. It is intermediate in severity between the mood fluctuations experienced by the majority of new mothers and frank postpartum psychosis
strictly, major depressive disorder
with psychotic features, such as hallucinations, delusions, mutism, or stupor. The term is often used more broadly to cover all severe depressions causing gross impairment of social or occupational functioning.
a usually transient depression that is precipitated by a stressful life event or other environmental factor, in contrast to an endogenous depression
retarded depression major depressive disorder characterized by signs and symptoms of psychomotor retardation, such as burdened movements and slowed, toneless speech.