Postpartum Depression
Postpartum depression is a feeling of extreme sadness and related psychologic disturbances during the first few weeks or months after delivery.
The baby blues--feeling sad or miserable within 3 days of delivery--is common after delivery. New mothers should not be overly concerned about these feelings because they usually disappear within 2 weeks. Postpartum depression is a more serious mood change. It lasts weeks or months. This form affects about 1% of women. An even more severe, very rare form, called postpartum psychosis, includes psychotic behavior.
The causes of sadness or depression after delivery are unclear. The sudden decrease in levels of hormones, particularly estrogen and progesterone, may contribute. Depression that was present before pregnancy is likely to evolve into postpartum depression. Women who have had depression before they became pregnant should tell their doctor or midwife about it during the pregnancy. The stresses of having and caring for a baby may also contribute. Such stresses include difficulties during labor and delivery, lack of sleep, and feelings of isolation and incompetence. Women who develop postpartum depression may have had depression or another psychologic disorder before pregnancy, or they may have close relatives with depression. Lack of social support and marital discord increase the likelihood of developing postpartum depression.
Symptoms may include frequent crying, mood swings, and irritability as well as feelings of sadness. Less common symptoms include extreme fatigue, difficulty concentrating, sleep problems, loss of interest in sex, anxiety, appetite changes, and feelings of inadequacy or hopelessness. These symptoms interfere with the woman's daily activities. A woman with postpartum depression may show no interest in her baby.
In postpartum psychosis, depression may be combined with suicidal or violent thoughts, hallucinations, or bizarre behavior. Sometimes postpartum psychosis includes a desire to harm the baby.
If the woman is sad, support from family members and friends is usually all that is needed. But if depression is diagnosed, professional help is also needed. Typically, a combination of counseling and antidepressants (see Section 7, Chapter 101) is recommended. A woman who has postpartum psychosis may need to be hospitalized, preferably in a unit that allows the baby to remain with her. She may need antipsychotic drugs (see Section 7, Chapter 107) as well as antidepressants. A woman who is breastfeeding should consult with her doctor before taking any of these drugs to determine whether she can continue to breastfeed (see Section 22, Chapter 259).
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