While postpartum psychosis is rare and extremely dangerous (see box
about Andrea Yates), postpartum depression - or PPD - is actually very
common. It's estimated that up to 70% of all new mothers experience the
"baby blues." These "blues" typically peak four to five days after
delivery and fade away within a week or two. However, sometimes these "blues"
don't go away. Instead the new mother becomes increasingly distraught.
She may become weepy, lethargic, agitated, or even have thoughts of
suicide. She may start to worry excessively about her new baby or have
unwanted thoughts of harming the child. These are all symptoms of PPD.
About one in ten new mothers experience some degree of postpartum
depression.
Historically, the connection between childbirth and psychiatric
illness has been well-recognized. In 460 BC, Hippocrates described
postpartum "fever," which produced "agitation, delirium and attacks of
mania." The 11th century writings of the gynecologist Trotula of
Salerno note that "if the womb is too moist, the brain is filled with
water, and the moisture running over to the eyes, compels them to
involuntarily shed tears."
Postpartum Depression On June 20, 2001,
Andrea Yates drowned her five children in the bathtub
of her home in a Houston suburb. The public was
shocked
that a mother could commit such a horrific act.
Yet many
believe that Andrea Yates was suffering from a
very severe
form of postpartum psychosis at the time of the
killings.
Although PPD is more common than many typical pregnancy ailments,
such as preeclampsia, gestational diabetes, and preterm delivery, this
condition is typically under-diagnosed. Despite its common occurrence
and devastating consequences, PPD receives little attention in modern
clinical literature, training, and practice.
Symptoms of Postpartum Depression
Signs that you may be suffering from PPD include:
Depressed (sad) mood
Lack of pleasure or interest in activities
Sleep disturbance (sleeping too much or too little)
Weight loss
Loss of energy
Agitation or psychomotor retardation (moving very slowly)
Feelings of worthlessness or inappropriate guilt
Diminished concentration, or indecisiveness
Frequent thoughts of death or suicide
Having thoughts about hurting self
Worrying about hurting baby
PPD may be hard to diagnose because of the new mothers' own feelings of
shame and secrecy. Women are expected to have a love affair with their
new babies, so if they start having even mild symptoms of PPD, they may
feel ashamed and guilty, thus new moms may be reluctant to get help.
They fear will be "locked up" or someone will take their baby away from
them. PPD can also be hard to diagnose because so many of the symptoms
- like sleep disturbance, weight loss, and lack of energy - are a
typical of new mothers. Therefore careful assessment by a qualified
professional is essential.
Women Vulnerable to Depression
Postpartum depression is not much different than major depression,
except that it strikes shortly after childbirth. Major depression is a
serious medical illness affecting about five percent of the adult
population in a given year. Unlike normal emotional experiences of
sadness, loss, or passing moods, major depression is persistent and can
significantly interfere with a person's thoughts, behavior, mood, and
physical health. Among all medical illnesses, major depression is the
leading cause of disability in the U.S. and many other developed
countries.
More than twice as many women (6.7 million) as men (3.2 million)
suffer from major depressive disorders each year. All ethnic, racial,
socioeconomic, and age groups suffer from depression. About three-fourths
of those who experience a first episode of depression will have at
least one other episode in their lives. Some individuals may have
several episodes in the course of a year.
Why are women so much more vulnerable to depression than men?
Differences in social status, expectations, and opportunities no doubt
play a role. Studies show that women with poor social support,
relationship difficulties, and child care stress are more likely to
affected by PPD. But there is also evidence to suggest that rapid
changes in women's hormones - such as following pregnancy, during
certain times of the menstrual cycle, or with the use of hormonal
contraceptives - can induce depression as well.
Postpartum Psychosis
Postpartum psychosis is a form of depression so severe that the patient
loses touch with reality. Although only about 1 in 500 women will get
postpartum psychosis, there is a sevenfold increase in the risk of
psychiatric hospitalization within the first three months after delivery,
and the risk of psychosis is 20 times higher than the pre-pregnancy
rate.
When delusions or hallucinations are present, they often involve the
infant. A woman may have thoughts that the baby is possessed by a demon
and should die. She may even hear voices (auditory hallucinations)
telling her to kill her infant. This is an emergency situation, and in
such cases a new mother should be taken to the hospital immediately.
Treatment
Postpartum depression is successfully treated with medications,
psychotherapy, or a combination of both. There are several types of
psychotherapy that have been shown to be effective for depression
including cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT).
Research has shown that mild to moderate depression can often be
treated successfully with either of these therapies used alone.
Severe depression may be best treated with a combination of
psychotherapy and medication. Medication is especially appropriate in
patients with more severe or chronic symptoms, prior episodes or family
histories, or who have done well with medication in the past. Selective
serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants are
most commonly used to treat depression. SSRIs, such as Prozac, Zoloft,
and Paxil, are known to be safe, effective, and produce few side effects.
However, if breastfeeding, the use of psychiatric medication must be carefully
monitored. Electroconvulsive therapy may also be an option for women
who do not respond to medications or psychotherapy.
The Main Message
Postpartum depression is a common disorder that is frequently
unrecognized. Early identification and intervention are important,
especially if psychosis is suspected. The good news is that there are
many proven treatments, including psychotherapy and medication. With
treatment, women suffering with PPD will be able to effectively manage
difficulties of motherhood and also experience its joys.
