Postpartum Depression

What is postpartum depression?

After childbirth, many mothers feel more emotional. They may feel sad, afraid, or angry. This is called postpartum blues or the baby blues. For most women these postpartum blues are mild and go away within a week. Postpartum depression lasts longer and is more severe. About 10 to 20% of women, especially very young mothers, have the more severe form.

What is the cause?

You may have postpartum depression within a few days to a few weeks after giving birth or having a miscarriage. For about 60% of women, it is their first episode of depression. While hormone changes after giving birth seem to play a part, the full causes are not known. Risk factors that increase your chances of getting postpartum depression are:

• having been depressed sometime before you got pregnant
• having been depressed after a previous pregnancy
• having family members who were depressed, especially after a pregnancy
• returning home with your baby to a very stressful home or relationship
• having a baby with health problems or a baby who cries often
• having a miscarriage late in pregnancy or a stillbirth

If your pregnancy was unwanted you are also at risk for postpartum depression.

What are the symptoms?

Besides feeling sad and uninterested in activities, you may also:

• feel unable or unwilling to care for your baby
• think often about bad things that could happen to your baby or feel like hurting your baby
• be irritable
• have trouble falling asleep, wake up very early, or sleep too much
• feel overwhelmed by everyday activities such as taking a shower or doing laundry
• have little appetite or eat too much
• be tired and low in energy
• have low sexual desire and function
• feel worthless and guilty
• have trouble concentrating or remembering things
• feel hopeless or just do not care about anything
• have unexplained pain in your back or abdomen, or get headaches
• worry that you will never feel better

Some women also become anxious, have hallucinations, or delusions. If you have hallucinations (hear voices or see things not present) or delusions (thoughts not grounded in reality) this is called postpartum psychosis. This is a medical emergency. Get help right away.

How is it diagnosed?

Your healthcare provider or a mental health professional can tell you if your symptoms are postpartum depression. He or she will ask about your symptoms and any drug or alcohol use. You may be tested to rule out medical problems such as hormone imbalances.

How is it treated?

Do not try to deal with postpartum depression by yourself. It can be successfully treated with either psychotherapy or antidepressant medicine or both. Discuss this with your healthcare provider or therapist.

Medicine

Several types of medicines can help treat postpartum depression. Discuss the use of medicines with your healthcare provider if you are breast-feeding. Your healthcare provider will carefully select a medicine for you.

You must take antidepressant medicines daily to get full benefit from them. It is recommended that you keep taking the medicine for at least 6 months.

Psychotherapy

Seeing a mental health therapist is helpful. Therapy may last a short time or may need to go on for many months. Cognitive behavioral therapy (CBT) is a way to help you identify and change thought processes that lead to depression. Replacing negative thoughts with more positive ones can help your depression.

Natural Remedies and Alternative Treatments

Claims have been made that certain herbal and dietary products help control depression symptoms. Omega-3 fatty acids may help to reduce symptoms of depression. St. John's wort may help mild symptoms of postpartum depression. It will not help severe cases of depression. It may worsen bipolar disorder. No herb or dietary supplement has been proven to consistently or completely relieve postpartum depression. Supplements are not tested or standardized and may vary in strengths and effects. They may have side effects and are not always safe.

Learning ways to relax may help. Yoga and meditation may also be helpful. You may want to talk with your healthcare provider about using these methods along with medicines and psychotherapy.

Support

Ask for help with night time feedings so that you can sleep. You may also find it useful to get help with household chores. Take time for yourself without your baby. Hire a sitter, leave your baby with a close friend or your spouse, and get out. Spend time with support groups and friends, and don't be afraid to share both your fears and your joys.

How long will the effects last?

In most cases postpartum depression slowly goes away in the first 9 months after birth. For a few women it lasts for more than 1 year. Treatment helps speed the recovery.

How can I take care of myself?

Maintaining a healthy lifestyle is crucial. Staying physically and socially active, especially with your partner, is very important. Having regular sleep and eating patterns will also help you. Since you will need to be up during the night with your baby during the first few months, it is important to take naps to keep your energy up.

Certain medicines such as benzodiazepines and levofloxacin (Levaquin) can add to the symptoms of depression. It is important to check with your healthcare provider before taking any new prescription or nonprescription medicines.

To help prevent postpartum depression:

• Get support. Talk with family and friends. Consider joining a support group in your area.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax, for example take up a hobby, listen to music, watch movies, take walks. Try deep breathing exercises when you feel stressed.
• Take care of your physical health. Try to get naps during the day as well as sleep each night. Eat a healthy diet. Limit caffeine. If you smoke, quit. Avoid alcohol and drugs, because they can make your symptoms worse. Exercise as appropriate for your physical condition in the days right after giving birth.
• Contact your healthcare provider or therapist if you have any questions or your symptoms seem to be getting worse.

When should I seek help?

Do not try to overcome postpartum depression by yourself. Seek professional help if you believe that you or a loved one has the symptoms described here.

Get emergency care if you or a loved one has serious thoughts of suicide or harming your baby, or if you hear voices or see things not present, or have delusions (thoughts not grounded in reality).