Depression, from mild to severe, is experienced by approximately eighty percent of mothers after giving birth. The “baby blues,” with feelings of anxiety and sadness, usually recedes within one or two weeks. However, some mothers (one or two out of ten) suffer more severe forms of this condition; post-partum depression (PPD) may have intense symptoms that would interfere with normal daily activities. PPD may appear in the first few weeks after the baby is born, or several months later. If not adequately treated, PPD may last much longer. Family support and medical treatment usually resolve most situations.
Guilt, feelings of weakness, and the perception of character or personality flaws may also be part of this condition. Other symptoms may include a sense of failure, unworthiness, and intense sadness. Many other symptoms have been described, which may appear at different times, such as insomnia, fatigue and mood swings, that usually affect family relationships.
There could also be a general emotional numbness, with lack of interest in normal, daily life, sometimes with fear of hurting herself and the baby. Withdrawal from family members, eating habits changes, with weight gain or loss, sense of loneliness, inability to concentrate, and memory changes are signs and symptoms that are frequently temporary.
In more severe cases, requiring prompt medical attention, the mother may feel strong, unexplained anger, having thoughts of harming the baby and herself, with confusion, agitation, and delusions, expressing unusual statements and symptoms of paranoia.
Physical signs and symptoms of PPD may appear at any time, including chest discomfort and pains, hyperventilation with some degree of numbness, and occasional headaches.
Mild, monthly hormonal changes are part of normal female physiology, causing tension and mood swings for several days before and after menstruation. Although the cause of PPD is not well known, it is thought that significant hormonal changes during and after pregnancy play an important role, having a marked effect on brain physiology.
Estrogen, progesterone, and thyroid hormones increase steadily during pregnancy; their effect on different parts of the brain may explain mood changes and peculiar food cravings, as well as having occasional, temporary influence on the senses of smell and taste.
After the baby is born, these hormones rapidly return to normal levels, again affecting brain functions, which may lead to PPD in a mild or severe form. Other symptoms such as fatigue and emotional instability, as well as metabolism, blood pressure, and immune system changes are caused by a drop in the amount of hormones produced by the thyroid gland.
There are many external factors that may affect the mother’s emotional health in a negative way causing feelings of inadequacy, changes in the sense of identity and life’s perspective, with loss of control and daily, marked frustration, body image perceptions, and feeling less attractive.
Difficulties giving birth and pain and other physical problems requiring medical attention, inability to properly care for the newborn and other children, inadequate support from the spouse (often due to a difficult relationship), family, and friends, and financial problems.
Some babies may need constant attention, which may intensify feelings of fatigue and frustration, as do physical and emotional difficulties with breast feeding.
PPD may affect mothers of any age after giving birth to any of their children a few days, weeks, or even months after they are born, particularly when they had suffered from depression before the pregnancy. If PPD appears after having the first child, it will probably happen after each subsequent pregnancy.
Although the causes of this disorder are similar for all races, culture and family structure play an important role; depression may be milder and shorter when close family members live nearby or in the same household, ready to provide emotional support and actual help for the newborn, as well as for the mother. In this situation, if depression occurs, recovery will happen sooner, often with no medical intervention.
Mild “baby blues” may last around a couple of weeks, at most. However, if signs and symptoms of depression do not subside, or they even intensify, medical treatments must be started in order to prevent their progression to postpartum psychosis, which, although infrequent, is a very serious disorder that endangers the life of both mother and child.
In the U.S., it is estimated that approximately one out of twenty mothers with postpartum psychosis commit suicide and kill their children—about five times more often than mothers who do not reach this stage.
Fatigue, mood swings, and emotional changes are expected, in a mild form, in the post-partum period. As described above, when signs and symptoms do not go away and even get worse, medical intervention is necessary in order to assess the situation and, if needed, start treatments. Medications may be prescribed to correct a thyroid gland imbalance and also antidepressants, concurrently with psychotherapy support.
Post partum psychosis is a rare occurrence; however, if the mother nears or reaches the psychosis stage, medical and psychiatric treatments are a must. In severe cases, the mother may have to be hospitalized. Antipsychotic medications and other medical resources may be needed; Lithium, usually with psychotherapy intervention, is occasionally used for long-term depression treatments.
Antidepressant medications are necessary to reverse severe PPD. When it comes to taking them, breast-feeding is a concern for many mothers, as well as for many doctors. Although the newer ones are fairly safe, at this time we do not have long-term studies proving them harmless to newborns. If the life of the mother and the child are compromised, breast-feeding will have to be interrupted.
It is advisable to talk to an experienced physician when PPD does not resolve in about a month, or when it worsens before this time. This disorder should not be left untreated because it will cause serious problems with close family members; children will suffer the most, with subsequent emotional and behavioral difficulties. In the long term, they would experience learning difficulties and have problems adjusting to many normal social situations.
Could PPD be prevented? The answer is yes, it could be prevented, to a certain extent. However, it will happen if the mother experienced depression before getting pregnant and also had PPD after the first child. A healthy lifestyle, with good nutrition and plenty of rest, a good relationship with the husband and family members, plus good and frequent pre-natal care will help a great deal, minimizing signs and symptoms in the post-partum days.
Once the baby is born, it is necessary to communicate negative feelings, seeking support from family and friends. Talk to your physician and other mothers, join a support group, and avoid isolation. Visit friends, go shopping, catch a movie, etc. New moms must take care of their newborns, but also they must take care of themselves.
By Julie M. Pearson, MD