“Birth, the first and direst of all consequences.”

Ambrose Bierce

Depression after childbirth was first described by Hippocrates in 460 BC.

Depression is twice as common in women as it is in men. The high rates of depression during premenstrual, perimenopausal and postpartum periods are evidence of the link between hormones and depression.

Postpartum depression is a spectrum disorder. On the mild end of the spectrum is the “baby blues.” Since up to 85% of new mothers have the baby blues it is considered to be an expectable consequence of childbirth. Mothers with the baby blues feel weepy. They may also feel moody or sad. Other symptoms include problems with sleep, appetite, restlessness and irritability. Baby blues begin 3-4 days after delivery and resolve within a few days. Baby blues get better with reassurance and support of friends and family members.

At the other end of the spectrum is postpartum psychosis. Although this condition is relatively rare it is devastating. Symptoms may begin as soon as the first month after childbirth or as late as 18 months afterward. Women with postpartum psychosis are extremely impaired with hallucinations and delusions that frequently involve thoughts of the baby dying or being demonic. Sometimes the hallucinations command the mother to harm herself or the baby. Women with postpartum psychosis are at great risk of taking their own life and the life of their child. They often have mood disorders and may have struggled with bipolar disorder or recurrent depression before their pregnancy. Postpartum psychosis is a medical emergency and requires immediate hospitalization or intensive outpatient treatment.

In the middle of the spectrum is postpartum depression. This unique and serious form of depression complicates 10 to 15% of all deliveries and up to 32% of teenage deliveries. Because many symptoms of postpartum depression are easily confused with normal post delivery symptoms, new mothers may have symptoms for 6 months before understanding that they are depressed. Postpartum depression usually begin within the first 6 weeks after delivery and more than 50% of the time will be the first episode of depression ever experienced by the new mother. Without treatment, 25% of women will still be depressed a year later.

Symptoms of postpartum depression:

• Sustained sad mood
• Loss of interest in activities or inability to experience pleasure
• Trouble thinking, concentrating or making decisions
• Anxiety, agitation or feeling slowed down
• Fatigue
• Changes in appetite and sleep
• Thoughts of death or suicide
• Overly focused on or worried about baby’s health
• Feeling worthless or like a failure
• Feeling like a bad, inadequate or unloving mother

Post partum depression has tremendous consequences for both a mother and her child. It can affect a mother’s ability to parent. She may lack energy, have trouble concentrating, be irritable, and not be able to meet her child’s needs for love and affection. As a result, she may feel guilty and lose confidence in herself as a mother, which can worsen the depression. Researchers believe that postpartum depression can affect the infant by causing delays in language development, problems with emotional bonding to others, behavioral problems, lower activity levels, sleep problems, and distress. It helps if the father or another caregiver can assist in meeting the needs of the baby and other children in the family while mom is depressed.

All children deserve the chance to have a healthy mom. All moms deserve the chance to enjoy their life and their children. Don’t suffer alone. If you are experiencing symptoms of depression during pregnancy or after having a baby, please tell a loved one and call a specialist right away.

Risk Factors for Postpartum Depression

• Previous history of depression or bipolar depression
• Family history of depression
• Teenage pregnancy
• History of emotional difficulty during other hormonal transitions (onset of menses, starting birth control pills, other pregnancies)
• Lack of family or social support
• Child care stressors
• Substance abuse or anxiety disorders
• Traumatic birth experience
• Early discharge from the hospital (less than 24-48 hours)
• Previous history of childhood abuse
• Multiple or serious life stressors (financial difficulty, death of loved one, recent move, and so forth)

Identification of women suffering from postpartum depression needs to be a priority. The symptoms of postpartum depression are the same as any other major depressive episode. The hallmarks are intensely sad mood (dysphoria) or loss of pleasure (anhedonia) most of the day, nearly every day, for at least 2 weeks. Additional symptoms include difficulty concentrating or making decisions; agitation or feeling slowed down; fatigue; changes in appetite and/or sleep; thoughts of suicide or death; feelings of worthlessness or guilt; focusing on failure at motherhood; anxiety; overfocusing on the child’s health.

Postpartum depression has biological underpinnings. The hormones that support pregnancy, estrogen and progesterone, fall dramatically within 48 hours following delivery. These major steroid hormones play important roles in memory, cognition, mood and overall brain function and rapid changes in their levels may be a primary cause of depression.

Postpartum depression is successfully treated with medications and psychotherapy or both. Medications are the preferred intervention and the major categories of psychiatric and neurological drugs have been extensively studied in breastfeeding patients. The vast majority of medications are considered safe because of the very low amounts that transfer from a mother into breast milk. Remember that the consequences of untreated depression to both mother and child are worse than medication side effects. Psychotherapy should be added in cases of severe depression or when social problems are present.

Steps to Take if You Suspect You Have Postpartum Depression

• Tell someone. Do not be embarrassed, ashamed or guilty that you aren’t happy.
• See a specialist. Research shows medication and therapy can change your life.
• Get as much rest as you can. Sleep when the baby sleeps.
• Stop pressuring yourself. Do as much as you can, then stop.
• Ask for help with chores and nighttime feedings.
• Do not spend a lot of time alone. Get dressed and get out of the house.
• Spend time alone with your spouse or partner.
• Talk with other mothers. Learn from their experience and advice.
• Don’t make major life changes while depressed. Major changes create more stress.

Postpartum depression has a major impact on the woman, her infant and her family. There is a great need for physicians, families and community based organizations to provide education, support and treatment for women at risk for depression following childbirth.

Dr. Lisa Routh is a Mayo Clinic trained neuropsychiatrist licensed in nuclear brain imaging. Dr. Routh and Brainwaves Neuroimaging Clinic can be contacted at 713-796-0022 for brain SPECT imaging and help with behavioral health concerns.