Postpartum Depression Health Article

Definition

Postpartum depression is a mood disorder that begins after childbirth and usually lasts at least six weeks.

Description

Postpartum depression, or PPD, affects approximately 15% of all childbearing women. The onset of postpartum depression tends to be gradual and may persist for many months, or develop into a second bout following a subsequent pregnancy. Mild to moderate cases are sometimes unrecognized by women themselves. Many women feel ashamed and may conceal their difficulties. This is a serious problem that disrupts women's lives and can have effects on the baby, other children, her partner, and other relationships. Levels of depression for fathers can also increase significantly.

Postpartum depression is often divided into two types: early onset and late onset. Early-onset PPD most often seems like the "blues," a mild brief experience during the first days or weeks after birth. During the first week after the birth, up to 80% of mothers will experience the "baby blues." This period is usually a time of extra sensitivity; symptoms include tearfulness, irritability, anxiety, and mood changes, which tend to peak between three to five days after childbirth. The symptoms normally disappear within two weeks without requiring specific treatment apart from understanding, support, skills, and practice. In short, some depression, fatigue, and anxiety may fall within the "normal" range of reactions to giving birth.

Late-onset PPD appears several weeks after birth. It involves slowly growing feelings of sadness, depression, lack of energy, chronic fatigue, inability to sleep, change in appetite, significant weight loss or gain, and difficulty caring for the baby.

Causes & symptoms

At present, experts cannot always say what causes postpartum depression. Most likely, it is caused by a combination of factors that vary from person to person. Some researchers think that women are vulnerable to depression at all major turning points in their reproductive cycle, childbirth being only one of these markers. Factors before the baby's birth that are associated with a higher risk of PPD include severe vomiting (hyperemesis), premature labor contractions, and psychiatric disorders in the mother. In addition, new mothers commonly experience some degree of depression during the first weeks after birth. Pregnancy and birth are accompanied by sudden hormonal changes that affect emotions. Additionally, the 24-hour responsibility for a newborn infant represents a major psychological and lifestyle adjustment for most mothers, even after the first child. These physical and emotional stresses are usually accompanied by inadequate rest until the baby's routine stabilizes, so fatigue and depression are not unusual.

In addition to hormonal changes and disrupted sleep, certain cultural expectations appear to place women from those cultures at increased risk of postpartum depression. For example, women who bear daughters in societies with a strong preference for sons are at increased risk of postpartum depression. In other cultures, a strained relationship with the husband's family is a risk factor. In Western countries, domestic violence is associated with a higher rate of PPD.

Experiences of PPD vary considerably but usually include several symptoms.

Feelings:

• persistent low mood
• inadequacy, failure, hopelessness, helplessness
• exhaustion, emptiness, sadness, tearfulness
• guilt, shame, worthlessness
• confusion, anxiety, and panic
• fear for the baby and of the baby
• fear of being alone or going out

Behaviors:

• lack of interest or pleasure in usual activities
• insomnia or excessive sleep, nightmares
• not eating or overeating
• decreased energy and motivation
• withdrawal from social contact
• poor self-care
• inability to cope with routine tasks

Thoughts:

• inability to think clearly and make decisions
• lack of concentration and poor memory
• running away from everything
• fear of being rejected by partner
• worry about harm or death to partner or baby
• ideas about suicide

Some symptoms may not indicate a severe problem. However, persistent low mood or loss of interest or pleasure in activities, along with four other symptoms occurring together for a period of at least two weeks, indicate clinical depression, and require adequate treatment.

There are several important risk factors for postpartum depression, including:

• stress
• lack of sleep
• poor nutrition
• lack of support from one's partner, family, or friends
• family history of depression
• labor/delivery complications for mother or baby
• premature or postmature delivery
• problems with the baby's health
• separation of mother and baby
• a difficult baby (temperament, feeding, sleeping problems)
• pre-existing neurosis or psychosis