Postpartum

Depression is a severe mental health condition that affects up to 8% of the U.S. population, and millions of people worldwide currently suffer from the disorder. Depression is a complicated and varied illness, and since the mid-20th century, depression has been classified into several subcategories.

  • Major Depressive Disorder (clinical or unipolar depression)
  • Bipolar Depression
  • Seasonal Affective Disorder (SAD)
  • Psychotic Depression
  • Dysthymia
  • Premenstrual Dysphoric Disorder
  • Postpartum Depression

Specific segments of the population are at increased risk of developing a depressive disorder. For example, more women than men have depression, even though men are more likely to commit suicide. Hormonal factors and specific life stressors increase a woman’s risk of experiencing depression symptoms.

Postpartum

What is Postpartum Depression?

Postpartum depression affects up to 15% of mothers after the birth of a child. This serious and disruptive mental health condition usually strikes several weeks after giving birth, but in some cases, symptoms can begin in the later stages of pregnancy.

Postpartum Depression and Premenstrual Dysphoric Disorder are both unique to women. Postpartum, or Perinatal Depression, happens just before or right after giving birth. Genetic and temperamental risk-factors, combined with sudden hormonal fluctuations and the stress of having and caring for a newborn all converge to trigger an episode of postpartum.

While it is normal for the majority of mothers, 85%, to experience a brief period of tearfulness or anxiety after the birth of a child, up to 15% of mothers in the U.S. will get postpartum depression, a much more severe and long-lasting mood disorder.

The first recorded cases of postpartum depression come from the physician Hippocrates in ancient Greece. Hippocrates noted emotional difficulties in some women following the birth of a child, but it wasn’t until the mid-19th century that postpartum depression became recognized as a legitimate medical disorder.

At the time, treatment usually wasn’t sought, and when it was, the option was usually electroconvulsive therapy. Until the last few decades, most women were too ashamed to ask for help, and the condition went quietly unnoticed and was suffered in silence.

Women with postpartum depression feel the usual, whole-body depressive symptoms, such as sleep disturbances, loss of energy and motivation, sadness and negative guilty thoughts. But postpartum depression is unique in that women also feel incredibly stressed, and worried about the care of their newborn. They often feel extreme guilt related to how they are doing as mothers. Oftentimes, women with postpartum will feel they are not able to care for their newborn, or that they are failing as a parent. Excessive worry and anxiety can also appear.

In addition, the lack of sleep and time for self-care that comes with being a new parent can exacerbate depression symptoms. Sometimes, new mothers are so bogged down with fear, worry, and guilt, that they are unable to sleep once the baby is settled.

These negative feelings and the disruption of depression symptoms in any sufferer’s life can make it extremely hard for mothers to adequately bond with their child. This lack of a stable maternal bond can impact the newborn’s development. Not only does depression affect the mother, but her child cannot escape from its clutches, either.

Postpartum depression is characterized by the following symptoms:

Excessive sadness, hopelessness, and feeling overwhelmed

Although caring for a newborn is normally an overwhelming feeling, the difference between ‘normal’ and postpartum depression is the excessiveness of it. Mothers with postpartum can feel paralyzed and unable to care for their newborn. Other symptoms include:

  • Worry and anxiety
  • Withdrawal
  • Trouble concentrating, making decisions, and remembering details
  • Sleeping too much or an inability to sleep
  • Loss of interest in activities that were once enjoyable
  • Disconnect from the baby, or having trouble forming an emotional attachment to the baby
  • Persistently doubting if she can care for the baby
  • Feelings of marked sadness, guilt, and worthlessness
  • Extreme fatigue
  • Inability to sleep even when the baby is asleep
  • Severe mood swings
  • Thoughts of death or suicide
  • Thoughts of harming the baby or self
  • Fear of being unable to care for the baby
  • Panic attacks
Guilt and shame

Most parents experience some form of guilt, but with postpartum, guilt becomes all-encompassing.

Rage, or extreme anger

Women with postpartum will often lash out at the baby’s other caregivers.

In extreme cases, postpartum depression can devolve into postpartum psychosis. When this happens, the underlying postpartum depression symptoms are present, but hallucinations, delusions, and thoughts of harming herself and/or her baby are present.

The 2001 Andrea Yates case is a tragic example of what can happen when postpartum depression is not treated. Left alone to care for five children while suffering from postpartum depression, Andrea Yates went on to develop psychosis and drowned her children in a bathtub. She was found not guilty by reason of insanity and ordered to reside in a mental hospital. Since 2006, she has been institutionalized.

Who is at-risk for developing postpartum depression?

Postpartum depression does not discriminate based on age, race, economic class, or even if the baby was planned or unplanned.

While some of the predictive criteria for postpartum are mood-related, a significant number of factors are environmental. A lack of support, unstable relationships, and lack of resources in caring for the newborn can all significantly increase a mother’s risk of contracting postpartum. Therefore, it is critical for women to have support before and after giving birth. They also need access to affordable childcare to mitigate their risks of getting postpartum depression.

Also, government studies indicate that women with a history of depression have an almost 20X greater chance of getting postpartum than women who’ve never experienced a depressive episode.

For a postpartum depression diagnosis, a woman has to have the symptoms either starting in the third trimester of pregnancy or for up to a year after giving birth. In the U.S., 1 in 7 women will experience postpartum depression within one year of having a baby. The U.S. is home to 4 million live births per year, meaning an estimated 600,000 women will get postpartum depression.

Lower-income countries tend to experience higher postpartum rates. The top ten countries for postpartum depression diagnosis are:

  1. Chile – 50%
  2. Pakistan – 30%
  3. Nigeria – 27%
  4. India – 23%
  5. Saudi Arabia – 22%
  6. Finland – 22%
  7. Turkey – 22%
  8. Austria – 21%
  9. Brazil – 20%
  10. Sudan – 15%

The U.S. rates of postpartum depression are on par with Sudan, an impoverished African nation. Since women with postpartum are often breastfeeding, and experiencing extreme hormonal fluctuations, treatment for postpartum may be contraindicated with the usual line of defenses against depressive symptoms.

Any woman who gives birth is at-risk for developing postpartum depression, but there are several known factors that can increase the risk:

  • A family history of mental health disorders
  • If the woman has a history of depression or bipolar disorder before giving birth
  • A lack of care and support after giving birth
  • Domestic violence
  • A traumatic or stressful event during pregnancy or soon after giving birth (job loss, the death of a loved one, personal injury or illness)
  • Medical issues during childbirth and pregnancy (premature delivery, a child with special needs, pre-eclampsia, etc.)
  • Mixed or ambiguous feelings about the pregnancy
  • Alcohol or drug abuse and addiction
  • Having twins or triplets
  • Trouble getting pregnant
  • Being a teen mother

What causes postpartum depression?

No single cause of postpartum depression has ever been determined, but the overwhelming physical and emotional results of pregnancy and childbirth can factor into its development.

During gestation, hormones like estrogen and progesterone are elevated and stay elevated to maintain the pregnancy. But once the baby is born, these hormones precipitously drop, falling back to their baseline levels. These sudden chemical changes can trigger mood swings.

Couple this with the fact that mothers are completely unable to rest and heal from the rigors and discomfort of pregnancy and childbirth, and the constant and long-term sleep deprivation from caring for a newborn can all contribute to the development of postpartum depression.

Mothers without adequate support from family and loved ones after birth are at an increased risk of developing the illness.

How is postpartum depression treated?

There are many treatment options for postpartum depression. Therapy, prescription medication, hands-on support, childcare help, and self-care are all effective when recovering from postpartum depression.

SSRIs, SNRIs, and therapy are effective treatment methods for postpartum. Since hormones trigger postpartum, hormone replacement therapy can also be used to treat the disorder.

Sometimes, women will present with what is called treatment-resistant depression. This can occur in as many as one-third of patients with a depressive sub-type. In these instances, patients have tried medication and therapy, but it doesn’t work for them. Estimates indicate that most of the costs associated with depression, i.e., productivity losses and health care spending, are from treatment-resistant depression. With this form of the disorder, patients require different treatment methods.

Antidepressant medication and hormone replacement therapies come with a list of unpleasant side effects. Also, some women may not want to risk having medicines pass through breast milk if they are nursing their infant. Mothers with depression may not want to stop breastfeeding their baby. Fortunately, there are non-medical depression treatments on the market for women in these circumstances.

Transcranial Magnetic Stimulation (TMS) is incredibly effective at alleviating the symptoms of depression. TMS is painless, quick, and convenient for busy, tired mothers. Sessions last about an hour and can be done in an outpatient setting.

With TMS, a magnetic coil is placed on the patients head, directed at areas of the brain found to be responsible for regulating mood. Magnetic pulses are transmitted to these brain regions. Patients show a marked improvement in moods, even after just one session of TMS. Side effects are short-lived, and TMS doesn’t include risks such as weight gain, lethargy, and passing into the newborn’s digestive system like with antidepressant medications.

Patients who receive TMS treatments can return to work or back home with their baby shortly after each session. Patients can also attend therapy sessions while still receiving TMS treatment as part of their maintenance plan. For busy, tired, nursing mothers, TMS is an excellent choice for alleviating the painful and potentially dangerous symptoms of postpartum depression.

Support

New mothers, especially those suffering from postpartum depression, need the support of family and loved ones to adequately recover. Sleep and eating a well-balanced diet are required. Help with the childcare duties is a must for any mother, but particularly for those who are in treatment for postpartum depression.

Therapy

Talk therapy and counseling can give mothers the support and validation they need when in recovery. Therapy offers them a chance to speak to a licensed professional one-on-one about their feelings and thoughts surrounding the birth of their children without judgment.

A therapist can also help women with postpartum on how to navigate their personal relationships. Furthermore, cognitive behavioral therapy can help women recognize negative thoughts and behavioral patterns which may contribute to or worsen their depression. Therapy can also help women learn how to bond with their baby.

Medication

Prescription antidepressants, SSRIs and SNRIs, block the reception and absorption of the neurotransmitters dopamine and norepinephrine. These brain chemicals regulate mood, energy, and motivation.

Although antidepressant medications take several weeks to take full effect, they are highly efficacious at treating and managing depression symptoms. Furthermore, antidepressants are safe for babies if a woman is breastfeeding.

Depending on the severity of the depression and the patient’s circumstances, these treatment methods can be used together or on their own; however, a holistic plan is usually more effective.

What can family and loved ones do?

While it is normal for new mothers to feel tired and inundated with the responsibilities and care of a newborn, the symptoms of overwhelm, exhaustion, and anxiety found in postpartum depression are much more severe than the typical ‘baby blues.’ Family and loved ones are usually the first to notice the signs of depression in their loved one.

First, understand that postpartum depression does not happen because of something a mother did or did not do. Postpartum sufferers often feel guilty and ashamed. So, when confronting a new mother, be sure to approach from a position of understanding and patience. Be sure to let her know that what she is feeling are the symptoms of depression, that they are not an inherent part of her personality, and she is not a defective mother for having depression.

Mothers with postpartum often feel they are unable to properly care for their newborn. Let her know that her family can see how hard she is trying and give examples of where she is succeeding as a mother. Suggest how getting treatment will not only help her but her child as well.

Most importantly, many mothers fear they cannot take the time to rest, participate in self-care routines, or seek treatment. Offer ongoing, hands-on support for her. If she can see that taking some time out to care for herself will not result in diminished care for the baby, she will be more likely to seek treatment. Be aware though, that depression can take several weeks to months to heal from. She and the baby will need long-term support, and she will need help finding it.

Postpartum depression is not something to ignore or diminish in the hopes it will dissipate on its own. Women and children greatly suffer from its effects, and if left untreated, it can develop into a full-blown, and potentially dangerous, psychosis.

New mothers need support and understanding during their postpartum period, and if postpartum depression is suspected, consider reaching out to the following institutions and hotlines:

  • Contact a healthcare provider
  • If a suicide attempt or self-harm is suspected, immediately call 911
  • Contact the toll-free National Suicide Prevention Hotline at 1-800-273-8255

With treatment and support, women can go on to make a full recovery from postpartum depression, and neither she nor her newborn will experience any long-term effects.