Beyond the relatively typical “Baby Blues,” caused by a rapid drop in hormones, some new mothers (as many as 25 percent) experience severe depression. For these mothers, extra special care is
Sad, anxious, empty, worthless, guilty — these are not words normally associated with new motherhood, but for more than 400,000 of the women that will give birth in America this year, these emotions are all too familiar. As many as 25 percent of new mothers experience post-partum depression (PPD) in the first year. PPD is characterized by severe disruptions in sleep (sleeping too much, too little, not being able to fall asleep or stay asleep), change in appetite, irritability, excessive crying without cause or provocation, lack of interest in the infant, trouble concentrating or making decisions, panic attacks and even thoughts of death or suicide.
IT'S NOT THE BABY BLUES
PPD should not, however, be confused with what is commonly termed “the baby blues.” Amanda Sparks, M.D., psychiatrist and medical director of The Sparks Clinic, P.C. in Nashville, says the baby blues are normal. “About 85 percent of women experience baby blues, characterized by crying, feelings of doubt (‘Oh, what have I done? I can’t take care of this baby!’) and being overwhelmed. This lasts for about two days to two weeks, and all the new mother needs is some support, a little extra sleep, some help feeding the baby, and the blues go away.” Sparks also points out that baby blues do not lead to PPD — just as diabetes doesn’t lead to hypertension. They are very separate disorders.
EMOTIONAL FACTORS PLAY A ROLE
PPD is diagnosed anytime following the first two weeks after the birth, with most studies showing its peak onset occurring somewhere between two and 12 weeks postpartum. Though there are no proven physical or genetic attributes that would make a woman more prone to PPD, there are emotional factors that play a role. Between 10 and 25 percent of women experience a major depressive episode of some sort at some point in their lives. Prior depressive episodes are a flag for PPD: If a woman has had a prior depression in her life not associated with childbirth, her risk of developing PPD is 25 percent. If she’s had a prior PPD, her risk of developing PPD again is 50 to 75 percent with every subsequent birth.
“Those patients in particular, we really try to find and treat. Either while they’re pregnant — as soon as they have symptoms we treat them, pregnant or not — or at the latest, as soon as they deliver. Their chances of developing PPD are so high, it feels more like ‘when’ than ‘if’ their symptoms are going to come back,” says Sparks. Other associated, but less clear predictors of PPD are ambivalency toward the pregnancy, low spouse or partner support and depression during pregnancy. PPD can last anywhere from six months to a year (the same statistics for any depression) if it goes untreated. However, Sparks points out that the more depressive episodes a woman has had the longer any subsequent episodes are likely to last. “And it’s so much easier to treat depression early than to have to catch up with it. The longer the person is depressed, typically the harder the depression is to treat,” says Sparks.
The prescribed treatment for PPD is antidepressant medication, the same medications prescribed for any depressive episode. “There are a large number of [antidepressant] medications that have good track records in pregnancy and with breastfeeding. The choice of medication is made based on the individual,” asserts Sparks. As for the safety of taking medication while pregnant and/or breastfeeding, Sparks says, “There’s no single thing that is absolutely safe in pregnancy. Tylenol is not absolutely safe in pregnancy, and neither is city water. If you’re looking at the risks versus the benefits, you’ve got much more risk to mom and fetus, or mom and baby, if mom goes untreated.” Normal statistics for depression, including postpartum, show that 85 percent of patients improve with treatment. Sparks also says that where some people might only need medication, the best outcome for anybody who is depressed — postpartum or not — is combining medication and therapy.
PPD EFFECTS ON NEWBORNS
The effects of PPD on a newborn baby are not fully known, though some data suggests that depressed women who go untreated have a harder time complying with their prenatal care. And since anorexia is often associated with depression, women experiencing depression while pregnant tend to have low-birth-weight babies. Women who are depressed, when they’re not treated, also tend to have a higher risk of substance abuse and being a victim of domestic violence. “In fact, a woman’s most likely time to be beaten in her home is while she’s pregnant,” says Sparks.
Though the optimal time to catch PPD is two to 12 weeks after the birth, there is no diagnostic test used universally at postpartum doctor visits. Sparks says that she, and other doctors who specialize in PPD or psychiatry, routinely use the Edinburgh Postnatal Depression Scale (EPDS).
“It’s a basic, 10-question test. It’s easy to administer — the patient can take it in the waiting room. It’s really easy to use, it’s just not used enough in general practice,” laments Sparks.
EPDS can be found quickly on the Web doing a simple search for it. The fact that this simple test is not commonly utilized makes the diagnostic challenges of PPD even greater. There is a tremendous sense of guilt associated with being depressed at a time when a woman feels sure she should be truly happy. Most women are reluctant to come forward with their feelings and unlikely to report the symptoms.
“The key, then, is to find them,” says Sparks. “So many people think, ‘Oh, I’ve just had a baby, this is normal.’ Or they’re told, ‘Oh, honey, it’s just your hormones.’ Well, when the symptoms are happening two weeks after the birth, you can’t say anymore that it’s just your hormones. You need to get help.”
In addition to consulting with your doctor, you can find local resources through Postpartum Support International (PSI). Call 800-944-4773 or visit postpartum.net.
— Jennifer Frisvold is a mother and freelance writer.