- PPD is the most common complication of childbearing.
- PPD occurs in 13% (one in 8) of women who give birth.
- PPD affects approximately half a million women per year in the US.
- Defining PPD: Women who have given birth within the past 3 months who have
five of the following symptoms of major depression, at least one of which
must be either depressed mood or decreased interest or pleasure in activities
(Diagnostic and Statistical Manual of Mental Disorders, fourth edition):
- Depressed mood, often accompanied by severe anxiety
- Markedly decreased interest or pleasure in activities
- Disturbed appetite, usually loss of appetite and weight loss
- Disturbed sleep, usually insomnia and disrupted sleep (even when the baby
- Physical agitation or, less commonly, physical slowing down
- Fatigue, decreased energy
- Feelings of worthlessness or excessive or inappropriate guilt
- Decreased concentration or difficulty making decisions
- Repeated thoughts of death or suicide
- PPD is believed to be related to the rapid decline in the levels of reproductive
hormones that occurs after delivery.
- Characteristic symptoms include crying jags, sadness, emotional lability,
guilt, loss of appetite or anorexia, profound sleep disturbances, poor concentration
and memory (most likely a consequence of the sleep disturbances), irritability,
feelings of inadequacy, and feelings of inability to care for the newborn
or other children.
- There is no consistent association between PPD and age, number of children,
the sex of the baby, socioeconomic status, whether the pregnancy was planned,
or any biologic factors.
- Risk for PPD is increased by:
- Personal or family history of depression
- Unmarried status at the time of birth
- Lack of social support
- Occurrence of negative life events during the pregnancy and/or delivery
- Personal history of premenstrual syndrome (PMS)
- Treatment must be medical and psychological; physical conditions (e.g. pituitary
or thyroid disorders) must be considered and ruled out before the diagnosis
of PPD can be given. The most important but most difficult condition
to rule out is simple sleep deprivation. Test whether the symptoms persist
even after mom has had a good opportunity to rest, undisturbed, for several
hours. A sleeping pill may be prescribed. Once the diagnosis of PPD
is made, group or individual psychotherapy may be helpful. Education
about newborn care, providing increased social support, and non-pressured
lactation counseling are often helpful.
- Drug therapy is highly effective and does not necessarily require women
to stop nursing. Even though anti-depressant medications all get into the
breast milk, it is unclear that this has any untoward effects on the baby
(Discuss this issue with your physician for any prescription or over-the-counter
medication you may take). There are several choices of antidepressant
medication; each has different side effect profiles and length of usage experience
for PPD. If antidepressant medication is prescribed, it will generally
be continued for at least six months. Occasionally, women have been
prescribed estrogen as part of their treatment regimen for severe PPD once
their periods have resumed.
- Any woman who has thoughts of suicide, harming herself, harming her baby
or harming others needs an immediate psychiatric consultation. This
must always be taken seriously.
For more information on PPD, click here.
Click here for more information about depression or other mental
Created: 7/30/2002  - Donnica Moore, M.D.