Postpartum Depression

• 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 is sleeping)
• 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 health issues.

Created: 7/30/2002  -  Donnica Moore, M.D.