Baby Blues and Postpartum Depression (PPD): Causes and Treatment

More than 85% of women who have delivered a child, experience some sort of mood disturbance.  For most women, the symptoms are moderate and last for a short period of time, however, between 10-15% of women develop more serious symptoms of depression, coupled with anxiety.  Postpartum psychiatric illnesses are divide into three categories:


•    Postpartum Blues (“Baby Blues”)
•    Postpartum Depression
•    Postpartum Psychosis


In the days and weeks following delivery, a womans body experiences a wide range of hormonal changes.  The levels of hormones which peaked during pregnancy, begin to taper off and the results to a womans body and mental health, can be devastating, if left untreated.  There are vast differences between a normal case of “baby blues,” and full blow postpartum depression or psychosis. Knowing how to discern the difference is extremely important, because with the proper diagnosis and treatment, the effects of depression can be managed effectively.


What is the Baby Blues?


Between 50-85% of women experience some form of the “baby blues,” which occurs during the first few weeks after delivery.   In contrast to depression, women who experience the blues report feeling mood swings, irritability, anxiety and weepy.  The symptoms usually peak anywhere from 4-5 days post delivery and may last for a few hours or days, most symptoms subside on their own within a 2 week period.  Women experience symptoms of unpredictability and doubt, but it should not interfere enough to impair the ability to function.  While no specific form of treatment is necessary, for women with a history of depression, sometimes the blues can lead to a more significant mood disorder.  If the symptoms of the “baby blues” last longer than 2 weeks, the patient will need to seek medical attention to rule out a more serious condition.


What is Postpartum Depression?


Postpartum depression on the other hand, is not simply a feeling of being “blue” for a few days.  Postpartum depression is a serious condition which involves the brain and extends way beyond the normal time frame for having the “baby blues.”    Approximately 15% of women experience depression during and after pregnancy.  The good thing about this condition is that with treatment, most people suffering from depression can make a full recovery.


If a woman is pregnant or just had a baby, she might not recognize the signs and symptoms of depression.  Some of the normal body changes a woman experiences during and after pregnancy can mimic the signs of depression.  Below is a list of depression symptoms, and if experienced for more than 14 days, should be addressed with a physician:


•    Feeling irritable, moody, overwhelmed, sad or hopeless
•    Frequent bouts of crying
•    Lack of energy or motivation
•    Appetite Fluctuations
•    Sleep disturbances or changes in sleeping pattern
•    Have trouble maintaining focus or being indecisive
•    Difficulty remembering things
•    Feelings of worthlessness or guilt
•    Loss of interest or joy in normal activities
•    Withdrawn and somber
•    Having frequent headaches, body aches and pains or stomach pain that will not subside


While postpartum depression occurs in women who have recently delivered a baby, it is important to note that women who experience a miscarriage or stillbirth, can also go through postpartum depression. Women who suffer from postpartum depression have more in depth issues than women with a case of the baby blues.  Postpartum depression can prevent the mother from being able to care for or bond with her new infant.  Feelings of postpartum depression can last for months, if not diagnosed and treated, while feelings of the blues will eventually resolve on their own with no necessary medical intervention.


In very rare instances, some women experience a severe form of postpartum  depression called postpartum psychosis.  Postpartum psychosis is the most severe form of postpartum depression and is such a rare occurrence in 1-2 per 1,000 women post delivery.  The symptoms of postpartum depression are often dramatic and the onset of symptoms can occur as quickly as the 3-4 days after delivery.  However, most women who have postpartum psychosis develop symptoms in the the two weeks following delivery.  Symptoms include:


•    Rapid, manic episodes
•    Rapid heartbeat
•    Weight loss
•    Irritability
•    Confusion
•    Disorientation
•    Insomnia
•    Restlessness
•    Rapid shift in moods (going from highs to extreme lows)
•    Erratic and scattered behavior
•    Delusions
•    Auditory Hallucinations that drive the mother to harm the infant, are also possible.
•    Risk of suicide or infanticide



Why Does Postpartum Depression Occur?


Within the first two days post delivery, the levels of estrogen and progesterone in a womans body sharply decline.  It is believed that the effects of hormonal fluctuations, is in large part responsible for causing postpartum depression.  Symptoms of postpartum depression are oftentimes compounded with other extenuating factors that increase the likelihood, such as previous history of depression, non-supportive partner or weak support system and high levels of stress.


Women at Risk for Developing Postpartum Depression


All women who have recently delivered are susceptible to experiencing postpartum depression.  The symptoms can strike a woman no matter what age, marital status, socioeconomic status or educational level.  It is still impossible to predict if a woman will experience postpartum depression, but certain risk factors have been established and include:


•    A previous case of postpartum depression with last delivery
•    Depression during the pregnancy
•    A past history of depression or bipolar disorder
•    Inadequate support system
•    Marital difficulties
•    Stressful life events
•    Suffering from premenstrual dysphoric disorder (PMDD), also increases likelihood


Postpartum depression does not discriminate and is a very real issue that should be addressed. If a new mother suffers from any of the symptoms of depression and has certain risk factors involved, seeking the advice of a medical professional is recommended.


How is Postpartum Depression Diagnosed?


While there is no definitive testing available for diagnosing postpartum depression, but it is a medical condition that needs to be treated.  The symptoms of depression are not always obvious to the person who has it, and there are no medical tests available, this is why it is important to seek the advice of a medical professional. 


What Can Be Done to Fight Against the “Baby Blues” and Postpartum Depression 


Though it can be hard to predict which women will suffer from postpartum depression, it is possible to determine which women are more likely to experiencing episodes of depression.  Current medical research indicates that early intervention instituted immediately after birth, can lessen the likelihood of postpartum depression.  There are certain things a new mother can to do ward off the chances of developing postpartum depression, which include:


•    Practice relaxation techniques
•    Getting adequate rest
•    Exercising
•    Think of motherhood as a job
•    Do not foster unrealistic expectations about motherhood
•    Do not be afraid to ask for help
•    Face up to fears (about motherhood, emotional concerns, etc.)
•    Remain flexible (do not expect to be able to do everything alone)
•    Join a new mothers support group
•    Remember that it will get better with time


There are many things a new mother can do to ease the transition into motherhood.  However, the best way to approach the postpartum period is with a plan of action designed to lessen the likelihood of postpartum depression developing. 


Medical Treatment for Postpartum Depression


It is imperative that a new mother experiencing postpartum depression seeks early intervention and treatment.  The sooner treatment starts the better the chances are for recovery and the less likely it is that the depression will effect the mother, family and new baby.  Treatment options for postpartum depression include the following:


•    Counseling: Cognitive:  Behavioral therapy has shown to be just as effective in the treatment of postpartum depression as antidepressant medications.  Interpersonal counseling is also another treatment option and focuses on familial relationships, as well as the personal adjustments that every new mother must go through.

•    Antidepressant medications:   These medications are effective for relieving the symptoms of post postpartum depression.  It is very important to let the physician know if breastfeeding a baby, because this will determine which antidepressants can be used.

•    Electroconvulsive Therapy (ECT):  For women experiencing suicidal tendencies as a result of sever postpartum depression, ECT has been shown to be a safe and effective treatment method.



Natural Treatments for Postpartum Depression


For women seeking a more natural approach to postpartum depression, there are also several treatment options available.  There have been several claims made about herbal and dietary products that are useful in the treatment of postpartum depression, however, St. Johns Wort is the only one that has been shown to be effective.


There are many types of natural treatments available for the treatment of postpartum depression, which include:


•    Dietary modifications:  Make sure the new mother is eating a well balanced diet and monitoring the intake of caffeine, chocolate, sugar and alcohol is also advisable.  Taking calcium and vitamin B6 supplements can also help decrease the symptoms of postpartum depression.

•    Biofeedback:  Through biofeedback a woman can learn to control certain body functions such as muscle tension and brainwave patterns.  Biofeedback has also been shown to help with tension, concentration and anxiety, which in turn may help alleviate the symptoms of depression. Biofeedback is designed to be used in combination with psychotherapy and antidepressant medications.

•    Relaxation Therapies:  Learning techniques to promote relaxation can help in the fight against depression, yoga and meditation are just two common forms of relaxation methods.

•    Massage Therapy:  Although it is not a cure for depression, massage therapy has been proven  effective for the  relief of stress and tension.

•    Art and Music Therapies:  Along with medication and psychotherapy, some women have found that art and music therapy are helpful.


It is important for women to realize that no matter what, the effects of postpartum depression do not last indefinitely.  However, the symptoms are very real and must be treated, if recovery is to occur.  Seeking out various treatment options, in conjunction with medical attention is imperative and must be done as quickly as possible.  If left untreated, the symptoms of postpartum depression can continue for months or years and have the same the potential for long-term problems are the same as with major depression.


Impact of Untreated Postpartum Depression on Child Development


Many doctors believe that a mothers attitude and behavior towards a new infant can have a direct impact on mother-infant bonding and as a result, effect the well-being and development of an infant.  For a mother suffering from the effects of postpartum depression, this can manifest itself into negative feelings towards the infant.  Mothers with postpartum depression have difficulty in engaging the infant, either being inattentive or overly attentive, and commonly exhibit negative facial expressions as a result.  With the early interactions being disrupted, it is more likely to have a profound impact on the infants development.


The children of mothers with postpartum depression are more likely to exhibit behavior issues such as, sleeping or eating problems, temper tantrums, acting out and hyperactivity.  There have also been cases of delay in cognitive development, emotional and social dysfunction and the early onset of depressive episodes.


Long Term Prognosis


Inadequate treatment of postpartum depression increases the risk of morbidity in both mothers and infants.  While the “baby blues” is oftentimes benign and self-limited, postpartum depression and psychosis cause significant dysfunction.  Oftentimes, a diagnosis of postpartum depression is overlooked and as a result, many women do not get the treatment they so desperately need.


Untreated psychiatric disorders set the stage for the mother to experience recurrent episodes.  One of the most important objectives is to raise awareness  of postpartum depression across all areas of health care that treat women during the postpartum period, this will have a direct impact on the condition being diagnosed early and treated appropriately.