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Are you simply overwhelmed by the demands of new motherhood, or could you be suffering from postpartum depression?

New mothers' postpartum experiences rarely match up to the pretty picture of floating on a proverbial "pink cloud" in innocently jubilant fashion that you'll find portrayed in some women's magazines. Physically sore after childbirth, busy changing maxi pads and diapers, sleep deprived, robbed of intelligent adult interactions, and wondering how on Earth to make this tiny little human stop crying already, between 50 and 70 of postpartum women will experience what's known as the Baby Blues [1].

This phenomenon could be described as a "mini depression". It tends to set in three or four days after the baby was born, and is characterized by maternal crying, fatigue, insomnia, an inability to concentrate, general feelings of being overwhelmed with motherhood, and worries about the future. These "Baby Blues" are completely normal, and don't require treatment beyond a good hug, a listening ear, and someone who can clean the house and do the laundry. They go away again within around two weeks, as new mothers adjust to life with the new little one.

Should you, or someone you care about, still be depressed after two weeks, and should the symptoms be significantly more severe, you might rightfully be wondering if you could be dealing with full-blown postpartum depression. 

Signs And Diagnosis Of Postpartum Depression

The fifth version of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, doesn't distinguish between depression during and after pregnancy any longer [2]. Though postpartum depression is, as such, not currently an official diagnostic category, most healthcare providers still continue to use the term to refer to depression that begins within 12 months of childbirth, with the diagnostic criteria being the same as those for clinical depression at at any other point in life [3].

The symptoms of postpartum depression are:

  • A depressed mood (feeling sad, hopeless, helpless, empty, worthless) for most of the day nearly every day, either as reported by the affected mother or by those around her. 
  • Loss of enjoyment or interest in all or most activities. 
  • Loss of appetite or spontaneous rapid weight loss. 
  • Being unable to sleep (other than caused by the baby being awake), or on the other hand sleeping excessively
  • Persistent feelings of guilt and worthlessness.
  • A lack of concentration. 
  • Fatigue and low energy
  • Being plagued by thoughts about death. This can but does not necessarily have to include actual plans to commit suicide, and mothers with postpartum depression may also suffer from recurrent thoughts of harming their baby or their baby being harmed by others.[3]
Research suggests that between 10 and 20 percent of new mothers will suffer from postpartum depression or anxiety [4].

While the diagnostic criteria don't differ from those for other types of depression, the causes of postpartum depression — not well understood at the moment — are believed to include hormonal change and the uniquely challenging nature of looking after a new baby. 

Postpartum Depression Risk Factors

A major Swedish study found that women with a history of major depression are more likely to fall victim to postpartum depression than others. Among women with a history of depression, pregestational diabetes and delivering even a little bit early were found to be risk factors for postpartum depression.

Interestingly enough, those new mothers who were over 35 when they gave birth, and those who suffered from gestational diabetes during their pregnancies, were also found to be at a higher risk of developing postpartum depression, even without a history of depression. Young mothers, those who had cesarean sections or delivered with the assistance of forceps or vacuum extraction, and those whose babies were born early were deemed to have higher rates of postpartum depression only when they didn't already have experience with depression. [5]

Postpartum Depression Treatment

If you or someone you love is affected by postpartum depression, it is important to recognize that though the symptoms are unlikely to simply subside on their own, help is out there.

Postpartum depression, like other forms of depression, can range from mild to severe and treatment should be tailored to the individual's specific needs. 

No matter the extent of the depression, therapy is always a recommended component. Interpersonal therapy (IPT) and cognitive behavioral therapy (CBT) have both been proven to be helpful, with CBT being the better choice in women whose postpartum depression includes a great deal of anxiety. [6]

Research shows that doctors are more reluctant to prescribe antidepressants to women with postpartum depression than to people affected by other forms depression, something that could partly be attributed to the fact that no antidepressants have been approved as category A agents in breastfeeding mothers. Where the symptoms of depression are severe enough that therapy alone does not help sufficiently, however, postpartum mothers do require medication to get better. Using antidepressants for six to 12 months offers the best chance of a complete recovery. [78]

Attending support groups for women with postpartum depression can also be beneficial, and, since hormonal changes are believed to be among the underlying causes, some data suggests that progesterone treatment may be helpful [9]. This is, however, inconclusive at this point, so progesterone therapy can be considered an experimental treatment. 

Those who are actively suicidal or have recurrent thoughts of harming their babies will be advised to undergo inpatient treatment for severe postpartum depression [10]. In most cases, that will not be necessary — and therapy, attending a support group where desired, increased social support to meet the demands of motherhood, and where necessary antidepressant treatment will be enough to help a mother overcome her depression and move on with her life. 

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