Postpartum Depression
"Baby Blues" or Postpartum Depression?

We don’t know exactly what causes postpartum depression, but research points toward hormonal factors that may in turn affect brain chemistry. It is a biological illness, and is not the mother’s fault or due to a “weak personality”. It is a medical illness that professional treatment can help.

Below we have addressed some commonly asked questions regarding postpartum depression. It is important to speak with your healthcare provider if you feel you may be suffering from postpartum depression.

What are the postpartum “blues”?
Postpartum “blues” or “baby blues” affect 50% to 80% of new mothers. The condition represents a temporary state of heightened emotional responses. New mothers may present symptoms such as mood swings, weepiness, anxiety, irritability, or difficulty sleeping, interspersed with times of feeling well. Symptoms usually begin 3-4 days after delivery (often coinciding with the onset of lactation), worsen by days 5-7, and tend to go away by day 12.
The propensity to develop “baby blues” is unrelated to previous psychiatric history, environmental stressors, cultural context, breastfeeding, or number of pregnancies. However, those factors may influence whether the “blues” lead to major depression. If symptoms last longer than 2 weeks, it is important to seek professional attention, since one in five women (20%) with postpartum “blues” go on to develop postpartum major depression.

How do I know if I have postpartum depression?
Postpartum depression can begin at any time in the first days, weeks, and up to 6 months after delivery. It occurs in approximately 10 % to 20% of women in the United States. It is far more serious than postpartum “blues” but it is often not diagnosed until several months after onset.

The symptoms of postpartum depression include a depressed mood most of the day, nearly every day, for at least two weeks and losing interest or pleasure in activities that the new mother used to enjoy. Other symptoms include fatigue, feeling restless or slowed down, a sense of guilt or worthlessness, difficulty concentrating, difficulty sleeping—even when the baby is sleeping, and recurring thoughts of death or suicide.

Who is likely to get postpartum depression?
The most important risk factor for postpartum depression is having had a similar episode before. Over 50% of the women with previous depression after the birth of a child will become depressed again when they next give birth. Women are also more vulnerable if they have been depressed during pregnancy or if they had significant premenstrual mood symptoms before they were pregnant. If a woman has been depressed at any other time in her life, her risk of developing postpartum depression also increases, from about 10% to about 25%. It is noteworthy to mention that women with bipolar disorder (also known as manic-depressive illness) are also at higher risk.
It is very important for a woman with a personal or family history of a mood disorder to talk to her doctor so that she can be monitored closely. Stressful situations, including health problems in the baby, marital discord, not having a partner, or poor social support, may also place women at increased risk for postpartum depression.

Is there any treatment or cure for postpartum depression?
Sometimes symptoms remit on their own; however, without treatment, many women are still depressed a year after giving birth. Several medications have been used in the treatment of postpartum depression. The most extensively studied are the selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs); however, other antidepressants are commonly used to treat postpartum depression as well. Typically it takes 2-4 weeks for antidepressants to take full effect, although some improvement may be noticed prior to that time. Evidence regarding the effectiveness of estrogen or progestin has been inconclusive.

Although it has been shown that a combination of medication and therapy offer the best results, some women opt not to take medications, for a variety of reasons. In these cases, there is still some benefit from receiving therapy only, either in support groups or individual, couples or family sessions, depending on the situation.

How long will I need to stay on medication?
The length of treatment will depend on the severity of symptoms and the individual’s response. It is generally recommended that medication be continued for at least 6 months after remission of symptoms if it is the first episode of depression. If there have been previous episodes of depression, medication may be needed for a longer period of time. Discontinuing medication too soon may increase the risk for subsequent episodes of depression.

Can I take medication while I’m breastfeeding?
In general, most antidepressants are safe during breastfeeding. Although small amounts are excreted in the milk (to varying degrees), there have not been any adverse effects reported in infants. Zoloft is the most commonly prescribed drug, due to the low amounts passed on to the infant. Prozac (fluoxetine) lingers in the milk longer and therefore is not recommended. It is advised that breastfeeding women should not take benzodiazepines (i.e., Ativan, Xanax).

What are the risks of not receiving treatment if I have postpartum depression?
The earlier you treat depression, the better the outcome. Untreated depression has many possible implications. The depression not only affects the mother; it may also have effects on the partner and others who are close to the mother. Postpartum depression may also hinder interactions with the newborn, which may influence development, attachment and temperament.

References:
• Miller, LJ, Rukstalis M. Beyond the “blues”: hypothesis about postpartum reactivity. In: Miller LJ, ed. Postpartum Mood Disorders. Washington, DC: American Psychiatric Press; 1999; 3-19.

• Miller, LJ. “Postpartum Depression”. JAMA, February 13, 2002-Vol 287,No6 762-765.

• Gold, Liza “Postpartum disorders in primary care. Diagnosis and treatment”. 2002.

• Llewellyn, Alexis and Stowe, Zachary “Psychotropic Medications in Lactation”. Journal of Clinical Psychiatry 1998:59 (suppl 2) 41- 52.