HEALTH: POSTPARTUM DEPRESSION (PREGNANCY)

HEALTH: POSTPARTUM DEPRESSION (PREGNANCY) PPD SYMPTOMS

What is Postpartum Depression (PPD)

Postpartum depression (PPD) is moderate to severe depression in a woman after she has given birth. It may occur soon after delivery or up to a year later. Most of the time, it occurs within the first 4 weeks after delivery. Postpartum depression can be treated with medication and counseling. Talk with your health-care practitioner right away if you think you have postpartum depression.

Depression that occurs during pregnancy or within a year after delivery is called perinatal depression. The exact number of women with depression during this time is unknown. But researchers believe that depression is one of the most common complications during and after pregnancy. Often, the depression is not recognized or treated, because some normal pregnancy changes cause similar symptoms and are happening at the same time. Tiredness, problems sleeping, stronger emotional reactions, and changes in body weight may occur during pregnancy and after pregnancy. But these symptoms may also be signs of depression.

There are three types of postpartum depression women can have after giving birth:

The so called "baby blues" happen in many women in the days right after childbirth. A new mother can have sudden mood swings, such as feeling very happy and then feeling very sad or angry. She may cry for no reason and can feel impatient, irritable, restless, anxious, lonely, and sad. The baby blues may last only a few hours or as long as one to two weeks after delivery. The baby blues do not always require treatment from a health-care provider. Often, joining a support group of new moms or talking with other moms helps.

Postpartum depression (PPD) can happen a few days or even months after childbirth. Postpartum can happen after the birth of any child, not just the first child. A woman can have feelings similar to the baby blues -- sadness, despair, anxiety, irritability -- but she feels them much more strongly than she would with the baby blues. Postpartum often keeps a woman from doing the things she needs to do every day. When a woman's ability to function is affected, this is a sure sign that she needs to see her health-care provider right away. If a woman does not get treatment for postpartum, symptoms can get worse and last for as long as one year. While postpartum depression is a serious condition, it can be treated with medication and counseling.

Postpartum psychosis is a very serious mental illness that can affect new mothers. This illness can happen quickly, often within the first three months after childbirth. Women can experience psychotic depression, in that the depression causes them to lose touch with reality, have auditory hallucinations (hearing things that aren't actually happening, like a person talking) and delusions (seeing things differently from what they are in reality). Visual hallucinations (seeing things that aren't there) are less common. Other symptoms include insomnia (not being able to sleep), feeling agitated (unsettled) and angry, strange feelings and behaviors, as well as having suicidal or homicidal thoughts. Women who have postpartum psychosis need treatment right away and almost always need medication. Sometimes women are put into the hospital because they are at risk for hurting themselves or someone else.

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Also see: DEPRESSION BIPOLAR DISORDER/MANIA CHILDREN/TEEN DEPRESSION DYSTHYMIA
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Health: Causes of depression (postpartum) during and after pregnancy

There may be a number of reasons why a woman gets depressed. Hormone changes or a stressful life event, such as a death in the family, can cause chemical changes in the brain that lead to depression. Depression (postpartum) is also an illness that runs in some families. Other times, it's not clear what causes depression.

During Pregnancy:

During pregnancy, these factors may increase a woman's chance of depression (postpartum):

History of depression or substance abuse

Family history of mental illness

Little support from family and friends

Anxiety about the fetus

Problems with previous pregnancy or birth

Marital or financial problems

Young age (of mother)

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HOW TO OVERCOME DEPRESSION
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After Pregnancy:

Depression after pregnancy is called postpartum depression (PPD) or peripartum depression. After pregnancy, hormonal changes in a woman's body may trigger symptoms of depression. During pregnancy, the amount of two female hormones, estrogen and progesterone, in a woman's body increases greatly. In the first 24 hours after childbirth, the amount of these hormones rapidly drops back down to their normal non-pregnant levels. Researchers think the fast change in hormone levels may lead to depression, just as smaller changes in hormones can affect a woman's moods before she gets her menstrual period.

Occasionally, levels of thyroid hormones may also drop after giving birth. The thyroid is a small gland in the neck that helps to regulate your metabolism (how your body uses and stores energy from food). Low thyroid levels can cause symptoms of depression including depressed mood, decreased interest in things, irritability, fatigue, difficulty concentrating, sleep problems, and weight gain. A simple blood test can tell if this condition is causing a woman's depression. If so, thyroid medicine can be prescribed by a doctor.

Other factors that may contribute to postpartum depression include:

Feeling tired after delivery, broken sleep patterns, and not enough rest often keeps a new mother from regaining her full strength for weeks.

Feeling overwhelmed with a new, or another, baby to take care of and doubting your ability to be a good mother.

Feeling stress from changes in work and home routines. Sometimes, women think they have to be "super mom" or perfect, which is not realistic and can add stress.

Having feelings of loss—loss of identity of who you are, or were, before having the baby, loss of control, loss of your pre-pregnancy figure, and feeling less attractive.

Having less free time and less control over time. Having to stay home indoors for longer periods of time and having less time to spend with the your partner and loved ones.

Expected Mood Changes

Women commonly have mood changes during pregnancy. They are caused by changes in hormone levels. Many mood changes are normal and even expected, since having a baby can lead to several lifestyle changes. Support from your family and friends can help.

Postpartum Blues

More than half of women may have depression for a short time after pregnancy. These are feelings of anxiety, irritation, tearfulness, and restlessness that are often called “the postpartum blues.” This generally occurs in the first few weeks after pregnancy and goes away soon, without the need for treatment.

Postpartum Depression (PPD)

Postpartum depression is a more serious condition that affects between 8 - 20% of women after pregnancy, especially the first 4 weeks. It is necessary to seek medical attention to treat postpartum.

You may have a higher chance of postpartum depression if you:

Are under age 20
Currently abuse alcohol, take illegal substances, or smoke (these are also serious medical health risks for the baby)
Did not plan the pregnancy or do not want the pregnancy
Had a mood or anxiety disorder prior to pregnancy, including depression with a previous pregnancy
Had something stressful happened to you during the pregnancy, including illness, death or illness of a loved one, a difficult or emergency delivery, premature delivery, or illness or abnormality in the baby
Have a close family member who has had depression or anxiety
Have a poor relationship with your husband, boyfriend, or significant other or are unmarried
Have financial problems (low income, poor housing)
Have little support from family, friends, and a significant other
Previously attempted suicide
Received poor support from your parents in childhood

Health: Warning signs of postpartum depression (PPD)

Any of these symptoms during and after pregnancy that last longer than two weeks are signs of depression:

Feeling restless or irritable

Feeling sad, hopeless, and overwhelmed

Crying a lot

Having no energy or motivation

Eating too little or too much

Sleeping too little or too much

Trouble focusing, remembering, or making decisions

Feeling worthless and guilty

Loss of interest or pleasure in activities

Withdrawal from friends and family

Having headaches, chest pains, heart palpitations (the heart beating fast and feeling like it is skipping beats), or hyperventilation (fast and shallow breathing)

After pregnancy, signs of depression may also include being afraid of hurting the baby or oneself and not having any interest in the baby.

Difference between "baby blues", postpartum depression (PPD), and postpartum psychosis:

The baby blues can happen in the days right after childbirth and normally go away within a few days to a week. A new mother can have sudden mood swings, sadness, crying spells, loss of appetite, sleeping problems, and feel irritable, restless, anxious, and lonely. Symptoms are not severe and treatment isn't needed. But there are things you can do to feel better. Nap when the baby does. Ask for help from your spouse, family members, and friends. Join a support group of new moms or talk with other moms.

Postpartum depression (PPD) can happen anytime within the first year after childbirth. A woman may have a number of symptoms such as sadness, lack of energy, trouble concentrating, anxiety, and feelings of guilt and worthlessness. The difference between postpartum depression and the baby blues is that postpartum often affects a woman's well-being and keeps her from functioning well for a longer period of time. Postpartum needs to be treated by a doctor. Counseling, support groups, and medicines are things that can help.

Postpartum psychosis is rare. It occurs in 1 or 2 out of every 1000 births and usually begins in the first 6 weeks postpartum. Women who have bipolar disorder or another psychiatric problem called schizoaffective disorder have a higher risk for developing postpartum psychosis. Symptoms may include delusions, hallucinations, sleep disturbances, and obsessive thoughts about the baby. A woman may have rapid mood swings, from depression to irritability to euphoria.

Health: Risks of untreated postpartum depression (PPD)

Depression not only hurts the mother, but also affects her family. Some researchers have found that depression during pregnancy can raise the risk of delivering an underweight baby or a premature infant. Some women with depression have difficulty caring for themselves during pregnancy. They may have trouble eating and won't gain enough weight during the pregnancy; have trouble sleeping; may miss prenatal visits; may not follow medical instructions; have a poor diet; or may use harmful substances, like tobacco, alcohol, or illegal drugs.

Postpartum depression (PPD) can affect a mother's ability to parent. She may lack energy, have trouble concentrating, be irritable, and not be able to meet her child's needs for love and affection. As a result, she may feel guilty and lose confidence in herself as a mother, which can worsen the depression. Researchers believe that postpartum depression can affect the infant by causing delays in language development, problems with emotional bonding to others, behavioral problems, lower activity levels, sleep problems, and distress. It helps if the father or another caregiver can assist in meeting the needs of the baby and other children in the family while mom is depressed.

All children deserve the chance to have a healthy mom. All moms deserve the chance to enjoy their life and their children. Don't suffer alone. If you are experiencing symptoms of depression during pregnancy or after having a baby, please tell a loved one and call you doctor or midwife right away.

Health: Treatment of postpartum depression (PPD)

The treatment for depression after birth often includes medication, therapy, or a combination of both. There are several types of antidepressant medications that may be given to breastfeeding mothers, including nortriptyline, paroxetine, and sertraline.

If you are thinking of harming yourself or your infant, seek immediate medical help. If depression is diagnosed, you may need to be followed closely for at least 6 months.

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Sources: NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services

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