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Postpartum Depression

Medical literature currently divides this condition into three categories. The mildest version is what we might call the ‘baby blues’, with onset within a few days of delivery and spontaneous resolution within a short period. At the other end of the spectrum is the rare and serious puerperal psychosis. These patients are severely impaired, and can suffer from hallucinations and delusions that focus on the death of their infant or on being divine or demonic. These hallucinations can cause the patient to hurt herself or others. Most of these patients have been, or will be, diagnosed with bipolar disorder, schizophrenia or even organic brain syndrome. The third and more classic form of this disorder, postpartum depression, can be a serious complication of childbirth.

Most patients suffer from this condition for more than six months. Left untreated, 25% of these patients will still be depressed a year after delivery.

Depressed mothers are at an increased risk of relapse into depression
and of other psychiatric illness or disorders. Postpartum depression is caused by the hormonal changes that occur in the body during and after pregnancy. It can run in families.

Research also indicates that the social and psychological changes associated with having a baby can increase the risk of postpartum depression. Those with severe premenstrual syndrome are also more likely to suffer from postpartum depression.

What are the symptoms?

General symptoms of Postpartum depression are:

• Unexplained weight loss or gain
• Thoughts about hurting self or baby
• Loss of appetite
• Loss of interest or pleasure in life, lack of energy or motivation to do things
• Restless, irritable, anxious
• Crying, teary-eyed
• Feels worthless, hopeless or guilty
• Difficulty in falling asleep or staying asleep, or sleeping more than usual

Symptoms of specific postpartum categories are:

Baby Blues: crying for no reason, feeling sad or anxious. Symptoms appear within four days of delivery and typically subside within two weeks without treatment.

Postpartum Depression: alternating highs and lows, frequent crying, irritability, fatigue, guilt, anxiety, inability to care for self or baby. Symptoms appear within days of delivery OR up to a year after delivery, and can last for weeks or months. Treatment is required.

Puerperal Psychosis: severe agitation, confusion, hopelessness, shame, insomnia, paranoia, delusions or hallucinations, hyperactivity, rapid speech and mania, thoughts of harming self or baby. Suicide is a risk. Symptoms occur soon after delivery and can last for weeks or months. Immediate treatment is required.

How is it diagnosed and treated?

Identification of patients suffering from postpartum depression is a priority for all doctors treating mothers after delivery. The Edinburgh Postnatal Depression Scale is a tool that is often used in patient evaluation. The diagnostic criteria for a major depressive disorder also apply to postpartum depression.

The symptoms must be present for more than two weeks to differentiate between ‘baby blues’ and classic postpartum depression, and the symptoms must include at least four of the following signs:

• Difficulty concentrating and making decisions
• Extreme fatigue
• Recurrent thoughts of death, suicide or harm (to self or baby)
• Unusual focus on baby’s health
• Psychomotor agitation or retardation
• Change in appetite or sleep patterns
• Feeling helpless, guilty or worthless, a failure as a mother
• Any history of depression prior to pregnancy

One episode of postpartum depression can increase the risk of recurrence up to 70%. The diagnostic criteria for the rarer form of postpartum psychosis are based on the exhibited symptoms detailed above for Puerperal Psychosis.

Treatment for each disorder is somewhat different. No treatment is required for the ‘baby blues’ except family and physician support of the mother as she recovers, and additional rest.

Treatment(s) for postpartum depression can include:

• Psychotherapy
• Parenting and Mothering Classes to increase skills and confidence
• Self-Help Groups
• Hormone Therapy if appropriate
• Electroconvulsive Therapy (ECT) for severe cases
• Hospitalization in severe cases
• Medication as appropriate: anti-anxiety medication, anti-depressants, tricyclics, SSRIs (when medicating patients, particular attention and monitoring should accompany the treatment of nursing mothers), antipsychotic medication for severe cases of Puerperal Psychosis.

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