The postpartum period begins immediately after the birth of a child and extends for approximately six weeks thereafter. The majority of women experience some type of mood disturbance during pregnancy and in the postpartum period. The majority of these mood disturbances are benign and resolve on their own. However, the postpartum period is the most vulnerable time for a woman to develop psychiatric illness with postpartum depression, which occurs in 10 to 15 percent of women in the general population (“Postpartum Major Depression” American Academy of Family Practice, Hirst M.D., October 2010)
The American Academy of Pediatrics estimates that more than 400,000 infants are born each year to mothers who are depressed (“Clinical Report — Incorporating Recognition and Management of Perinatal and Postpartum Depression Into Pediatric Practice,” March 25, 2015). Postpartum depression is a serious disorder that is often overlooked by patients and caregivers. Too often, postpartum depression is dismissed as a normal or natural consequence of childbirth (“Managing Maternal Depression Before and After Birth,” American Academy of Pediatrics, Oct. 25, 2010).
Women at the highest risk for postpartum depression are those with a personal history of depression, who have suffered a previous episode of postpartum depression (the strongest risk factor), or who have experienced depression during pregnancy, according to an article in the New England Journal of Medicine (“Postpartum Depression,” Katherine L. Wisner, M.D., Barbara L. Parry, M.D., and Catherine M. Piontek, M.D., July 18, 2002). In addition to a history of depression, recent stressful life events and daily stressors, such as childcare, lack of social support, unintended pregnancy, financial difficulties and insurance status, have been validated as risk factors for developing postpartum depression.
Not just the “baby blues”
The severity and duration of symptoms differentiates postpartum depression from “baby blues.” Postpartum blues begins during the first couple of days after delivery and resolves within 10 days without any treatment. Symptoms are mild and include brief crying spells, irritability, poor sleep, nervousness and emotional reactivity. Suicidal ideation is not present in baby blues. Although baby blues was previously considered benign, evidence now suggests that women with these symptoms are at risk of progression to postpartum major depression.
Postpartum depression: More persistent and debilitating than postpartum blues, postpartum depression often interferes with the mother’s ability to care for herself or her infant. Symptoms of depression might include depressed mood, tearfulness, lack of pleasure, insomnia, fatigue, appetite disturbance, suicidal thoughts and recurrent thoughts of death. Symptoms of postpartum depression persist for longer than two weeks and the onset is within four weeks of delivery, even though it can be diagnosed up to the first year after delivery.
Postpartum major depression: Up to 60 percent of women with postpartum major depression have obsessive thoughts focusing on aggression toward the infant. These thoughts are intrusive and similar to those in obsessive-compulsive disorder (“Postpartum Major Depression,” Kathryn P. Hirst, M.D., and Christine Y. Moutier, M.D., American Family Physician, Oct. 15, 2010).
Postpartum psychosis: Also known as postpartum depression with psychotic features, postpartum psychosis can be seen in 1 in 500 to 1 in 1,000 deliveries, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Hallucinations are common in postpartum psychosis, especially command hallucinations to kill the infant or delusions that the infant is possessed. Once a woman has had a postpartum episode with psychotic features, the risk of occurrence in each subsequent delivery is approximately 30 to 50 percent.
Diagnosing and treating postpartum depression
The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item, self-rated screening questionnaire used for detection of postpartum depression. The diagnosis of postpartum major depression should be strongly considered in women who score above 12 on the EPDS, experience symptoms that cause moderate to severe social dysfunction, report any suicidal ideation or experience symptoms for more than 10 days.
Antidepressant pharmacology remains the first-line treatment for postpartum depression. Selective serotonin reuptake inhibitors (SSRIs) are the most common medications prescribed. Breastfeeding is generally safe when taking these medications and women should be encouraged to continue breastfeeding. Antipsychotic medications such as valproic acid, carbamazepine and lithium are not recommended during breastfeeding and, therefore, mothers should discontinue breastfeeding if they are prescribed these medications. Other treatment modalities, such as psychotherapy, are recommended for mild postpartum depression and as an adjunctive treatment with pharmacotherapy for moderate to severe postpartum depression.
Depression is an illness that can take root at any moment, especially after childbirth and it can be isolating. Sovereign Mental Health Services understands that life is complicated and doesn’t always go as planned. That is why we provide state-of-the-art treatment for mental health issues and any co-occurring conditions. If you need help, please call 866-954-0529.