Baby Blues or Beyond? Recognizing Postpartum Depression
Authored by:
Anna Glezer, M.D.
The majority of women, more than three-quarters, experience the baby blues immediately after childbirth. It is a feeling precipitated by the sudden change in hormones after delivery, coupled with sleep deprivation and fatigue. You might feel more tearful, overwhelmed, and emotionally fragile. Generally, this will start within the first couple of days after delivery, peak around one week, and taper off by the end of the second week postpartum.
But what if these feelings do not dissipate? About 15% of women experience postpartum depression. Given the number of women giving birth yearly, this is a huge number! Postpartum depression is a condition that began to be recognized in the 1980s and now has much more research, with recent studies investigating the different biological theories of the cause of the condition.
However, it is a condition still under-recognized and underdiagnosed. This is in part due to the overlap of symptoms between depression and new motherhood: problems with sleep, energy, and appetite can be hard to differentiate from what is expected postpartum. This is also in part because in many cases it does not present as classic depression does, but rather with a significant component of anxiety. In fact, there is scientific debate about whether postpartum depression is a separate diagnostic entity compared to non-pregnancy related depression.
Regardless, postpartum depression is a condition that is essential to understand and treat because untreated, it can have a significant impact on both mom and the development of her infant. It can also make breastfeeding more challenging and cause weight retention postpartum.
Diagnosing Postpartum Depression
Women often ask how to tell if what they are experiencing is postpartum depression or just the baby blues. There are several ways to tell the difference. First, there is timing. Postpartum depression often begins within the first 4-8 weeks postpartum, though there are many women whose symptoms might not begin until much later in that first year postpartum and many others for whom depression begins during pregnancy. Second, there is the severity of symptoms. While baby blues is a feeling of emotionality and tearfulness, postpartum depression is more significant.
You might find yourself withdrawing from your partner or being unable to bond well with your baby.
You might find your anxiety out of control, preventing you from sleeping or eating appropriately.
You might find feelings of guilt or worthlessness overwhelming or begin to develop thoughts preoccupied with death or even wish you were not alive.
These are all red flags for postpartum depression.
In the postpartum period, your obstetrician or pediatrician may have given you a questionnaire to complete to screen for postpartum depression. You can find it HERE. A score greater than 13 suggests the need for a more thorough assessment because you could have postpartum depression.
Risk Factors for Postpartum Depression
Several factors can predispose you to postpartum depression: The most significant is a history of postpartum depression, as a prior episode can increase your chances of a repeat episode to 30-50%. A history of non-pregnancy related depression or a family history of mood disturbances is also a risk factor. As are social stressors, such as a lack of emotional support, an abusive relationship, and financial uncertainty.
Treatment of Postpartum Depression
There is good news. Postpartum depression is quite responsive to treatment. Treatment can include psychiatric medications, including medications that have good safety profiles in breastfeeding women. The most common first line medication treatments are medications that target the serotonin system of the brain, called SSRIs (Read: SSRIs in Pregnancy and Lactation).
With my patients, I have found that women who are postpartum (or pregnant) often respond faster and lower doses of these medications compared to women outside of this reproductive cycle. One scientific hypothesis for this difference is the influence of hormones and their interaction with the medications.
Non-medication treatment options include psychotherapy. For women with postpartum depression, cognitive behavioral therapy and interpersonal therapy have proven successful. My patients have also found group therapy and support helpful, along with good self-care techniques such as exercise, yoga, and meditation. A number of other supports can be put in place, such as a postpartum doula to help with caring for the infant or home nursing visits.
Selected References:
Bobo, W.V., Yawn, B.P. Concise review for physicians and other clinicians: Postpartum depression. Mayo Clin Proc 2014 June; 89(6): 835-844.
Hantsoo, L. et. al. A randomized, placebo-controlled, double-blind trial of sertraline for postpartum depression. Psychopharmacology (2014) 231: 939-948.
