Ask Dr. Pat

Dr. Pat Consults: New Mothers and Postpartum Depression—When It’s More Than Baby Blues

Although these issues have traditionally been thought of as occurring primarily right after childbirth—the postpartum period—it is now understood that emotional issues can develop during the pregnancy as well. About half of the cases of “postpartum” depression actually develop during pregnancy, so sometimes this mood is now referred to as “peripartum” depression, covering the period from pregnancy to after delivery. Another point about timing: the DSM-5, the diagnostic manual for psychiatry, confines the diagnosis of peripartum depression to the month following childbirth. However, practitioners and many studying the illness tend to take a more liberal view; they include women up to a year after giving birth. This is basically semantics, but it is important to realize that the emotional roller-coaster of early motherhood can continue for months after delivery.

During the period following childbirth, as many as four out of five women develop the postpartum blues (“baby blues”). This typically occurs in the days immediately following the delivery. The new mother can feel depressed and anxious, quick to tears and more irritable. Unlike postpartum depression, postpartum blues should be improving within about two weeks. This is a time where an understanding and helpful spouse—and grandparents!—can provide much-needed support and encouragement. A savvy pediatrician or obstetrician can help to normalize these feelings while also keeping an eye out for more significant issues.

You mention that you now realize that you were suffering from postpartum blues. However, given the length of time your symptoms lasted and the severity you describe, it is likely you were experiencing a depressive episode. Studies have found that up to 15 percent of women develop postpartum depression (PPD) within three months after giving birth. Symptoms are the same as for major depressive disorder, including a depressed mood, trouble with concentration, difficulty with sleep, loss of interest in activities once enjoyed, changes in appetite, feelings of guilt, and thoughts of suicide.

Sometimes it can be difficult to differentiate symptoms of depression from the normal experience of having a new baby: When your baby won’t let you get a good night’s sleep and you are too exhausted to do things you previously would have enjoyed, this can be a normal part of parenthood. However, as you describe, when you have the opportunity to rest but still cannot sleep and feel overwhelmed and constantly anxious, this raises suspicion of something more serious than the baby blues. Thus it is important for new mothers to talk to their physician about what they are experiencing and work with him or her to decide whether it is appropriate to seek further help.

Screening tools have been developed to help detect cases of PPD, including the well-studied Edinburgh Postnatal Depression Scale.  While not diagnostic, this quick screening can help raise a red flag and suggest that a more extensive conversation with an obstetrician or psychiatrist would be beneficial. My rule of thumb is that if a new mother is concerned about her emotional state, that merits further discussion, regardless of how she scores. Also of note: Medical conditions such as a thyroid issue or anemia can present with symptoms of depression, so these should be ruled out as well.

Postpartum depression is a serious mental health issue that affects the entire family. Adding depression to the challenges of motherhood makes it that much more difficult to care for the child, and has a negative impact on the development of the mother-infant bond, which is critical for healthy social, cognitive, and emotional development of the infant.   The spouses of those with PPD are also more likely to suffer from depression. Depression can have lasting and devastating consequences for the sufferer. In the one study published out of Great Britain, suicide was the leading cause of maternal death in the year following the birth of a child. Thus it is critical that those experiencing symptoms of postpartum depression be encouraged to seek mental health treatment.

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