Postpartum Depression is Treatable and Can Be Prevented

Colette Dowling, LMSW

Equally mysterious, because they don't get adequately discussed, are methods of treatment--and even methods of prevention. I will talk about these, but first, here's what postpartum depression can look like.

A thirty-eight year old woman with her first baby described herself, within the first months following birth, as "losing it". She said, "I awake each day with dread. I can't face another day of feedings and diapers and small excursions to the neighborhood park. I feel myself getting unhinged. Each day is endless and like the day before. I feel I made a terrible mistake and I worry that I'm not taking good care of the baby."

Her husband is supportive and helpful. So are her mother and friends. Nothing makes a dent in the woman's low mood and anxious worry over her child. Perhaps BECAUSE she's a new mother people want to avoid the obvious: she's depressed.

The birth of a child, usually regarded as a joyous event, paradoxically brings an increased risk of emotional illness to the mother. One out of three women has an episode of at least mild clinical depression after childbirth. Experts in postpartum depression recognize three levels of the disorder. The so-called "maternity blues" is a brief depression affecting 50 to 70 percent of all mothers. This relatively mild postpartum depression can nevertheless include crying spells, restlessness, feelings of unreality and confusion--and, less frequently, feelings of depersonalization, guilt, and negativity toward husband and baby. The symptoms may disappear within a week. Ten to twenty percent of postpartum women will experience a moderately severe depression that lasts six weeks to a year or longer. The specific content of postpartum worries seems to distiguish it from mood disorders at other times in a woman's life. Postpartum depressed mothers have extreme anxiety about their infants' wellbeing, and they doubt their ability to have normal maternal feelings toward the child.

Pospartum depression may be worsened by outside events in the woman's life but the fact that hormones play at least a role in the phenomenon has become quite clear. At some point within five days after delivery there's a dramatic drop in estrogen and progesterone and a large increase in prolactin. Studies correlating hormone levels with mood both before and after childbirth have found that the more the estrogen drops, the worse the new mother sleeps.

Plummeting progesterone also predicts problems. The lower the progesterone drops, the more likely it is the new mother will become depressed within the first ten days of giving birth.

A very small number of women--.01 to .02 percent--experience postpartum psychosis, a remarkable illness that hits between the third and fourteenth day after the baby is born. (It has virtually never been known to occur in the first two days postpartum.) When it happens, it happens fast. What at first may look like the onset of a mildly depressed mood very quickly intensifies into an entirely different phenomenon. Obstetric nurses will keep a sharp eye on any depressed new mother, knowing there's a chance that insomnia, exhaustion, agitation, and irritability could escalate to a full-scale psychosis, with alternating states of elation and depression, delusions, and hallucinations. Often the hallucinations--including "voices"--warn the mother of imminent harm to her children. This is the type of depression suffered by Andrea Yates when she killed her children.

Women with a past history of depression--and especially women who've previously experienced postpartum depression--are at risk. It's important, whenever possible, to try to prevent this illness from occuring, not only because of the suffering it brings to the mother, but because of its devastating effects on the child and the infant-mother bond.

Here's up-to-date research on how depression in the mother causes risks for her fetus.

Pregnant women should take pains to tell their ob/gyns of any prior experience with depression, no matter how far in the past--and particularly if the depression was moderate to severe. Antidepressant intervention either shortly before or immediately after birth can prevent both mother and baby from having to endure the effects of this physically and emotionally debilitating illness. If the depression is of a bipolar type, intervention is especially important because the hormone changes after birth can trigger a manic episode.

Milder forms of postpartum depression should be treated with therapy. This is too critical a juncture in the life of mother and baby to "wait out" in the hope that the illness will pass. Friends, loved ones, and young mothers' groups can help, but at the very least the mother should be professionally assessed to determine the nature and degree of her depression and whether or not it requires clinical treatment.

The good news is that postpartum depression can be effectively treated. The sooner the treatment is started, the better for both mother and baby.

To hear Colette speaking on what it's like starting therapy with someone new, click the audio button.

For more on post partum depression and other mood disorders see Colette's website on women's wellbeing and mental health.