Understanding Postpartum Depression

Q. How does Postpartum Depression (PPD) differ from a classic “depres­sion”? (which is referred to as a Major Depressive Episode)

A. The answer is that PPD does not differ, clinically speaking, from depression. PPD is a major depressive episode that follows the birth of a baby accord­ing the Diagnostic and Statistical Manual –4th Edition Text Revision (DSM-IV-TR). The DSM-IV-TR requires that symptoms present within four weeks of childbirth to receive the “postpartum-onset specifier” but clinicians with expe­rience treating PPD often extend the time frame to one to two years postpartum. The diagnostic crite­ria are as follows:

Five or more of the following symp­toms, persisting for at least a two week period where at least one of the symptoms is either 1) a depressed mood or 2) loss of interest or plea­sure.

✦Depressed mood most of the day, nearly every day, as indi­cated by either self report or observations made by others
✦Markedly diminished interest in pleasure in all, or almost all, activities most of the day, nearly every day, as indicated by either self report or observations made by others
✦Changes in weight (increased or decreased), or changes in appe­tite (increased or decreased)
✦Increased need for or decreased ability to sleep
✦Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
✦Fatigue or loss of ener­gy nearly every day
✦Feelings of worthless­ness or excessive or inappropriate guilt nearly every day
✦Diminished ability to think or concentrate, or indecisiveness, nearly every day
✦Recurrent thoughts of death (not just fear of dying), recur­rent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Clinicians who treat Postpartum Depression know that PPD is dif­ferent because of how it is perceived by the woman, her significant other, her family, and society. Women are often afraid to seek the treatment that they need because of fear. She fears that someone will take her baby away, that she will be viewed as a bad mother, and that she is weak or defective in some way. Families are often resistant to refer their loved ones to treatment because of a limited understanding of the illness – thinking that maybe she will just “snap out of it” or that her mood will improve in time.

Q. What are the risk factors for Postpartum Depression?

A. No one knows or is certain what causes PPD but we do know that the following factors are associated with an increased risk:

✦Past history of depression (relat­ed or unrelated to childbirth)
✦History of severe PMS some­times called PMDD (Pre-Menstrual Dysphoric Disorder, PMDD)
✦History of childhood abuse (emotional, physical or sexual)
✦Inadequate support – (conflict with partner, being a single mother)
✦Current stress (i.e., financial, environmental, emotional)
✦Previous birth related loss
✦Grief

It is recommended that preg­nant women with one or more of these risk factors seek counsel­ing during pregnancy to put a plan into place if they become depressed after the birth of their baby.

Q. Does hav­ing Postpartum Depression impact the baby?

A. Yes, mothers with PPD have been observed to be less playful, have fewer positive interactions, and talk less with their babies. It has also been reported that mothers with PPD experience their babies as more bothersome and are more preoc­cupied or withdrawn that mothers who are not depressed. Babies of depressed mothers cry more, smile less, gaze less, are less involved socially and with objects, and have lower activity levels. This may sound scary but all of these things can be mediated when the mother gets treatment. It should be noted that involvement of other family members during the time that the mother is depressed protects the baby from adverse effects of its mother’s depression.

Q. How do you treat Postpartum Depression?

A. Treatment generally involves the use of psy­chotherapy (talk therapy) and medications. Many medications are considered “compatible” with breastfeeding so mothers should not let that be a deterrent to them seeking help. In addition, many alternative therapies are being researched; however, it is generally recommended that these methods be reserved for those who do not respond to traditional treatments.