Ask the Doctor: What Is Postpartum Depression? By Maria Muzik, MD

Ask the Doctor: What Is Postpartum Depression? By Maria Muzik, MD
(Originally published on June 6, 2018, in esperanza.)

Postpartum depression is extremely common; 80% of all new mothers experience some form of the ‘baby blues’. But what exactly is it?

Q: I just had a baby and thought this would be the happiest time in my life. And now I feel so anxious and down all the time and don’t enjoy my baby. I worry that I am losing my mind. What is happening and is there anything safe that will help?

A: Although there is a popular conception that pregnancy and the time following birth (postpartum) are supposed to be the most joyful of a woman’s life, the truth is that many women struggle during this period. For many new mothers, this period is also colored by emotional struggle, increased worry, more pronounced physical discomfort, and severe sleep disruption. While women may feel worried about acknowledging their struggles during this time, it is critical they know they are not alone, and help is available.

Immediately after giving birth almost 80 percent of women experience the “baby blues,” characterized by mood lability, tearfulness, worry, and just not feeling like oneself. This is believed to be triggered by the massive hormonal drop (at the end of pregnancy reproductive hormone levels are 50-fold increased from baseline and drop shortly after labor), and by the life shifts underway during this time (e.g., sleep deprivation, recovery from labor and pain).

For most women this period of “the blues” passes within a week or two, but for some the “blues” symptoms may worsen and lead to a clinical postpartum depression. Approximately 15 percent of women develop clinical postpartum depression with a peak symptom severity around six weeks postpartum. In fact, the same number of women also experience depression symptoms already in pregnancy, which, if untreated, may continue and even worsen in the postpartum period.

Postpartum Depression Symptoms

Predominant symptoms are feelings of being overwhelmed, anxious, preoccupied with worries about harm befalling the baby (even worries about unintentionally causing harm), and fears of “going crazy” or thoughts that “I am not a good mom,” or “I don’t feel bonded with my baby.” Stigma and shame may prevent women from sharing these thoughts and feelings since others may assume that this is only a joyful time. Women who struggle with depression and anxiety still love their children and want to be good mothers, but may worry that their struggles will have ill effect on their parenting or child, or that others may think badly of them for “failing” in this task.

To further complicate matters, things that we know really help minimize the effects of depression, such as regular sleep and social support, may be harder to manage given the circumstances of parenting a new baby. The good news is that there is help.

Psychotherapies

Current published treatment guidelines favor psychotherapy above medicines as first-line treatment for mild to moderate depression or anxiety, and several evidence-based psychotherapies are available, including Interpersonal Psychotherapy (IPT), Cognitive-Behavioral Therapy (CBT), or Dialectical Behavior therapy (DBT).

Medications

Medications are the first choice for severe illness, often in combination with psychotherapy and lifestyle/complementary approaches. However, many women may be unwilling or apprehensive to seek treatment with medicines due to safety concerns for the fetus or while breastfeeding. Overall, current data support safety of many commonly used antidepressants, sleep aids and anxiolytics, and women and families are advised to consult with psychiatrists specializing in this area (perinatal psychiatrist).

Complimentary Approaches

More recently, data on yoga, meditation, mindfulness, light therapy, exercise, and nutritional supplements such as Vitamin D and omega-3 fatty acids to alleviate depression are accumulating, but their efficacy has yet to be definitively elucidated. In summary, safe and well-validated treatments are available. The first step is for women to talk with their primary care provider, and ask for help.

This article is provided by the National Network of Depression centers. The NNDC, a partner of esperanza, fosters connections among members to advance scientific discovery, improve care, and drive the national conversation on mood disorders through collaborative efforts.

Printed as “Ask The Doctor: Postpartum Help and Hope”, Spring 2018

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