McKesson Clinical Reference Systems: Women's Health Advisor 2002.2

What is postpartum depression?

Feeling sad or blue shortly after the birth of a baby is very common. For most women these postpartum blues are mild and go away within a week. However, for 10 to 20% of women, especially very young mothers, the depression is more severe and lasts longer.

How does it occur?

You may have postpartum depression within a few days to a few weeks after giving birth or having a miscarriage. For about 60% of women, it is your first episode of depression. While hormone changes after giving birth seem to play a part, the full causes are not known. Risk factors that increase your chances of getting postpartum depression are:

• having been depressed sometime before you got pregnant
• having been depressed after a previous pregnancy
• having family members who were depressed, especially after a pregnancy
• returning home with your baby to a very stressful home or relationship
• having an baby with health problems or a baby who cries often
• having a miscarriage late in pregnancy or a stillbirth

If your pregnancy was unwanted you are also at risk for post partum depression.

What are the symptoms?

Besides feeling sad and uninterested in activities, you may also:

• Feel unable or unwilling to care for your baby.
• Feel like harming your baby.
• Be irritable.
• Have trouble falling asleep, wake up very early, or sleep too much.
• Have little or excessive appetite.
• Be tired and low in energy.
• Have low sexual desire and function.
• Feel worthless and guilty.
• Have trouble concentrating or remembering things.
• Feel hopeless or just do not care about anything.
• Have unexplained pain in your back or abdomen, or get headaches.
• Worry that you will ever feel better.

Some women also become anxious, have hallucinations, or delusions. If you have hallucinations (hear voices or see things not present) or delusions (thoughts not grounded in reality) this is called postpartum psychosis.

How is it diagnosed?

Your health care provider or a mental health professional can tell you if your symptoms are postpartum depression. He or she will ask about your symptoms and any drug or alcohol use. You may be tested to rule out medical problems such as hormone imbalances. There are no lab tests to diagnose postpartum depression.

How is it treated?

Do not try to overcome postpartum depression by yourself. It can be successfully treated with either psychotherapy or antidepressant medicine or both. Discuss this with your health care provider or therapist.

Medicine

Several types of medicines can help treat postpartum depression. Discuss the use of medicines with your health care provider if you are breast-feeding. Your health care provider will carefully select a medicine for you. Some medicines are:

• monoamine oxidase inhibitors (MAOs) such as tranylcypromine (Parnate), meprobamate (Equanil, Miltown), and phenelzine (Nardil)
• other antidepressants such as mirtazapine (Remeron), venlafaxine (Effexor), trazodone ( Desyrel ), and bupropion (Wellbutrin)
• selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and several other newer antidepressants
• tricyclic antidepressants such as imipramine (Tofranil), nortriptyline (Aventyl HCl, Pamelor), and desipramine (Norpramin).

You must take antidepressant medicines daily for 3 to 6 weeks to get full benefit from them.

There are no nonprescription medicines available to treat depression.

Psychotherapy

Seeing a psychologist, psychiatrist, or psychotherapist is helpful with postpartum depression. Therapy may last a short time or may need to go on for many months. Cognitive Behavioral Therapy (CBT) is a form of psychotherapy that is especially helpful. CBT is a way to help you identify and change thought processes that lead to depression. Replacing negative thoughts with more positive ones can help your depression.

Natural and Alternative Treatments

Claims have been made that certain herbal and dietary products help depression. St. John's Wort is the only one that research shows is effective in treating postpartum depression. Check with your health care provider before beginning St. John's Wort if you are breast-feeding.

Many types of alternative treatments may help depression. Some of them are:

• Biofeedback Through biofeedback you learn to control body functions such as muscle tension or brain wave patterns. Biofeedback can help with tension, anxiety, and concentration, and indirectly may help depression. Biofeedback, like relaxation therapies, should be done only in addition to psychotherapy and medicine.
• Massage Therapy Massage therapy may help lower stress, but it does not cure depression.
• Relaxation Therapies Learning special relaxation methods can help with depression, along with medicines and psychotherapy. Yoga and meditation may also be helpful.
• Art and Music Therapies Some women find art and music therapy, along with medicines and psychotherapy, are helpful in treating postpartum depression.

How long will the effects last?

In most cases postpartum depression slowly goes away in the first nine months after birth. For a few women it lasts beyond one year. Treatment helps speed the recovery.

What can I do to help myself or my loved one?

Maintaining a healthy lifestyle is crucial. Staying physically and socially active, especially with your significant other, is very important. Having regular sleep and eating patterns will also help you. Since you will need to be up during the night with your baby during the first few months, it is important to take naps to keep your energy up.

Certain medicines such as reserpine, benzodiazepines, digitalis, and possibly beta-adrenergic blockers can add to the symptoms of depression. It is important to check with your health care provider before taking any new prescription or nonprescription medicines.

To help prevent postpartum depression:

• Exercise as appropriate for you physical condition in the days right after giving birth.
• Participate in activities with your significant other and baby.
• Talk to your family and friends.
• Eat a healthy diet.
• Develop a regular sleep and nap pattern.
• Learn ways to lower stress, such as breathing and muscle relaxation exercises.

When should I seek help?

Do not try to overcome postpartum depression by yourself. Seek professional help if you believe that you or a loved one has the symptoms described here.

When should I seek immediate help?

Get emergency care if you or a loved one have serious thoughts of suicide or harming your baby, or if you hear voices or see things not present, or have delusions (thoughts not grounded in reality).

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.