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Post-partum depression

Alternative Names

Depression - postpartum

Definition

Post-partum depression is severe depression in a woman after she has given birth. It may occur soon after delivery or up to a year later. Most of the time, it occurs sometime in the first 4 weeks after delivery.

Causes, incidence, and risk factors

Expected Mood Changes

Women commonly have mood changes during pregnancy. They are caused by changes in hormone levels. Many mood changes are normal and even expected, since having a baby can lead to several lifestyle changes. Support from your family and friends can help.

Post-partum Blues

Approximately 50 - 70% of women may experience depression for a short time after pregnancy. These are feelings of anxiety, irritation, tearfulness, and restlessness that are often called “the post-partum blues.” This generally occurs in the first few weeks after pregnancy and goes away soon, without the need for treatment.

Post-partum Depression

Post-partum depression is a more serious condition that affects between 8 - 20% of women after pregnancy, especially the first 4 weeks. It is necessary to seek medical attention to treat post-partum depression. You may have a higher chance of post-partum depression if you:

• Had a mood or anxiety disorder prior to pregnancy, including depression with a previous pregnancy
• Have a close family member who has had depression or anxiety
• Had something stressful happened to you during the pregnancy, including illness, death or illness of a loved one, a difficult or emergency delivery, premature delivery, or illness or abnormality in the baby
• Are under age 20
• Did not plan the pregnancy or do not want the pregnancy
• Currently abuse alcohol, take illegal substances, or smoke (these are also serious medical health risks for the baby)
• Have little support from family, friends, and a significant other
• Have a poor relationship with your husband, boyfriend, or significant other or are unmarried
• Previously attempted suicide
• Have financial problems (low income, poor housing)
• Received poor support from your parents in childhood

Symptoms

Most of the symptoms are the same as in major depression.

In addition to depressed mood, you may have the following symptoms nearly every day:

• Negative feelings toward the baby
• Lack of pleasure in all or most activities
• Decreased appetite
• Loss of energy experienced
• Feeling withdrawn, socially isolated, or unconnected
• Feelings of worthlessness or guilt
• Agitation and irritability
• Trouble sleeping
• Difficulty concentrating or thinking
• Thoughts of death or suicide (a suicide plan)

Signs and tests

There is no single test to diagnose post-partum depression. Your doctor may have you complete a questionnaire at your office visit to look for signs of depression or risks for depression.

Sometimes depression following pregnancy can be related to other medical conditions. Hypothyroidism, for example, causes symptoms such as fatigue, irritability, and depression. Women with post-partum depression should have a blood test to screen for low thyroid hormones.

Treatment

The treatment for depression after birth often includes medication, therapy, or a combination of both. There are several types of antidepressant medications that may be given to breastfeeding mothers.

If you are thinking of harming yourself or your infant, seek immediate medical help. If depression is diagnosed, you may need to be followed closely for at least 6 months.

Support Groups

Participating in support groups may be valuable, but should be combined with medication and formal psychotherapy.

Expectations (prognosis)

Medication and professional counseling are often successful in reducing or eliminating symptoms.

Complications

If left untreated, post-partum depression can last for months or years, and you may be at risk of harming yourself or your baby.

The potential long-term complications are the same as in major depression.

Calling your health care provider

Notify your doctor or pediatrician if you experience depression after pregnancy. Do not be afraid to seek help immediately if you feel overwhelmed and are afraid that you may hurt your baby.

Prevention

Having good social support from family, friends, and co-workers probably helps to reduce the seriousness of post-partum depression, but may not prevent it.

Screening questionnaires may help with early detection of depression or risks for depression.

Review Date:1/23/2007
Reviewed By:Audra Robertson, MD, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network.

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