Postpartum Depression- More Than Baby Blues

Postpartum depression can affect moms or dads

While many people have not heard of prenatal depression and anxiety, which I discussed in last week’s article on mood disorders and pregnancy, most have heard of postpartum depression. However, being aware that a condition exists and then actually recognizing when you might be suffering from it are two separate things. The “baby blues,” experienced by four of every five women in the two weeks after giving birth, can really suck. But they usually go away. And if they don’t, or if they worsen, there’s a problem – regardless of whether it’s mom or it’s dad who is suffering.

Postpartum Depression

If the one to two weeks after giving birth are a roller coaster ride, then postpartum depression is a twisted amusement park where you hop from a vomit-inducing zero-gravity spaceship to a submarine that plunges you to the bottom of the ocean. Postpartum depression doesn’t always develop immediately after giving birth. It can take several months to show up for some women, so women shouldn’t dismiss creeping feelings of worthlessness or resentment toward their baby just because it’s been several months since they gave birth.

Like so many mental conditions, scientists don’t fully understand what causes postpartum depression, and it’s most likely a combination of factors anyway. Hormones almost certainly play some part, as well as too little sleep, anxiety about motherhood, a demanding baby, other stressful events in your life and other physical changes in your body from pregnancy or delivery. There’s some weak evidence that postpartum depression could be related to nutrient deficiencies, such as too little vitamin D, during pregnancy, but the data on that is fuzzier, and there’s not much evidence that popping extra vitamins or other supplements will help much (though a balanced diet may help some).

How do you know if what you’re experiencing might be postpartum depression? Health care professionals mostly use the Edinburgh Postnatal Depression Scale to screen women for depression, and diagnosis is based on experiencing at least five key symptoms – see the box – that last two weeks or longer and prevent you from being able to function well. The tricky part is that several of those symptoms are par for the course with a new baby. Decreased energy? Insufficient or fragmented sleep? Changes in your weight? Mommy guilt? Decreased concentration? All of those may continue throughout the first year after giving birth, but postpartum depression also tends to involve persistent feelings of worthlessness or extreme guilt and an inability to enjoy pleasurable activities.

Postpartum symptomsMore than half of women with postpartum depression have obsessive thoughts related toward harming their baby, even though they are extremely unlikely to do so. In fact, the shame and guilt women might feel about those thoughts may prevent them from divulging them to a professional even though that’s precisely what they should do. Women might also experience “passive suicidal ideation,” which means they don’t think about plans to kill themselves, but they might feel a desire to die without any clear method.

Consider the list of symptoms in the box and if even a handful of them sound like a description of your day in between feedings and diaper changes, it’s important to talk to your care provider about how you’re feeling, especially if you’re finding it increasingly difficult to function. Most likely, your doctor will want to do lab tests to eliminate the possibility of a thyroid disorder since the symptoms are similar.

If you do have postpartum depression, it’s more likely to get worse without treatment, and it affects more than just you. It can interfere with breastfeeding and, more problematically, affect your attachment to your baby. Women with postpartum depressed are also less likely to use healthy feeding and sleeping practices with their baby, to be attentive or sensitive to their baby, to continue breastfeeding, to talk to or play with their infant, to show their child books and to follow routines. The children of depressed mothers may be at risk for being less attached to their mothers or for greater behavioral problems, and they may be at higher risk for depression in the teen years.

However, it’s important to keep in mind that some of these concerns may be outside a mother’s control whether she is treated or not. Depression itself has a genetic component, and some children’s behavioral or mood difficulties, while young or as teens, may be related to inheriting a bit of mom’s mental health, to oversimplify it a bit. The good news is that long-term cognitive development does not seem affected by depression, but it is affected by poor mother-child interactions in the first year and a half of life, which depression might contribute to.

Postpartum Psychosis

Postpartum psychosis is rare, occurring among only 1 to 2 women out of every 1,000 who give birth, but that statistic still means several thousand women experience it every year. It’s also very serious and requires immediate treatment, often hospitalization. Onset is usually within the first few weeks after birth, and women with bipolar disorder are at much higher risk – by some estimates a hundredfold more likely than women without bipolar disorder – for postpartum psychosis.

Symptoms include thoughts, desires or attempts to harm your baby or yourself, hallucinations such as hearing voices, intense anger toward your baby or your self, bizarre and/or unpredictable behavior, paranoia, disorganized thinking, impulsivity, severe agitation and mania. Treatment can involve psychotropic drugs (including antidepressants, anti-epileptics and others), hospitalization, psychotherapy and, in some cases, electroconvulsive therapy.

Postpartum Anxiety (Panic) Disorder

Like prenatal depression, postpartum anxiety disorder is less known to most people, but it can be just as debilitating as depression, and the causes and risk factors are thought to be similar. Up to 10 percent of women experience the symptoms, which include, as you’d expect, extreme anxiety and panic attacks, including a racing heartbeat, agitation, shortness of breath or chest pain. Dizziness, nausea and ongoing insomnia are red flags too. Women with postpartum anxiety disorder may excessively worry or feel consumed by fears, especially fear of losing control, fear that they are “going crazy,” and/or fear that they or their child will die. In addition to the risk factors for postpartum depression, a history of an anxiety disorder puts a woman at higher risk for this condition.

Another type of more specific but less common (but also underreported) postpartum anxiety disorder is postpartum obsessive compulsive disorder (OCD), which affects 3 to 5 percent of mothers. Although a history of OCD is a risk factor for this condition, it’s not required, and other risk factors include unrealistic expectations of one’s self as a mother and negativity toward motherhood. Similar to non-pregnancy-associated OCD, symptoms include repetitive actions – such as repeatedly giving a baby a bath or excessively changing their clothes diapers – and obsessive thoughts, especially related to harming or even killing their baby. But women with postpartum OCD feel a sense of horror or embarrassment about these obsessions; unlike psychosis, they *recognize* that they are having bizarre thoughts and are not likely to actually harm their child.

The treatments for postpartum anxiety disorders are generally similar – therapy and psychotropic medications – to those for prenatal and postpartum depression.

Paternal (or Partner) Depression

Just because dad – or another partner – isn’t incubating the baby (or even if neither of you did) doesn’t mean the experience cannot affect his mental health as well. Paternal depression affects approximately one in every ten fathers, though some estimates put it at one in four fathers during the period of three to six months postpartum. A father may be at higher risk for depression if the mother is experiencing depression already. One study found that younger men, under age 29, were up to two and a half times more likely to experience postpartum depression, and other risk factors included a low educational level, low income, financial worries or a poor relationship with their partner. As with mental health concerns among moms, a father’s mental health may affect his children. A depressed father is less likely to engage in enriching activities with his child, such as reading, singing songs and telling stories.

It’s tough to keep all the balls in the air after a baby arrives, and it’s even tougher to care for yourself at the same time that you’re caring for a brand new tiny human. But ignoring the signs of any of these mood disorders is likely to interfere with caring for that tiny human. Taking care of yourself is one of the ways you also ensure that you are taking care of your child.

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