The postpartum period is a time of extreme vulnerability to depression. Up to eighty percent of women experience a phenomenon called the "postpartum blues." This is a brief period during which women are tearful or extremely sensitive and may be more moody. Sometimes sleep is a problem. The "blues" usually resolve without treatment within 1 to 2 weeks of giving birth.

About twelve to fifteen percent of women develop postpartum depression. This involves more significant symptoms of depression which women begin to experience within a few days of giving birth, and may continue to experience for weeks or months following delivery. Rapidly changing hormones seem to play a role in sensitizing women to depression. The psychological changes involved in parenting a new infant, the physical stress of the birth, and lack of sleep may also play a role. Rarely, depression can progress to the point where women develop confused and disorganized thinking about themselves or the baby, hallucinate, or even consider suicide. Suicide or even infant homicide are the most catastrophic results when this disorder is not properly identified. If you are experiencing any of these symptoms, call your health care provider immediately.

Women who are most vulnerable to postpartum depression usually have a personal or family history of depression. Studies show that most women who experience major depression after childbirth have had prior episodes of depression even though they may not have been diagnosed or treated. Those with prior episodes of postpartum depression will experience a recurrence following the next delivery about half of the time. Single women, those in unsupportive relationships, and women with multiple children also may be more at risk.

What can I do about postpartum depression?

You have already taken one of the most important steps in treating your depression -- you have come for help. Fortunately, depression is treatable. Believing one's condition is "incurable" is part of the hopelessness that accompanies depression. This way of thinking is a symptom of depression and will improve with treatment. There are many treatment options available.

Medication -
Many effective, well-tolerated antidepressant medications are safe for use during breast-feeding. Antidepressant medications are an essential part of treatment for women who are moderately to severely depressed.

Therapy -
Therapy involves talking with a trained professional (psychologist, psychiatrist, clinical nurse or social worker) on a short term (12-20 weeks) or a long-term basis and can take many forms. Two types of therapy are particularly effective for depression. Cognitive Behavioral Therapy (CBT) targets negative thoughts and behaviors that tend to worsen depressed mood and teaches better ways of thinking and behaving. Interpersonal Therapy (IPT) helps a person deal with changing roles and other stressors by learning how to communicate more effectively with others.

Alternative medicine, herbal remedies and dietary supplements -
There has been rising interest in the use of herbs and dietary supplements for the treatment of depression. St John's Wort (hypericum perforatum) has been the most common of these. However, scientific studies of these alternative forms of treatment have so far been short-term and not well controlled. There is no uniformity of dose or amounts and types of ingredients because the Food and Drug Administration does not regulate them. Be sure to tell your health care provider if you are taking an herbal or dietary supplement. Some of them may negatively interact with antidepressant medication or other medications you are taking.

Is there anything else that I can do?

Along with professional treatment, there are several other things that you can do to help yourself feel better.

Support -
It is very important that you get support for yourself and communicate your needs to others. Ask for help with the demands of caring for a newborn baby. Consider hiring a doula, a woman specially trained to help women with newborn babies. If you are breast-feeding, consider pumping for the nighttime feedings and have your partner do at least some of the nighttime feedings so you can sleep. Friends and family members often want to help during the post-partum period. Ask for help with housekeeping and preparing meals. Many people who no longer have young children feel honored to be asked to care for the baby for short periods of time. Let them rock or walk the baby, give a feeding, or even change a diaper. Don't feel you have to do it all yourself.

Exercise -
The benefits of exercise in depression are well documented. Exercise helps treat depression by releasing the body's mood-elevating compounds, reducing the depression hormone, cortisol, in the blood, providing perspective on life, providing a feeling of accomplishment, enhancing self-esteem, and increasing levels of serotonin, a neurotransmitter, found to be key in the development of depression). It doesn't matter what you do as long as you do something physical for 20 to 30 minutes three times a week or more. Even exercising as little as 10 minutes a day has been found to have beneficial effects. Walking is perhaps the most accessible form of exercise because it costs nothing and you can start it immediately.

Stress Management -
Stress can make depression worse and a newborn adds new stresses to a woman's life. Learning to deal more effectively with stress may reduce depression. The first step is to identify the main sources of stress in your life and find the most effective way to cope with those (such as avoiding them or using relaxation techniques). Identify stressors that you are putting on yourself (trying to be "perfect", doing too much). Set priorities and let unnecessary tasks wait.

Promote sleep -
Adequate sleep can make depression worse. Take care to keep your sleep cycle regular by going to bed and waking around the same time. Develop relaxing bedtime rituals such as reading or a warm bath.

Dietary changes -
Eating a well balanced diet and regularly scheduled meals is important. Decreasing refined sugar, caffeine, alcohol, and chocolate may help. Use of calcium, and B vitamins (B6) may also decrease symptoms.

Spend time with others -
Depressed women often withdraw from others because they mistakenly feel they would not be good company. Being with others is another way to gain perspective, which helps with the symptoms of depression. Consider joining a support group for new mothers or even a support group for others experiencing problems with depression.

Make time to do what you enjoy -
Depressed women sometimes temporarily lose the ability to enjoy themselves. Avoiding enjoyable activities only makes this worse. Continue doing pleasurable activities even if you don't feel like it. You will soon find that you have come to enjoy yourself again, at least for short periods.

Give yourself a break -
The initial demands on a new mother are exciting and tremendous. Feeling better takes time. You will feel like yourself again and better able to handle the everyday pressures as well as the demands of motherhood. Be realistic about the demands and expectations you make on yourself.

Last updated on:
Wednesday, 05-May-2004 10:37:24 EDT

http://www.med.umich.edu/depression/postpartum.htm

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