Postpartum Blues

More than half of women may have depression for a short time after pregnancy. These are feelings of anxiety, irritation, tearfulness, and restlessness that are often called “the postpartum blues.” This generally occurs in the first few weeks after pregnancy and goes away soon, without the need for treatment.

Postpartum Depression

Postpartum depression is a more serious condition that affects between 8 - 20% of women after pregnancy, especially the first 4 weeks. Postpartum depression is moderate to 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 within the first 4 weeks after delivery.

Most of the symptoms are the same as in major depression.Depression is more than just feeling “blue” or “down in the dumps” for a few days. It’s a serious illness that involves the brain. With depression, sad, anxious, or “empty” feelings don’t go away and interfere with day-to-day life and routines. These feelings can be mild to severe. The good news is that most people with depression get better with treatment.

When you are pregnant or after you have a baby, you may be depressed and not know it. Some normal changes during and after pregnancy can cause symptoms similar to those of depression. But if you have any of the following symptoms of depression for more than 2 weeks, call your doctor:

Feeling restless or moody
Feeling sad, hopeless, and overwhelmed
Crying a lot
Having no energy or motivation
Eating too little or too much
Sleeping too little or too much
Having trouble focusing or making decisions
Having memory problems
Feeling worthless and guilty
Losing interest or pleasure in activities you used to enjoy
Withdrawing from friends and family
Having headaches, aches and pains, or stomach problems that don’t go away

The two common types of treatment for depression are:

Talk therapy. This involves talking to a counselor or therapist to learn to change how depression makes you think, feel, and act.
Medicine. Your doctor can prescribe an antidepressant medicine. These medicines can help relieve symptoms of depression.

What causes depression? What causes postpartum depression?

There is no single cause. Rather, depression likely results from a combination of factors:

Depression is a mental illness that tends to run in families. Women with a family history of depression are more likely to have depression.
Changes in brain chemistry or structure are believed to play a big role in depression.
Stressful life events, such as death of a loved one, caring for an aging family member, abuse, and poverty, can trigger depression.
Hormonal factors unique to women may contribute to depression in some women. We know that hormones directly affect the brain chemistry that controls emotions and mood. We also know that women are at greater risk of depression at certain times in their lives, such as puberty, during and after pregnancy, and during perimenopause. Some women also have depressive symptoms right before their period.

Depression after childbirth is called postpartum depression. Hormonal changes may trigger symptoms of postpartum depression. When you are pregnant, levels of the female hormones estrogen (ESS-truh-jen) and progesterone (proh-JESS-tur-ohn) increase greatly. In the first 24 hours after childbirth, hormone levels quickly return to normal. Researchers think the big change in hormone levels may lead to depression. This is much like the way smaller hormone changes can affect a woman’s moods before she gets her period.

Levels of thyroid hormones may also drop after giving birth. The thyroid is a small gland in the neck that helps regulate how your body uses and stores energy from food. Low levels of thyroid hormones can cause symptoms of depression. A simple blood test can tell if this condition is causing your symptoms. If so, your doctor can prescribe thyroid medicine.

You may have a higher chance of postpartum depression if you:

· Are under age 20

· Currently abuse alcohol, take illegal substances, or smoke (these are also serious medical health risks for the baby)

· Did not plan the pregnancy or do not want the pregnancy

· Had a mood or anxiety disorder prior to pregnancy, including depression with a previous pregnancy

· 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

· Have a close family member who has had depression or anxiety

· Have a poor relationship with your husband, boyfriend, or significant other or are unmarried

· Have financial problems (low income, poor housing)

· Have little support from family, friends, and a significant other

· Previously attempted suicide

· Received poor support from your parents in childhood

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

Having good social support from family, friends, and coworkers may help to reduce the seriousness of postpartum depression, but may not prevent it. Screening questionnaires may help with early detection of depression or risks for depression.

Complications:

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

Other factors may play a role in postpartum depression. You may feel:

Tired after delivery
Tired from a lack of sleep or broken sleep
Overwhelmed with a new baby
Doubts about your ability to be a good mother
Stress from changes in work and home routines
An unrealistic need to be a perfect mom
Loss of who you were before having the baby
Less attractive
A lack of free time

Any woman may become depressed during pregnancy or after having a baby. It doesn’t mean you are a bad or “not together” mom. You and your baby don’t have to suffer. There is help.

Here are some other helpful tips:

Rest as much as you can. Sleep when the baby is sleeping.
Don’t try to do too much or try to be perfect.
Ask your partner, family, and friends for help.
Make time to go out, visit friends, or spend time alone with your partner.
Discuss your feelings with your partner, family, and friends.
Talk with other mothers so you can learn from their experiences.
Join a support group. Ask your doctor about groups in your area.
Don’t make any major life changes during pregnancy or right after giving birth. Major changes can cause unneeded stress. Sometimes big changes can’t be avoided. When that happens, try to arrange support and help in your new situation ahead of time.

What can happen if depression is not treated?

Untreated depression can hurt you and your baby. Some women with depression have a hard time caring for themselves during pregnancy. They may:

Eat poorly
Not gain enough weight
Have trouble sleeping
Miss prenatal visits
Not follow medical instructions
Use harmful substances, like tobacco, alcohol, or illegal drugs

Depression during pregnancy can raise the risk of:

Problems during pregnancy or delivery
Having a low-birth-weight baby
Premature birth

Untreated postpartum depression can affect your ability to parent. You may:

Lack energy
Have trouble focusing
Feel moody
Not be able to meet your child’s needs

As a result, you may feel guilty and lose confidence in yourself as a mother. These feelings can make your depression worse.

Researchers believe postpartum depression in a mother can affect her baby. It can cause the baby to have:

Delays in language development
Problems with mother-child bonding
Behavior problems
Increased crying

It helps if your partner or another caregiver can help meet the baby’s needs while you are depressed. All moms deserve the chance to enjoy their life and their children. If you are feeling depressed during pregnancy or after having a baby, don’t suffer alone. Please tell a loved one and call your doctor right away.

For More Information . . .

For more information on depression during and after pregnancy, call womenshealth.gov at 1-800-994-9662 or contact the following organizations:

National Institute of Mental Health, NIH, HHS
Phone: (301) 496-9576
Internet Address: http://www.nimh.nih.gov

National Mental Health Information Center, SAMHSA, HHS
Phone: (800) 789-2647
Internet Address: http://www.mentalhealth.org

American Psychological Association
Phone: (800) 374-2721
Internet Address: http://www.apa.org

National Mental Health Association
Phone: (800) 969-NMHA
Internet Address: http://www.nmha.org

Postpartum Education for Parents
Phone: (805) 564-3888
Internet Address: http://www.sbpep.org
Postpartum Support International
Phone: (805) 967-7636
Internet Address: http://www.postpartum.net

Cheryl Osler, Ed.D, MS, RN, CNS, MA, LMHC, NCC
South Hill Counseling	509-869-5050