Postpartum Depression

Postpartum depression is caused by changes in hormones and can run in families. Women with severe premenstrual syndrome are more likely to suffer from postpartum depression. Mild or moderate depression, either postpartum or otherwise, can be treated with medication or with psychotherapy, or, particularly for women with severe cases, a combination of the two. Women who have postpartum depression love their children but may be convinced that they're not able to be good mothers.

Postpartum depression is distinguished from the baby blues both by its duration and the debilitating effects of indifference the mother has about herself and her children.

Baby Blues
Many women experience baby blues – an extremely common reaction following delivery – it usually appears suddenly on the third or fourth day. It’s estimated that up to 70% of all new mothers experience this emotional letdown, which generally does not impair functioning. Symptoms usually include crying for no reason, irritability, restlessness and anxiety. These are common and frequently less severe postpartum reactions.

Postpartum Depression
About one in 10 new mothers experience some degree of postpartum depression. These complications usually occur within just days after the delivery, and can occur even a year later. These symptoms include:

• Sluggishness
• Fatigue
• Exhaustion
• Feelings of hopelessness or depression
• Disturbances with appetite and sleep
• Confusion
• Uncontrollable crying
• Lack of interest in the baby
• Fear of harming the baby or oneself
• Mood swings – highs and lows

At Risk
A past history of non-postpartum mood disorder and a family history of mood disorder increases the risk of postpartum depression.

• A woman experiencing postpartum depression usually has several of these mild to severe symptoms – the symptoms and their severity may alternate. Usually the woman experiencing these symptoms feels isolated, guilty and ashamed.·
  
• Postpartum-onset mood episodes can present with or without psychotic features. Infanticide is most often associated with postpartum psychotic episodes that are characterized by command hallucinations to kill the infant, but it can also occur in severe postpartum mood episodes without such specific delusions or hallucinations.
  
• The risk of postpartum episodes with psychotic features is particularly increased for women with prior postpartum mood episodes, but elevated for those with a history of mood disorders. Once a woman has a postpartum episode with psychotic features, the risk of recurrence is 30-50% with each delivery.
  
• There is a subset of women who experience postpartum psychotic episodes that may include infanticide. This is characterized by hallucinations by the new mother to kill the infant, or delusions that the infant might be possessed.

Postpartum Anxiety or Panic Disorder
There are some women who, after giving birth, have intense anxiety or irrational fears. They may have symptoms such as rapid heart rate, sense of impending doom and dizziness. There is also another subset of women that experience OCD after birth. They may have repetitive thoughts, including harming the baby. They may avoid the baby to alleviate these thoughts, and they may feel anxious.

Researchers have suggested that rapid changes in hormone levels such as estrogen, progesterone and thyroid have a strong effect on moods.

Treatment for postpartum depression
Women need to be taken seriously when these symptoms occur. Generally a combination of psychotherapy and medication can reduce these symptoms. The ideal treatment plan includes:

• Medical evaluation to rule out physiological problems
• Psychiatric evaluation
• Psychotherapy
• Possible medication
• Support group

It is imperative that women being treated for postpartum depression continue with treatment even after they feel better, because if they stop the treatment prematurely, symptoms can recur.

Psychosis of Postpartum Depression
Postpartum-onset mood episodes can occur with or without psychotic features. Infanticide is most often associated with postpartum psychotic episodes characterized by command hallucinations to kill the infant, or delusions that the infant is possessed. But it can also occur in severe postpartum mood episodes without such specific delusions or hallucinations.

Postpartum mood episodes with psychotic features appear to occur in from 1 in 500 to 1 in 1,000 deliveries.

Postpartum depression can evolve into psychosis following a dramatic or traumatic event.