What is Postpartum Depression?

Postpartum depression is defined by the DSM-IV as the onset of depressive symptoms within 4 weeks of childbirth. Symptoms are very similar to major depression, and can also include fluctuations in mood, preoccupation with infant well-being, as well as at times just the opposite, complete disinterest in the infant which, if prolonged, may result in failure to thrive syndrome. Although the DSM-IV suggests rigid guidelines in terms of time periods where this diagnosis should or should not be made, it is imperative to note that in medicine, as well as psychiatry and psychology, there is leeway. Subsequently, at 4 weeks and 2 days, if the mother comes down with depressive symptoms, this diagnosis still should be made.

Infantcide, where children are killed by their mother, is most often associated with postpartum psychotic episodes that are usually characterized by hallucinations. These are usually auditory command hallucinations directing the mother to kill the infant. There can be delusions that the child may be possessed. Statistics for psychotic breaches with postpartum depression range anywhere from 1 in 500 to 1 in 1,000, as per the DSM-IV.

Once a woman has had a postpartum episode, the risk of occurrence for future deliveries is approximately a 30-50% increase.

Other symptomatology may include anxiety attacks, panic attacks, fear of being alone with the infant, and complete disinterest. This is not to be confused with the “baby blues,” which does affect up to approximately 70% of women during the first 10-14 days postpartum. This is transient, and usually does not impair functioning.

It is not uncommon for the healthiest of mother to experience fear and anxiety with the birth of a child. Common fears that are not often voiced may relate to ability to raise a child successfully, questioning whether she will do a “better job or worse job” than her own mother, fears regarding possible health issues that could develop in her child, and ability to care for a child in the event that occurs, fear regarding ability to maintain her relationship with her significant other (“Will I still be a good wife?). All of these feelings and questions are normal, and only become “abnormal” when they impact daily routines and/or involve risky caretaker behavior.

Good communication is crucial. It is extremely helpful to talk about these feelings with other mothers, or a spouse.

Any time there is a major life event such as giving birth to another human being, a barrage of feelings are to be expected. There may even be feelings of regret, which many women stifle, and never share, feeling very guilty having these feelings, which can cause transient depression. “I didn’t want the baby” is also a common feeling. This does not mean that the mother is not a loving mother. This does not mean that the mother cannot take care of her child. These are common, transient type feelings that do occur.

It is imperative that we understand the dark side contained in each of us. When we begin to understand our dark sides, admit to those feelings, we are better able to address them and move on with less anxiety and less stress in a variety of interactions.

What are postpartum depressive symptoms?

As with all illnesses, there are symptom gradations. Postpartum depression symptoms may be mild, moderate or severe in nature. Symptoms usually affect the entire family network. Postpartum depression can also be associated with anxiety. Please see Anxiety Disorders on Peace and Healing.com. Symptoms of postpartum depression may include insomnia, fluctuations of anger, sudden outbursts of crying, feelings of isolation, wanting to leave the baby and/or family network, fear of not being a good caretaker. As with most depression, there may be decreased personal hygiene, and although somewhat uncommon, eating disturbances. There are also physiological symptoms associated with this disorder including weight fluctuations. Breastfeeding issues are also common. The baby rejecting breastfeeding can cause an exacerbation of depression. Other symptoms: Headaches, feeling decreased support from the husband, especially if he doesn’t understand what his wife is experiencing and not being emotionally supportive.

What is the treatment for postpartum depression?

The most important part of treating any depression is recognition of the problem and getting the individual into treatment. Traditional treatment includes a combination of anti-depressants and psychotherapy. Family support, especially spousal, is very important. Individuals often feel like they are losing their minds. Much encouragement is needed. However, bear in mind that postpartum depression is not a normal process. Additional spousal help and support may alleviate many symptoms. It is important for the mother to try to rest/sleep at the same time as her baby. Subsequently, house chores should not be a priority. If the individual has a good family support network, asking for help with the chores or errands is essential, and in fact is key. Nowadays, in our society, we “want to do it on our own.” We have been taught not to ask for help as we don’t want to appear dependent on others. As Dr. Hammerschlag points out most eloquently, it is much easier to paddle a canoe across the lake with two individuals paddling, than one. If you have ever paddled a canoe by yourself, you realize how difficult it is. If you have two individuals paddling, it is much easier. This analogy applies to sufferers of postpartum depression. There has to be a team in place, and the husband plays a vital role.

Try to get away; even it is only for a cup of coffee for half hour. Try to spend time in the outdoors, go shopping or to a movie. Seeing a movie is the epitome of self-hypnosis, as you are engrossed in the film and therefore momentarily distracted.

Anti-depressants can be extremely helpful in treating postpartum depression. There are many anti-depressants than can be used even if the mother is breastfeeding. Examples include Zoloft, Anafranil, and Norpramin. Paxil is questionable. Anti-depressant usage doesn’t need to be the first line of treatment; however, this would clearly dependent on the severity of the depression and how debilitating the symptoms are. If the symptoms were severe enough that child care is impacted, clearly this would be a first line treatment option.

Also it is important to realize how guilty the mother feels for even having these symptoms. They frequently feel as if they are not a good mother, and feel they are looked upon with disdain from others. Recognizing this is the first step in showing empathy and giving reassurance.