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Postpartum depression

Alternative Names

Depression - postpartum

Definition

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.

Causes

Expected Mood Changes

Women commonly have mood changes during pregnancy. They are caused by changes in hormone levels. Many mood changes are normal and even expected, since having a baby can lead to several lifestyle changes. Support from your family and friends can help.

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. It is necessary to seek medical attention to treat postpartum depression.

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

Symptoms

Most of the symptoms are the same as in major depression.

In addition to depressed mood, you may have the following symptoms nearly every day:

• Agitation and irritability
• Decreased appetite
• Difficulty concentrating or thinking
• Feelings of worthlessness or guilt
• Feeling withdrawn, socially isolated, or unconnected
• Lack of pleasure in all or most activities
• Loss of energy experienced
• Negative feelings toward the baby
• Thoughts of death or suicide
• Trouble sleeping

Exams and Tests

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.

Sometimes depression following pregnancy can be related to other medical conditions. Hypothyroidism, for example, causes symptoms such as fatigue, irritability, and depression. Women with postpartum depression should have a blood test to screen for low thyroid hormones.

Treatment

The treatment for depression after birth often includes medication, therapy, or a combination of both. There are several types of antidepressant medications that may be given to breastfeeding mothers, including nortriptyline, paroxetine, and sertraline.

If you are thinking of harming yourself or your infant, seek immediate medical help. If depression is diagnosed, you may need to be followed closely for at least 6 months.

Support Groups

Participating in support groups may be valuable, but should be combined with medication and formal psychotherapy.

Outlook (Prognosis)

Medication and professional counseling are often successful in reducing or eliminating symptoms.

Possible Complications

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

The potential long-term complications are the same as in major depression.

When to Contact a Medical Professional

Notify your doctor or pediatrician if you experience depression after pregnancy. Do not be afraid to seek help immediately if you feel overwhelmed and are afraid that you may hurt your baby.

Prevention

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.

References

Wisner KL, Sit DKY, Reynolds SK, et al. Psychiatric disorders. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 50.

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