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Postpartum Depression

Postpartum depression is a major mood disorder

AKA chronic depressive syndrome

In general, women who experience postpartum depression had a favorable attitude toward their pregnancy:

Elated and excited about the pregnancy

Tolerated pregnancy well with minimal discomfort

Eager to breastfeed, generally follow through with breastfeeding and are usually quite successful with it

Some literature sources indicate it may be related to the change (sudden decrease) in hormone levels-- estrogen, progesterone and cortisol--during the postpartum period

Excitement and elation are evident during the pregnancy when placental levels are at high levels

Following delivery and the sudden decrease in levels, postpartum depression appears

Controversy still continues regarding high prolactin levels in the breastfeeding woman and the association for an increased risk of postpartum depression or postpartum psychosis

Prolactin inhibits the release of progesterone

While there is no specific cause, there are some predictors of postpartum depression:

History of manic depressive behaviors (Bipolar Disorder)

History of prenatal depression/labile emotions

History of previous postpartum depression (self) or in blood relatives

Obsessive personality

Multiple life stressors

Poor self-esteem

Poor coping skills

Single, separated, divorced

Significant loss in the last year

Previous miscarriage or stillbirth

Substance use

History of STDs

History of physical or sexual assault/abuse

History of severe premenstrual tension syndrome (PMS)

Poor relationship with parents and/or partner

Child care issues

Single parent

Congenital anomalies

Infant with health problems

Incidence:

10-20% of all delivering women are diagnosed with postpartum depression

Occurrence:

60-70% occur within the 1st three (3) months, the greatest risk seeming to be around the 4th week postpartum

But can occur anytime during the 1st year postpartum

Can last for up to 3 years postpartum

Symptoms may include:

Feelings of:

Inadequacy

Being overwhelmed

Guilt

Rejection

Loss of weight

Irritability, Anxiety

Tearful

Fatigue

Sleeplessness

Anorexia

Headaches

Difficulty concentrating

Concerns about ability to be a parent

Unable to cope with or provide basic needs

Little interest in interacting with infant

Difficulty bonding with infant

Despondent/Depressed for at least 2 weeks

Loss of interest in almost all activities, even those that were once pleasurable

Appearance

Sex

Sometimes, physical symptoms may not be evident, so watch for.....

Negative emotional response to infant, family, spouse/partner, staff

Insensitive, inappropriate or unresponsive response to family & infant

States "bad mother," "inadequate mother," ".....better off without me"

Withdrawal from family, activities

Expressed thoughts of harming self or infant

Infant may also display symptoms of mother's postpartum depression

Makes little eye contact with caregivers

Feeding difficulties

Frequent illnesses

Treatment Interventions/Options:

Active empathic listening

Hormone replacement

Support groups

Psychiatric care

Psychotherapy--individual, group or both

Counseling

Hospitalization

Especially if woman expressed plans to harm self or infant

Medications

Serotonin-reuptake inhibitors (SSRIs)

Serotonin is a hormone manufactured in the brain (by the amino acid Tryptophan) that acts as a neurotransmitter, carrying impulses between nerve cells

Serotonin's role is to calm our anxiety, relieve depression and to keep our moods even and stable allowing us to sleep

SSRIs increase the extracellular level of serotonin by inhibiting its reuptake into the pre-synaptic cells

SSRIs generally have fewer side effects and are better tolerated than MAO inhibitors

They usually take about three (3) weeks for their full effect to be realized

Common examples include: Paxil,^* Zoloft, Prozac, Luvox

Tricyclics

Tricyclics increase the levels of both neurotransmitters--norepinephrine and serotonin--by blocking their reuptake into the pre-synaptic cells. They may also interact with other chemicals in the body

Tricyclics have a sedating effect that improves anxiety symptoms

Though not addictive, tricyclics should not be abruptly stopped as they may cause GI disturbances, insomnia, chills, headaches, dizziness, nightmares, anxiety, panic and/or a general felling of being ill

Common examples include: Tofranil, Norpramin, Aventyl, Elavil

^*^Note:^{The FDA recently issued an alert based
on results from new studies regarding Paxil. These
studies suggest that Paxil taken during the 1st trimester of a pregnancy
increases the risk of birth defects and increases the risk of heart defects in
the fetus from
1-2%. The manufacturer, GlaxoSmithKline, is being asked by the FDA to
update the drug's label to reflect these results and to
indicate that, when taken during a pregnancy, Paxil poses
a risk to the fetus. The FDA is also recommending the drug be moved from a
Category C to a Category D drug in pregnancy.}

^{In addition, a
recent study reported that women who take}^{the SSRI group of
antidepressants after the 20th week of pregnancy are}^{approximately}^{6 times` more likely to give birth to infants with persistent pulmonary
hypertension of the newborn (PPHN), a rare by}^potentially^{fatal heart and lung condition. The FDA is investigating further and may
consider}^asking^the^{manufacturers}^{to
change the drugs' labels to warn of the danger.}

Postpartum depression is disabling

Takes a toll on the entire family and family relationships

Affects/changes relationship with other children in the family

May result in spousal abuse, divorce

Children, whose moms experienced postpartum depression, may continue to show symptoms for several years

Continued feeding/eating difficulties

Continued frequent illnesses

Sleeping difficulties

Temper Tantrums

Hyperactivity

Delays in cognitive development

Early onset depressive illness themselves