What is Postpartum Depression?

Often the term Postpartum Depression (PPD) is used to describe mood and anxiety disorders that occur within the first year after a baby is born.  There are five postpartum mood/anxiety disorders.  Postpartum Depression is the most common. 

The Baby Blues occurs in up to 80% of new moms.  This is a normal response to the hormonal changes, the sleep depravation and adjustments that occur immediately after birth.  We don’t consider the blues a mood disorder.  The blues usually begins around day 3 postpartum, and should be gone within 2-3 weeks.  With the blues, mood is up and down, and women sometimes find themselves bursting into tears for no reason.  But, overall, there is a positive outlook.  It differs from postpartum depression in timing (only occurs in the first three weeks) and severity (it’s mild and goes away without treatment). 

We believe postpartum depression occurs in between 15% to 20% of all new moms.  That’s up to 1 in 5 mothers! Many of us have a stereotype of a depressed person being curled up in a ball with the blanket pulled up over her head, crying.  That’s not really how it looks for most women with Postpartum Depression. What new mom has the time to hide in bed? Some call it Postpartum Depression/Anxiety because many women experience both depression and anxiety.

Who gets Postpartum Depression?

Women who have a history (or family history) of depression or anxiety, a previous postpartum depression, depression during pregnancy, a history of abuse, marital/relationship problems, teenage moms, social isolation, or a sick baby are all at an increased risk of postpartum depression.  Women who have severe mood changes before their periods or while taking the birth control pill are also at an increased risk of postpartum depression.

Postpartum depression can begin at the birth of the baby, or can occur at any time within the first year.  Sometimes sudden weaning or a first menstrual period can trigger the onset. 

How do I know if I have postpartum depression or anxiety?

Symptoms can vary from woman to woman.  Here are some of the most common symptoms

1. ❖  Sadness (sometimes comes in waves-women feel “up and down”)
   

2. ❖  Guilt (often women feel like they aren’t good moms, “maybe I just wasn’t cut out to be a mom”)
   

3. ❖ Irritable, angry and less patient than normal (women often say they are snapping at their partners, or not enjoying their older child/children the way they did before)
   

4. ❖  Sleep problems (often hard to fall and/or stay asleep at night)
   

5. ❖  Appetite changes (may eat more or less than usual), often rapid weight loss
   

6. ❖  Lack of feelings toward baby (“I can bathe her and feed her, but I don’t really feel what I thought I’d feel towards her)
   

7. ❖  Worrying about every little thing  (“it feels like my mind won’t shut off”)
   

8. ❖ Lack of fun or pleasure (I often hear things like, "I used to sing in the shower or with the car radio…. I’m not singing anymore”).
   

9. ❖  Overwhelm  (“I just can’t cope”)
   

10. ❖  Lack of focus and concentration and difficulty making decisions
    

Postpartum Obsessive-Compulsive Disorder (OCD)

About 3-5% of new moms get postpartum Obsessive Compulsive Disorder.  Women who have a history of OCD or a family history of OCD are at a higher risk.  I find that in my practice women who describe themselves as “worriers” or “anal” (have a high need for order and things being “just right”) are at a higher risk. 

The word obsessive refers to repetitive thoughts.  Compulsions refer to the behaviors people do to avoid or minimize the anxiety produced by the obsessive thought.  In the movie As Good As It Gets, Jack Nicholson portrayed a character with severe OCD. 

Postpartum, some women get obsessive worry, often about things happening to the baby.  Sometimes women get frightening thoughts or even mental pictures of something bad happening to the baby; often the pictures may be about the mom herself hurting the baby.  These pictures can seem vivid and horrifying.  Unlike women with psychosis, who are not in touch with reality, these women are painfully in touch with reality.  These women know they do not want to hurt their babies, and we call these thoughts “ego alien”.  Women with postpartum OCD are horrified, “how could I have these thoughts?  I love my baby.  I would never hurt her.  I feel like a monster”.

These thoughts may just pop into her mind- we call them intrusive, and they are repetitive.  Sometimes women have behaviors or compulsions that help them feel safer.  These are may include things like hiding the kitchen knives or avoiding being alone with the baby. 

Postpartum Panic Disorder

About 10% of new moms experience panic disorder.  Some of these women have had panic before, sometimes even in pregnancy.

Symptoms of Postpartum Panic include episodes of extreme anxiety or worry, rapid heartbeat, tight chest or shortness of breath, choking feelings, dizziness, restlessness, and irritability. Panic attacks can happen without any specific triggers, even in the middle of the night.  Women often feel a sense of doom or that they are going to die.  They worry about when the next attack will happen.

Postpartum Posttraumatic Stress Disorder (PTSD)

Posttraumatic Stress Disorder can occur after birth.  PTSD is seen in about 1-6% of women.  Symptoms of PTSD include recurrent nightmares, extreme anxiety, reliving past traumas, avoidance of reminders of the trauma (for example, the hospital).  Women with Postpartum PTSD often feel that they were abandoned, not well cared for, and stripped of their dignity during the birth.  Another common feeling is that their voices were not heard and that there was poor communication during the labor and/or delivery.  Some women with Postpartum PTSD state their trust was betrayed; they felt a sense of powerlessness and lack of protection by their caregivers.

Perinatal  Bipolar Disorder

Bipolar disorder is often incorrectly diagnosed as depression, because help is sought during the depression phase.  It is not uncommon for people with bipolar disorder to suffer over 10 years with an incorrect diagnosis, and therefore, inadequate treatment.  Women taking medication for bipolar disorder are often told to stop medication before getting pregnant.  Some, but not all, medications used for bipolar treatment can cause birth defects.   Unfortunately, up to 80% of women who stop medication become ill during the pregnancy.  Postpartum, bipolar disorder puts women at risk for a manic or psychotic episode.  Women with bipolar disorder need to be working very closely with a psychiatrist trained in reproductive mental health. 

Symptoms of postpartum bipolar episode can include a decreased need for sleep and severe and rapid mood swings.  Sometimes it presents with extreme irritability.  Often there is a family history of bipolar disorder.

Postpartum Psychosis

Postpartum psychosis is considered a medical or psychiatric emergency. There is an increased risk of a woman hurting her self or her infant or children. 

Symptoms of postpartum psychosis can include:

1. ❖  Difficulty relaxing
   

2. ❖   Incoherence (not making sense)
   

3. ❖   Decreased appetite
   

4. ❖   Paranoia and confusion
   

5. ❖   Hearing or seeing things others do not (hallucinations)
   

6. ❖   Inability to differentiate reality from hallucinations
   

7. ❖   Difficulty sleeping
   

8. ❖   Delusional thinking (lack of touch with reality)
   

9. ❖   Manic behavior (hyperactivity, impulsive behavior)
   

10. 
    

11. These symptoms come and go (she may be fine one minute, and acting strangely the next).
    

All of these postpartum mood disorders can be treated.  If a mom is not well, the family is not well.  We now know that untreated maternal illness can cause long term consequences for the infant, as well as other children in the home.  Postpartum mood disorders also contribute to marital/relationship stress and discord.

Unfortunately, these postpartum mood disorders do not always go away by themselves without treatment. 

YOU ARE NOT ALONE

YOU ARE NOT TO BLAME

WITH HELP, YOU WILL RECOVER!

Seek treatment from someone trained specifically in postpartum depression and postpartum mood disorders.  To learn how to screen a potential therapist, go to my Office/Contact page.

Important resources:

http://www.MedEdPPD.org  (a very informative website)

http://www.postpartum.net   Postpartum Support International  1.800.944.4PPD

Beyond the Blues, A Guide to Understanding and Treating Prenatal and Postpartum Depression  (2006) by Bennett and Indman