Postnatal Depression (Postpartum Depression)

Postnatal depression is also known as puerperal depression, postpartum depression, baby blues, and puerperal psychosis.

The first month after the delivery of a newborn baby (the postpartum period) is a time of major changes for women. Female hormones and weight are rapidly readjusting. There may be new and stressful changes in relationships with other children, the father of the baby, parents and in-laws, colleagues at work, and friends. Of course, the new baby needs almost constant attention and feeding every two hours, resulting in the feeding mother's sleep deprivation. All of these factors can contribute to postnatal depression and mood swings.

If the moodiness only lasts 2-3 weeks and then goes away, it is commonly called the "baby blues". This natural reaction to stress is experienced by more than half of new mothers.

However, if the feelings of depression or anxiety continue for more than three weeks, a more serious condition called postpartum depression may exist.

For most women, symptoms are transient and relatively mild (i.e. postpartum blues). However, 10-15% of women experience a more disabling and persistent form of mood disturbance (e.g. postpartum depression, postpartum psychosis).

Postpartum psychiatric illness was initially conceptualized as a group of disorders specifically linked to pregnancy and childbirth, and thus was considered diagnostically distinct from other types of psychiatric illness. More recent evidence suggests that postpartum psychiatric illness is virtually indistinguishable from psychiatric disorders that occur at other times during a woman's life.

During the postpartum period, up to 85% of women suffer from some type of mood disturbance. About 10% of women experience significant depression after a pregnancy.

You have a higher chance of postnatal depression if:

You experienced mood disorders prior to pregnancy, including depression with a prior pregnancy. You have a close family member who has had depression or anxiety. Anything particularly stressful happened to you during the pregnancy (e.g. illness, death or illness of a loved one, a difficult or emergency delivery, premature delivery, illness or child abnormailty). You are in your teens or over 40 years of age. The pregnancy in question is unwanted or unplanned. You are currently substance abusing.

There is no single test to diagnose postpartum 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. This condition is easily treated with supplemental hormone. Another clue to this condition can be weight gain or failure to lose weight after pregnancy, despite breastfeeding the baby.

Because postpartum depression is so common, questionnaire screening tests are available. Women with any of the risk factors, or with symptoms of depression, should consider taking such a test to determine if they need treatment.

Medication for postnatal depression and psychotherapy are effective in reducing or eliminating symptoms of depression in new mothers.

If left untreated, postpartum depression can last for months or years. The potential long-term complications are the same as in major depression.

The treatment for depression after birth often includes medication, psychotherapy, or a combination of both. Fortunately, several antidepressant medications may be given to breastfeeding mothers.

Once postnatal depression is diagnosed, the mother will need to be followed closely for at least six months.

Appleby L, Warner R, Whitton A. A controlled study of fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression [see comments]. BMJ 1997; 314(7085): 932-6. Davidson J, Robertson E. A follow-up study of post partum illness, 1946-1978. Acta Psychiatr Scand 1985; 71(5): 451-7. eMEDICINE. Medline Plus.


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