Depression After the Birth of a Child or Pregnancy Loss

Depression After the Birth of a Child or Pregnancy Loss
What is postpartum depression?
Postpartum depression is a complex mix of physical, emotional, and behavioral changes that occur after giving birth that are attributed to the chemical, social, and psychological changes associated with having a baby.

Who is affected by postpartum depression?
Postpartum depression is common. As many as 50 to 75 percent of new mothers experience the "baby blues" after delivery. About 10 percent of these women will develop a more severe and longer-lasting depression, called postpartum depression, after delivery. One in 1,000 women develop the more serious condition called postpartum psychosis.

What factors increase my risk of being depressed after the birth of my child?

Having a personal or family history of depression or premenstrual dysphoric disorder (PMDD)
Age at time of pregnancy -- the younger you are, the higher the risk
Living alone
Limited social support
Children -- the more you have, the more likely you are to be depressed in a subsequent pregnancy
Marital conflict
Ambivalence about the pregnancy
A history of depression during pregnancy -- 50% of depressed pregnant women will have postpartum depression
Types of postpartum depression

Postpartum blues -- Better known as the "baby blues," this condition affects between 50 and 75 percent of women after delivery. If you are experiencing the baby blues, you will have frequent, prolonged bouts of crying for no apparent reason, sadness, and anxiety. The condition usually begins in the first week (one to four days) after delivery. Although the experience is unpleasant, the condition usually subsides within two weeks without treatment. All you'll need is reassurance and help with the baby and household chores.

Postpartum depression -- This is a far more serious condition than postpartum blues, affecting about 1 in 10 new mothers. If you've had postpartum depression before, your risk increases to 30 percent. You may experience alternating "highs" and "lows," frequent crying, irritability, and fatigue, as well as feelings of guilt, anxiety, and inability to care for your baby or yourself. Symptoms range from mild to severe and may appear within days of the delivery or gradually, even up to a year later. Although symptoms can last from several weeks up to a year, treatment with psychotherapy or antidepressants is very effective.

Postpartum psychosis -- This is an extremely severe form of postpartum depression and requires emergency medical attention. This condition is relatively rare, affecting only 1 in 1,000 women after delivery. The symptoms generally occur quickly after delivery and are severe, lasting for a few weeks to several months. Symptoms include severe agitation, confusion, feelings of hopelessness and shame, insomnia, paranoia, delusions or hallucinations, hyperactivity, rapid speech, or mania. Postpartum psychosis requires immediate medical attention since there is an increased risk of suicide and risk of harm to the baby. Treatment will usually include admission to hospital for the mother and medicine.

What causes postpartum depression?
More research is needed to determine the link between the rapid drop in hormones after delivery and depression. The levels of estrogen and progesterone, the female reproductive hormones, increase tenfold during pregnancy but drop sharply after delivery. By three days postpartum, levels of these hormones drop back to pre-pregnant levels. In addition to these chemical changes, the social and psychological changes associated with having a baby create an increased risk of postpartum depression.

Can postpartum depression be prevented?
Here are some tips that can help prevent, or help you cope with postpartum depression:

Be realistic about your expectations for yourself and your baby
Limit visitors when you first go home
Ask for help -- let others know how they can help you
Sleep or rest when your baby sleeps!
Exercise; take a walk and get out of the house for a break
Screen your phone calls
Follow a sensible diet; avoid alcohol and caffeine
Keep in touch with your family and friends -- do not isolate yourself
Foster your relationship with your partner -- make time for each other
Expect some good days and some bad days
Treating postpartum depression
Postpartum depression is treated differently depending on the type and severity of the woman’s symptoms. Treatment options include anti-anxiety or antidepressant medicines, psychotherapy, and support group participation.

In the case of postpartum psychosis, medicines used to treat psychosis are usually added. Hospital admission is also usually necessary.

If you are breastfeeding, don’t assume that you can't take medicines for depression, anxiety, or even psychosis. There have been no reports of breastfed babies whose mothers are taking antidepressants suffering any ill effects, but as yet no long-term follow-up data is available.

What is the outlook?
With professional help, almost all women who experience postpartum depression are able to overcome their symptoms.

When should a new mom should seek professional medical treatment?
A new mom should seek professional help when:

Symptoms persist beyond two weeks
She is unable to function normally; she can’t cope with everyday situations
She has thoughts of harming herself or her baby
She is feeling extremely anxious, scared, and panicked most of the day
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional written health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771 or visit www.clevelandclinic.org/health/. This document was last reviewed on: 4/12/2005




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