Public awareness of postpartum depression is on the rise thanks to Very Special Episodes of sit-coms and Tom Cruise's public chastising of Brooke Shields for taking anti-depressants after her daughter was born. The "baby blues" — feelings of fatigue, worry and depression in the first days after giving birth — are common and usually disappear within a week or two. Postpartum depression is a more serious condition that can strike later and does not subside on its own. Medical opinions on postpartum depression run the gamut. Some think the condition is under-diagnosed and under-medicated. Others feel it's over-diagnosed and should be medicated only with extreme caution. Opinions differ on which types of anti-depressants should be used to treat postpartum depression, and on whether medication should ever be given to women who are breastfeeding. But it's generally safe to say most cases of baby blues don't warrant medical treatment.
BABY BLUES ARE NORMAL: Dr. Cohen, excerpt from The New Basics "Postpartum Letdown"
Having a baby is draining, both emotionally and physically, and before you adjust fully to your new life, you might experience a letdown moment (sometimes known as postpartum depression), typically after a week or two. If you feel spent, tired, and weepy, you would also feel guilty that you don't feel happy and fulfilled. You are all of those things, but you are also very tired. My advice is to sleep when Lucy sleeps, lay off work for a while, take time to chill out, and only think from one day to the next. Accept that Lucy is having her own letdown as well; she was much cozier inside you, and she needs a couple of weeks to adapt to her new environment. Be like her: Cry if you need to. There is a light at the end of the tunnel, and you'll reach that light of joy and contentment very soon. Having said that, mothers who tend toward depression will experience a rougher bout of postpartum letdown. If this describes you, talk to doctor about taking or resuming medications.
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Antidepressants have not been formally endorsed as safe for breastfeeding mothers, but I have seen many women who took small doses of Prozac or other anti-depressants for postpartum depression while nursing, and their babies suffered no consequences. The problem is not simple. Often, the thought of discontinuing nursing is just too much, and it induces a sense of failure and worsens the depression. On the other hand, mothers who already have a tendency to depression will turn even bluer with postpartum let-down and really need some help to get over the hump. When in doubt discuss the matter with your doctor.
ANTIDEPRESSANTS ARE SAFE: Dr. Sears "Postpartum Depression"The "baby blues" have always been viewed as a normal part of the postpartum period. Usually starting between the third and fifth day after delivery, feelings of mild depression, crying spells, anxiety, irritability, and mood swings occur in as many as 85 percent of women. Because this expected phase of mothering is so common, and usually resolves after a few days without any intervention, health care professionals often ignored these symptoms, and left the new mothers and families to deal with it on their own.
In the past few years, mothers and doctors have become more aware of the high incidence of postpartum blues. They are realizing that often the "blues" are much more than a temporary normal phase that "every mother goes through." Some mothers will continue into a more severe depression that, if ignored and untreated, can have severe consequences for the new mother and baby.
Postpartum Depression occurs in ten to fifteen percent of deliveries. It is much more than the standard "baby blues" discussed above. Most cases begin within the first few weeks after delivery, but onset can be delayed for several months. Symptoms include:
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How can you distinguish the difference between routine baby blues and postpartum depression? To diagnose postpartum depression, the following criteria must be met:
Symptoms persist for more than 2 weeks Depressed mood or lack of interest in pleasurable activities must occur much of the day, almost every day At least four of the remaining symptoms must be present[...]
It is unclear exactly what causes postpartum depression, but research has shown that genetic risk, situational stresses, changes in a variety of hormones, and changes in certain chemicals in the brain may all play a roll in triggering this disorder.
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Most uncomplicated cases can be managed by an OB/GYN with antidepressant medications. The two most common types are tricyclic antidepressants (TCA's) and serotonin reuptake inhibitors (SRI's). Counseling and support groups are an important part of treatment, as are regular exercise, good nutrition, and a supportive family.
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Physicians sometimes recommend weaning while taking antidepressants or other psychiatric medications because it seems to them the safest and simplest alternative. Antidepressant medications have been researched and found to be safe during breastfeeding. You may have to be the one who seeks out additional information or who presses your physician to learn more about medications and breastfeeding. Impress upon the prescribing physician that you wish to continue breastfeeding and that this is an important part of how you care for and mother your baby. Abrupt weaning in itself can cause depression, so the effects of weaning on your feelings should not be taken lightly.
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St. John's Wort is also used for depression, however, there is conflicting research regarding its safety during breastfeeding. Some experts feel it is safe, while others do not. Until we know for sure, it is safer not to use it unless your doctor advises you to.
POSTPARTUM PSYCHOSIS
It is this extreme form of postpartum depression that has made the medical community and the general public more aware of postpartum mood disorders. Symptoms include (in addition to those above) delusions, hallucinations of the infant suffering from illness or even dying, severely impaired day-to-day functioning, and suicidal or homicidal thoughts. This severe disorder affects one or two per thousand deliveries. This is about 12 times the occurrence of psychosis in non-pregnant women. It usually begins during the first month, but can be delayed for 3 months. It is extremely important for the family and the doctor to recognize these symptoms so that immediate treatment and safeguards can be initiated.
TRY TALK THERAPY: U.S. Department of Health and Human Services, Office on Women's Health "Depression During and After Pregnancy"The baby blues can happen in the days right after childbirth and normally go away within a few days to a week . . . Postpartum depression can happen anytime within the first year after childbirth . . . The difference between postpartum depression and the baby blues is that postpartum depression often affects a woman's well-being and keeps her from functioning well for a longer period of time. Postpartum depression needs to be treated by a doctor. Counseling, support groups, and medicines are things that can help.
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During pregnancy, the amount of two female hormones, estrogen and progesterone, in a woman's body increases greatly. In the first 24 hours after childbirth, the amount of these hormones rapidly drops back down to their normal non-pregnant levels. Researchers think the fast change in hormone levels may lead to depression, just as smaller changes in hormones can affect a woman's moods before she gets her menstrual period.
Occasionally, levels of thyroid hormones may also drop after giving birth. The thyroid is a small gland in the neck that helps to regulate your metabolism (how your body uses and stores energy from food). [...] A simple blood test can tell if this condition is causing a woman's depression. If so, thyroid medicine can be prescribed by a doctor.
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Postpartum psychosis is rare. It occurs in 1 or 2 out of every 1000 births and usually begins in the first 6 weeks postpartum.
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Some women don't tell anyone about their symptoms because they feel embarrassed, ashamed, or guilty about feeling depressed when they are supposed to be happy. They worry that they will be viewed as unfit parents. Perinatal depression can happen to any woman. It does not mean you are a bad or "not together" mom. You and your baby don't have to suffer. There is help.
There are different types of individual and group "talk therapies" that can help a woman with perinatal depression feel better and do better as a mom and as a person. Limited research suggests that many women with perinatal depression improve when treated with antidepressant medicine. Your doctor can help you learn more about these options and decide which approach is best for you and your baby.
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The risks of taking medicine have to be weighed against the risks of depression. It is a decision that women need to discuss carefully with their doctors. Women who decide to take antidepressant medicines should talk to their doctors about which antidepressant medicines are safer to take while pregnant or breastfeeding.
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Researchers believe that postpartum depression can affect the infant by causing delays in language development, problems with emotional bonding to others, behavioral problems, lower activity levels, sleep problems, and distress. It helps if the father or another caregiver can assist in meeting the needs of the baby and other children in the family while mom is depressed.
DON'T STOP BREAST-FEEDING: Healthwise — Yahoo Health "Postpartum Depression"Antidepressants are commonly used to treat postpartum depression (PPD), usually in combination with counseling and support . . . Breastfeeding offers numerous emotional and physical benefits for both baby and mother. For this reason, experts have carefully studied and identified which antidepressants are safest for breastfeeding babies. So, you need not stop breastfeeding while taking an antidepressant for postpartum depression.
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Selective serotonin reuptake inhibitors (SSRIs) are the first-choice medication for treating postpartum depression. They usually take 4 to 8 weeks to improve depression, though some women improve sooner. SSRIs are considered relatively safe for use while breastfeeding because in general they pass into the breast milk at low levels (with the exception of fluoxetine [Prozac, Sarafem], which has been found in higher amounts in breast milk).
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Antidepressants are typically used for at least 6 months, first to treat postpartum depression and then to prevent a relapse of symptoms. To prevent a relapse, your health professional may recommend that you take medication for up to a year before considering discontinuing it.
PPD IS UNDER-DIAGNOSED: McMan's Depression and Bipolar Web "Postpartum Depression"Postpartum depression [...] can ambush hopeful new mothers at the time when they least expect it and turn their dreams of parenthood into the worst of nightmares. The term postpartum merely refers to the triggering event. This is major depression, pure and simple, but with this cruel twist: A combination of ignorance and misplaced expectations, both on the part of the new mother and those who should know better — conspire to cause far more suffering than necessary.
" Bookstores file postpartum depression under psychology," Pamela Gerhardt notes in her article. "And how many women, giddy with the thought of becoming a mother, are perusing the mental illness section of Barnes & Noble?"
One guidebook offers this advice: "Treat yourself to a dinner out ... put on makeup." Another recommends a little mascara.
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Some form of mild depression strikes most new mothers. Up to 40 percent of new mothers actually experience indifference toward their babies within a day or so of delivery, though the duration is thankfully short, about three days.
Then there are the "baby blues," affecting some 50 to 70 percent of new moms, with onset occurring within three days to a month after delivery, and a duration of less than ten days.
at the other extreme is postpartum psychosis, affecting one in 500 births, accompanied by hallucinations, delusional thoughts, and agitated behavior. The mother cannot care for her baby, and there is serious risk of both suicide and infanticide. Women with bipolar disorder are at particular risk (with odds of one in five).
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Treat postpartum depression as a potential part of the birthing and parenting process, and learn as much as you can.
Have your doctor screen you for depression, whether you feel you need it or not.
Don't overburden yourself. You don't have to keep up appearances.
Get help from friends and family. Make friends with other parents.
If you suffer from bipolar, prepare yourself for the possibility of postpartum psychosis, and have your support systems well in place.
Postpartum depression responds to antidepressants, talking therapy, and group support. Do not be afraid to get help.
If you are breastfeeding: Small amounts of SSRI antidepressants find their way into baby's milk, but not enough to be considered unsafe.