Postpartum Depression

Introduction

What is Postpartum Depression

Having a baby should be one of the happiest and most important events in a woman's life. However, although life with a new baby can be both thrilling and rewarding, it can also be a difficult and quite stressful task. Most women make the transition without great difficulty, yet some women experience considerable complexity that may manifest itself as a postpartum psychiatric disorder (O'hara, Hoffman, Philips, & Wright, 1992). Many physical and emotional changes can occur to a woman during the time of her pregnancy as well as following the birth of her child. These particular changes can leave a new mother feeling sad, anxious, afraid and confused. For many women, these feelings; which are known as baby blues, go away fairly quickly. But when they do not go away or rather they get worse, a woman may be experiencing the effects of postpartum depression (PPD). This is a serious condition that describes a range of physical and emotional changes and that requires prompt treatment from a health care provider. According to Mauthner, (1999) postpartum depression occurs when women are unable to experience, express and validate their feelings and needs within supportive, accepting and non-judgmental interpersonal relationships and cultural contexts.

Postpartum psychiatric illness was initially characterized as a group of disorders specifically linked to pregnancy and childbirth and thus was considered diagnostically distinct from other types of psychiatric illness. It has long been thought that the postpartum period is a time of increased risk for the onset of psychiatric disorders and adjustment difficulties in women (Campbell & Cohn, 1991). The link between reproductive status and depressive illness is further evidenced by the high frequency of depression during the premenstrual phase, and the immediate postpartum period (Yonkers, 1995). As one of the major physical, psychological, and social stresses of a woman's life, childbirth is gaining an increasing amount of recognition as a major risk factor in the growth of mental sickness. Postpartum depression is defined as a mild to moderate mood disturbance occurring between birth and six months post birth, rather than the less frequent, more severe postpartum psychosis, or the more prevalent but transient blues (Crokenberg & Leerkes, 2003). It is clear that the postpartum period is unique in the development of mental illness. As stated by O'hara & Zekoski (1988), approximately 10% to 30% of mothers report clinical levels of depression during the postpartum period.

The "Baby Blues"

Although the current literature divides the spectrum of postpartum mood disorders into three distinct categories, these classifications frequently blend at the margins. At the mildest end of the spectrum is the "maternity blues" or "baby blues." Because this condition arises after 40% to 85% of deliveries, practitioners and patients often view it as a "normal" phenomenon. Nonetheless, patients and their families are distressed by the patients' depressed mood, irritability, anxiety, confusion, crying spells, and disturbances in sleep and appetite. These symptoms peak between postpartum days 3 and 5, and typically resolve spontaneously within 24 to 72 hours. According to Marcotty (2003), The baby blues is common and is considered a normal part of childbirth. However its duration is short, typically starting within the first five days of childbirth, and disappearing within a few weeks, mothers with the blues become emotionally sensitive, weepy and irritable. This stage in postpartum is particularly common among many woman and typically is nothing to be concerned a great deal about

PPD: The Ultimate Paradox

At the core of the spectrum lies postpartum depression, which is increasingly recognized as a unique and serious complication of childbirth. The majority of patients suffer from this illness for more than 6 months and, if untreated, 25% of patients are still depressed a year later (Lee, 1997). Although effective medical treatments are available, both patients and their caregivers frequently overlook postpartum depression. Untreated postpartum affective illness places both the mother and infant at risk and is associated with significant long-term effects on child development and behavior; therefore, prompt recognition and treatment of postpartum depression are essential for both the maternal and infant's well being.

Postpartum Psychosis

Conclusively, at the other end of the spectrum is the truly devastating postpartum psychosis. This is known as a relatively rare disease that occurs in approximately 1-2 per 1,000 women after childbirth (Campbell et al, 1991). The condition resembles a rapidly evolving manic episode with symptoms such as restlessness and insomnia, irritability, rapidly shifting depressed or elated mood, and disorganized behavior. The mother may have delusional beliefs that relate to the infant, or she may have hallucinations that instruct her to harm herself or her child. Nonetheless, risks for infanticide and suicide are high among women with this disorder.

As these patients often suffer from delusions and suicidal tendencies, the consequences of this disease to both mother and child are significant. Furthermore, depressed mothers have an increased risk of relapsing and/or continued psychiatric illness. Depressed mothers often show a more negative attitude toward their children, and an injured new mother puts significant emotional and perhaps economic burdens on family relationships. The patients themselves are often the most sensitive to these consequences. This particular stage is obviously the most severe and possibly at times initially undetected.

Detection & Symptoms

Postpartum depression frequently goes unrecognized, in part, because mothers often hide their symptoms from even the most supportive husbands and family members. People around the female can be unfamiliar with the disease and its danger signs and attribute changes in the mother to the physical and emotional effects of having a new infant as stated by Marcotty (2003). Identification of patients suffering from postpartum depression should be a priority for all physicians who treat women. The diagnostic criteria for a major depressive disorder are no different in the postpartum period, with the exception that symptoms must be present for more than 2 weeks postpartum to distinguish them from the "baby blues." Weight and appetite changes in recently delivered women are expected, and sleep deprivation is universal in early motherhood. Therefore, the