Postpartum Depression

Postpartum Depression is a major depression occurring during or more likely within four weeks after a pregnancy. The incidence is approximately 10% of pregnancies. Postpartum depression may last up to a year (20%).

This is not to be confused with “the baby blues” which peak at 2 to 5 days after delivery consisting of weeping, sadness, mood changes, irritability and anxiety. They do not interfere with care of the newborn and resolve spontaneously by two weeks.

Regarding the diagnosis of major depression at least five of the following symptoms occurring for more than two weeks make the diagnosis: sadness, hopelessness, loss of self-esteem, guilt, insomnia, over or under eating, inability it concentrate, loss of pleasure from hobbies, avoidance of social intercourse, low energy, anxiety, fearing the coming day and suicidal ideation.

A stand-alone diagnosis not related to postpartum depression is postpartum psychosis. Like other types of schizophrenia this diagnosis includes hallucination, delusions, bizarre behavior and disorganized speech. Although this psychosis is considered a variant of bipolar disorder most feel it is a severe manic state that has led to psychosis also called schizoaffective disorder. The incidence is 1 to 2 cases per 1000 births. It requires hospitalization because of the chance of suicide and infanticide.

It is felt that the greatest risk factor for post-partum depression is having a major depression during a pregnancy. There is a seven-fold higher chance of postpartum depression if antenatal depression is not treated. This is me, the author of this piece, interjecting here. In the three articles I read to research for this review none state whether prenatal depression means that the women have had a history of major depression in the past i.e. unrelated to any pregnancies. I interpret the statistic on antenatal depression means a history of prior diagnosis of major depression that then occurs during a pregnancy. The articles are confusing as they use the terms perinatal, postnatal, and postpartum interchangeably and perinatal means prior to pregnancy.

This is an important distinction because major depression during pregnancy whether first episode or subsequent episodes can only be treated safely with SSRI medications such as Zoloft and Celexa.

Children of parents with postpartum depression have higher rates of emotional problems, behavioral problems, defiance disorder and hyperactivity.

The other risk factors are social, lack of a support person or group, marital difficulties, current or history of violence or abuse, major life events, decreased income, unintended or unwanted pregnancy.

The major cause of this form of depression is felt to be hormonal. Sudden drop in estrogen and progesterone after pregnancy being the most likely. Low thyroid, testosterone and cortisol are also felt to play a role. A thyroid level and a thyroid stimulating hormone should be measured to rule out Hashimoto’s thyroiditis which is correlated with depression.