Postpartum depression

Definition
Postpartum depression is depression that develops after the birth of a baby. Technically, postpartum depression can be divided into three reactions: postpartum blues, depression and psychosis.
Postpartum blues, commonly referred to as the "baby blues," is the mildest form of depression. Up to 75 percent of new mothers experience the baby blues a few days after delivery. The condition may last from a few days to two to three weeks.

Postpartum depression is more severe depression experienced by 10 to 15 percent of new mothers. It occurs when the baby blues intensify rather than decrease as normally expected. Postpartum depression occurs within three to six months after childbirth and lasts at least two weeks, but often longer.

Postpartum psychosis is the most severe form of depression that occurs after childbirth. It affects one to two of every 1,000 new mothers. Postpartum psychosis usually appears within the first two to four weeks after delivery. Again, duration varies.

Causes/associated factors
The exact cause of depression during the postpartum period is unknown. A combination of factors may be responsible, including:
hormonal changes (After delivery, the level of estrogen and progesterone in your body drops. There is a similar drop when each menstrual cycle begins, and there is some evidence that women who have premenstrual syndrome may be more likely to experience some type of postpartum depression.)
exhaustion after labor and delivery
the adjustment to motherhood or the added responsibilities
lack of sleep
Other factors that may contribute to postpartum depression and psychosis may include:

isolation
perceived lack of support from others, especially the father
marital or family problems
unplanned or complicated pregnancy
personal or family history of psychiatric conditions
previous delivery followed by postpartum depression or psychosis

Signs/symptoms
The baby blues are often characterized by:
crying
irritability
restlessness
rapid mood swings (sadness or elation)
forgetfulness
difficulty concentrating
feelings of loss and being overwhelmed
fatigue
headaches
nightmares
In addition to symptoms of the baby blues, postpartum depression may be characterized by:

anxiety
insomnia
feelings of sadness, helplessness and hopelessness
fear of hurting the baby
worry about your ability to care for the baby
fear of hurting yourself or thoughts of suicide
appetite loss and/or weight loss
Going a level deeper, symptoms of postpartum psychosis may include:

hallucinations or delusions
loss of contact with reality
suicidal or homicidal thoughts
paranoia
If you have the symptoms of postpartum depression or psychosis, it's important to seek medical help. Often, the symptoms themselves make it tough to seek treatment. Some mothers downplay their feelings out of embarrassment or guilt.


Diagnosis
Diagnosis is based on your symptoms. Thyroid function tests may be done to rule out a thyroid condition, which can cause similar symptoms. (The thyroid is the gland that helps, in part, regulate the body's metabolism.)

Treatment
The baby blues typically clear up on their own. Physical comfort and support can do wonders. To help get over the blues, try the following suggestions.
Sleep when the baby sleeps, or have family or friends care for the baby so you can get some rest.
Accept offers of household help from family or friends.
Eat healthfully, avoiding sugar and caffeine when possible.
Get regular exercise, such as daily walks.
Talk to another mother who has experienced the blues.
Remember that the baby blues is only temporary.
When depression is more severe, treatment may include antidepressant medications, psychotherapy and joining a support group for others who've had or are experiencing postpartum depression. Your health care provider may recommend estrogen suplements if you're not breastfeeding. You may need family therapy if family problems are contributing to your depression. With severe depression or in cases of postpartum psychosis, hospitalization may be necessary.

If you're breastfeeding and choose to take an antidepressant medication, consult your baby's doctor. The drug will pass into your breast milk, and some medications are considered safer for the infant than others. Your doctor and the baby's doctor will consider the drug's compatibility with breastfeeding regarding the baby's age and medical history, your health needs and the possible alternatives. It may help to remember that breastfeeding itself may help lift your spirits.


Complications
Studies have noted that infants may be negatively affected when their mothers are depressed. With the more severe forms of postpartum depression, an affected mother may not be able to care for her infant. In rare cases, she might even harm herself or the baby.

Prevention
Support from your partner, family, friends and health care provider during pregnancy, delivery and the postpartum period can help prevent severe depression after delivery. In some cases, preventive psychotherapy or medication may be recommended.