Postpartum Depression

I recently saw a 22 year old patient with complaints of fatigue, muscle aches, and feeling down for several weeks. She recently had her second child with no obstetrical complications. She feels depressed and is also worried about not bonding with her baby. Her medical history is unremarkable with no history of psychiatric disorders. She has a very supportive family. The patient was diagnosed with postpartum depression and was started on treatment with success.

Postpartum depression is a common type of depression affecting about 15% of women after the birth of their child. PPD usually begins several weeks after delivery but can occur anytime in the first year. PPD can last for several weeks to months.

There is a milder form of depression called the baby blues that begins a couple days after delivery and lasts for about 2 weeks. About 50% of women experience this condition. The signs and symptoms include trouble sleeping, irritability, heightened emotions, but it does not interfere with the mother's ability to care for her child. PPD does affect the woman's ability to function.

Risk factors include history of depression, psychosocial stress, lack of family support, young age, substance abuse, and problems with a previous pregnancy.

It is not clear what causes PPD but hormonal or chemical changes may play a factor.

Signs and symptoms of PPD (lasting more than two weeks) include:
1. Agitation
2. Feeling sad, hopeless, and overwhelmed
3. Crying a lot
4. Fatigue
5. Loss of appetite
6. Insomnia
7. Trouble focusing, remembering, or making decisions
8. Feeling worthless
9. Loss of interest or pleasure in activities
10. Headaches
11. Chest pain
12. Body aches
13. Lack of motivation
14. Withdrawal from friends and family
15. Decreased sex drive
16. Negative thoughts about the baby

Treatment includes
1. Family support
2. Asking for help
3. Rest and taking naps
4. Exercise, take walks
5. Talk to other mothers
6. Breast feeding
7. Eating healthy and continuing a prenatal vitamin (add fish oil to your diet)
8. Counselling with a professional
9. Medications such as antidepressants

Postpartum psychosis is a rare, severe form of postpartum depression that requires immediate medical attention. Mothers may experience hallucinations, display bizarre behavior, thoughts of hurting or killing herself or the infant. Postpartum psychosis requires psychiatric hospitalization and treatment.

Bringing a newborn into the world is a beautiful but life changing experience. If you have any concerns of the "baby blues" or postpartum depression, contact your physician immediately. Early intervention will improve the quality of the baby's life and your life.

Here is a postpartum checklist adapted from the New England Journal of Medicine
Click here

Talk to your healthcare professional for more information. Thank you.