Postpartum depression, anxiety, and psychosis are mood disorders that affect approximately 10-20% of new moms.
Most moms can expect to experience some 'baby blues' symptoms in the first week or two postpartum - crying over anything (and nothing), some anxiety, and unpredictable mood swings. However those symptoms are usually self-limiting and do not cause harm to either mother or baby.
Most people in healthcare know the classic symptoms of depression: intense sadness, increased crying, fatigue, lack of interest in things once enjoyed, changes in eating and sleeping habits, mood swings, and increased irritability, and feelings of inadequacy. However, in the postpartum period, it becomes tricky to differentiate whether these symptoms are a result of new motherhood or of depression. Is the new mom fatigued because she's up four times a night with a baby, or is it because her body's chemical balance is off? Is she feeling inadequate because she's got a hard-to-soothe colicky baby, or is there something more to it?
It is so easy for new mothers to be so focused on caring for their new baby that they forget to take care of themselves, and may not even realize that they're experiencing symptoms of postpartum depression (PPD). For this reason, I'm always glad to have a support person present in the room when I'm doing this part of the hospital discharge teaching. And I let that person know that it's ok to call her on her symptoms, for she may not see them in herself.
PPD can have a rather insidious onset; symptoms may come on so gradually that the woman doesn't even realize she has a problem. Also problematic is the fact that postpartum depression can occur at any time during the first year postpartum. Most people, in my experience, do not realize this and think once the first month or two is past, they are out of danger. Not so, though symptoms do tend to show up in this time frame. However, a woman may be free from depression symptoms for weeks, maybe even months, and then become depressed.
Unlike the 'baby blues', which are not generally harmful, PPD can have real consequences. Women suffering from PPD can have difficulty on the job, difficulty bonding with their babies, and familial difficulties. Worst case scenario is the woman harming herself or someone else as a consequence. As such, it is so important for a) treatment to be available to these moms; b) these moms to know that it's there; and c) the stigma be removed from seeking said treatments. Unfortunately for so many, there is still a mindset that those who seek treatment for mental health issues are 'crazy' and need to 'just pull it together and go on.' (No one would say these things to someone with diabetes or cancer, and why someone would say it to someone whose illness lies in a chemical imbalance is beyond my understanding.) No one wants that label, understandably, and some would rather suffer than seek treatment. In my patient education, I make sure the patient (and her support system) hear that PPD is a real disease with real consequences and that there is absolutely nothing wrong with seeking help.
Postpartum psychosis is the severest of postpartum mood disorders, and fortunately the most rare (incidence being less than less than 0.5% of diagnosed postpartum mental health disorders). This disorder is what generally makes for sensational news headlines, such as the tragic story of Andrea Yates in Texas. Women with postpartum psychosis often suffer from paranoia (someone or something is out to harm them or their baby), hallucinations (voices tell them they are worthless and should die), and/or delusions (their baby is demon-possessed and therefore must die). I always tell my patients (and their support) that if these symptoms ever show up, it is to be considered an emergency. They should not wait, they should immediately get help. Call 911, get to the hospital, leave the baby somewhere safe, and get help. There is no way I can stress that enough.
So what do we do for these women? I think the answer lies in early screening, even pre-conception. A woman that has already been depressed or has a family history of depression is going to have a higher-than-usual risk for PPD. She should be followed closely. Women who have poor support systems in place are at high-risk as well. Postnatal factors include a preterm or ill infant, fetal loss, breastfeeding issues, and a host of other issues. There is no one single cause, but the aforementioned situations should put up a red flag for anyone dealing with this patient to be alert for symptoms. I'm seeing more and more women come to the hospital for birth with at least one depression screening during their prenatal visit, which makes me glad. The Edinburgh Postnatal Depression Scale is the most often used, though there are many others that exist.
It's also vitally important for nurses (not by any means excluding other fields) to make patients aware of what their treatment options are. There are antidepressants available that are generally considered safe for use in breastfeeding, as well as nonpharmacological treatment methods - support groups, one-on-one counseling, hypnosis, acupuncture, all of which may be beneficial to a mom suffering with PPD. The key for these women is treatment. Some do well with purely nonpharmacological methods, and others require medications, or a combination of both; it depends upon each woman what best keeps her healthy.
There is not nearly enough awareness of postpartum mood disorders, it seems. It's just too easy to write off a new mom's depression symptoms as 'new motherhood.' While I'm not one to slap a disorder label on everything out there, if we ignore PPD symptoms, we are doing so at our own peril and that of our children.
(I can't in good conscience write an article on PPD without ending it this way: if you or someone you know is suffering, please do not wait to get help. There are resources out there. Please keep searching until you find what you need, and do not give up. Your health and your baby's health depend on it.)
General information about postpartum mood disorders
Help/Resources/Support Groups
