Postpartum Mood Disorders

The postpartum period - just after giving birth - is, for most a time of happiness and adjustment to new family roles. However, for some women it is a time of overwhelming sadness, anxiety, and inability to cope with the stressors at hand. Nurses Announcements Archive Article

Postpartum Mood Disorders

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

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Elvish

About Elvish, BSN, DNP, RN, NP

Wife, nurse, mom, bookworm, FNP, Elvis fanatic, Brokeaholic, and LOTR junkie.

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Is it really only 10% who have this problem?

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Specializes in Community, OB, Nursery.

You bring up an excellent point, Vito.

10-20% is the official figure, though I wouldn't be surprised to find that it's more widespread because a lot of people don't seek treatment. That's talking postpartum depression/anxiety/psychosis. The 'baby blues', so I read, affect about 70-80% of postpartum moms.

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Great article. Thanks!

Enid

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Specializes in allergy and asthma, urgent care.

Thank you for posting this. I went through PPD with both my children, and I know from experience that many providers do not have the awareness they need of this condition. Thanks for helping to change this. :redbeathe

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I had never heard of post-partum Psychosis- I had only heard of the Depression- so since I was SCARED after having my baby, not SAD- I figured I was just going crazy, felt like a terrrible mother, and didn't want to tell ANYONE for fear they would take my daughter away. I had my first baby girl in 2006- she was perfect and I LOVED her so much. Then at about 3 weeks post-partum, I noticed I was becomming increasingly scared and anxious. I didn't lose touch with reality, thankfully, but I did FEAR that my daughter might HURT me (maybe be evil) {meanwhile knowing that was impossible and I was just being stupid} I became afraid to bathe her, for fear I would drown her (something I knew I was incapable of doing but became an unavoidable fear) It got so bad I couldn't even enter the bathroom with her because I was so overwhelmed with fear. I also couldn't handle it when she cried because it made me so scared.

I finally heard about post-partum Psychosis about 2 years after I gave birth to my daughter. By that time, my hormones had evened out with the pregnancy of my son. Although I was so nervous that I would experience the same with my son, the pregnancy actually cured my anxiety and I've never felt with him what I did with my daughter. My case was never documented by a healthcare professional- so just know that statistics can be deceiving.

I am better now and my children are very safe. I did reach out to my family during the hard time and tried to explain in the best way I knew how without making myself sound insane.

Thanks for letting tell my personal experience with PPD-Psychosis.

-A future L&D nurse that will ALWAYS help patients understand about PPD AND Psychosis!

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Specializes in Geriatrics/ALZ, MDS/CPC.

Great article...glad someone understands. Unfortunately I suffered from postpartum psychosis after the birth of my first child. I am a nurse so when the s/sx of depression crept in I kept it to myself. When the paranoia, hallucinations and delusions started I had finally admitted to the depression and was on medication, but I was not honest with my Dr. I was hearing and seeing a large smoky-grey, winged demon that told my I was unfit and that my baby and husband would be better off without me. It told me the only way it would go away and leave my family alone was if I hung myself. So I did. Obviously I failed. If I had not been ashamed and had been honest with my Dr, I probably would not have experienced this.

I got lucky that day. My son was 7 months old when this happened, so I'm really glad that you mentioned that you tell families up to a year after birth. I was admitted to the Psychiatric Ward and to my horror, the psychiatrist on call was someone that I had worked with for years. That probably saved me. I was very honest with her. I broke down and told her everything...right back to the abuse I had experienced at the hands of my step-father from the age of 12 to 18. He inflicted physical, emotional and sexual abuse on me for 6 years. I told my mom when I was 15 and she said I was lying and told him so the abuse got worse. I was suicidal for most of my teenage years. I had blocked most of that out, but after my son was born I started to remember small details. The psychiatrist and the staff on the psych ward helped me so much. With them I did not have to be ashamed.

When I became pregnant w/ my daughter, my Dr and I worked together to keep the depression at bay and even though I was on several meds, starting as soon as she was born, it worked.

Hope my story will help someone else who may be hesitant to be honest about what they are feeling.

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Specializes in Community, OB, Nursery.

Wow everyone....thanks for your comments and stories. :redbeathe

I am a PPD survivor myself, and mine started pretty much the day I went back to work. I just could not shake the guilt of leaving him in daycare, and cried every single day for 7 months (at which point I took a different job to be w/ him more).

All I wanted to do was stay in bed. I did not cook, I did not clean, I did not take care of myself. It took every ounce of emotional energy I had to get my son to daycare and myself to work and back. I wanted the world to just go away.

At one point I had a plan for suicide; I knew which bridge I would drive off of, and when. The only thing that stopped me on several occasions was that my son was in the car with me...and for whatever reason I realized that if the plan didn't work, if he died and I lived, and then I'd have to live with having killed my child.

Everyone around me wanted me to feel better. Heck, I wanted with all my heart to feel better - but no matter how hard I tried, it just never happened. There is no 'snapping out of it.' Finally, my son's pediatrician pulled me aside (we worked together) and called me on it: "You are depressed. You need help, and you need it NOW." When she said those words, it was scratching an itch I didn't know I had.

Nearly four years later, I still take Zoloft, and don't know that I'll ever willingly go off it. Depression is still a struggle, but I realize that I am nowhere near where I was then. In my d/c teaching, I make sure my patients know that I've been there and survived and there is hope.

PPD survivors are strong women!

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Specializes in Home Care, Primary care NP, QI, Nsg Adm.

Nice review, I will share this with my staff tomorrow.

We have had several cases over the years and periodically with psychosis. We recently received a woman who killed her 18 month old then called the police telling them that something was wrong with her baby. She had auditory hallucinations of command nature telling her to kill her baby. You note that PPD can occur up to a year later and I suspect symptoms begin much earlier than that but ignored. In your experience, does the one year also include psychosis? This patient was transferred to a forensic unit so we were not able to complete a full assessment but I suspect she is schizophrenic. Have you seen any similar cases?

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Specializes in Community, OB, Nursery.

Hi Saifudin....I believe the literature says that any of the mood disorders (depression/anxiety/psychosis) can occur up to a year after the birth of a baby and still be classified as 'postpartum.' Now, I do know of cases (mine included) where in the disorder begins in the first year postpartum and never really goes away. Does this answer your question at all, or were you looking for something different?

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Specializes in Dialysis, ICU and ER.

My heart goes out to everyone that has had this happen to them,Even the men! Yes the men! We too have to deal with the circumstances of postpartum depression. I will admit it is one of the saddest things I've ever seen. My ex-wife went from a caring loving person, to a mean self-centered mother of two. I could tell within the first six months of our daughter's birth that my ex-wife was not bonding with our daughter. I was no psychologist but I could tell what was happening at an early stage in my daughter's life. The chemical imbalance that occurred within my ex has never been corrected. I can honestly say that it destroyed the family we had back then. I have had custody of our children for 15 years now and it's sad to see how the relationship between the children and their mother has been severely affected due to postpartum depression. I feel a deep sadness within my chest as I'm writing this, knowing what many of you have also experienced. My heart goes out to everyone of you. As I finish my nursing school this year, I will keep you all in my prayers.

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Specializes in Home Care, Primary care NP, QI, Nsg Adm.

Elvish,

I think that at 18 months out, this particular patient likely has a primary psychiatric disorder. Unfortunately, I don't have more information, however, postpartum psychosis usually occurs between 2-4 weeks after delivery and is a different illness than PPD. Often there is an underlying mood disorder (bipolar disease) or schizophrenia.

From what I have read, this is not likely related to PP Psychosis and it is actually a moot point anyway because she has a psychotic disorder which seems to be what lead her to killing her child.

The main point is raising awareness of the problem, how common it is, how easily it can be ignored and how dangerous it can be for mom and baby if the more rare but far more dangerous, psychosis occurs.

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