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Postpartum Depression

Definition:
The birth of a baby can trigger a jumble of powerful emotions, from excitement and joy to fear and anxiety. But it can also result in something you might not expect — depression.

Many new moms experience the baby blues — a mild, short-lived depression — for a few days or weeks after childbirth. According to the American College of Obstetricians and Gynecologists, about 10 percent of new moms experience postpartum depression — a more severe form of depression that can develop within the first six months after giving birth.  For women with postpartum depression, feelings such as sadness, anxiety and restlessness can be so strong that they interfere with daily tasks. Rarely, a more extreme form of depression known as postpartum psychosis can develop.

Experiencing depression after childbirth isn't a character flaw or a weakness. Sometimes it's simply part of giving birth. If you're depressed, prompt treatment can help you manage your symptoms — and enjoy your baby.

Causes:
There's no single cause for depression after childbirth. Physical, emotional and lifestyle factors may all play a role.
  • Physical changes. After childbirth, a dramatic drop in estrogen and progesterone may trigger depression. The hormones produced by your thyroid gland also may drop sharply — which can leave you feeling tired, sluggish and depressed. Changes in your blood volume, blood pressure, immune system and metabolism can lead to fatigue and mood swings.
  • Emotional factors. When you're sleep deprived and overwhelmed, you may have trouble handling even minor problems. You may be anxious about your ability to care for a newborn. You may feel less attractive or struggle with your sense of identity. You may feel that you've lost control over your life. Any of these factors can contribute to depression.
  • Lifestyle influences. Many lifestyle factors can lead to depression, including a demanding baby or older siblings, difficulty breast-feeding, exhaustion, financial problems, and lack of support from your partner or other loved ones.

Risk Factor :
Postpartum depression can develop after the birth of any child — not just the first. In fact, postpartum depression is more common in second-time mothers.

The risk of postpartum depression increases if :

  • You have a history of depression, either during pregnancy or at other times
  • You had postpartum depression after a previous pregnancy
  • You have a history of severe premenstrual syndrome
  • You experienced stressful events during pregnancy, including illness, premature birth or a difficult delivery
  • You have a difficult marriage
  • The pregnancy is unplanned or unwanted

When to seek medical advice :
If you're feeling depressed after your baby's birth, you may be reluctant or embarrassed to admit it. But it's important to tell your doctor. If the signs and symptoms of depression don't fade after a few weeks or if they're so severe that they interfere with your ability to complete everyday tasks, call your doctor. Early intervention can speed your recovery.

If you suspect that you're developing postpartum psychosis, seek medical attention immediately. Don't wait and hope for improvement. Postpartum psychosis may lead to life-threatening thoughts or behaviors.

Symptoms:
The signs and symptoms of depression after childbirth vary depending on the form of depression. Signs and symptoms of the baby blues — which last only a few days or weeks — may include :

  • Anxiety
  • Sadness
  • Irritability
  • Crying
  • Headaches
  • Exhaustion
  • A sense of inadequacy

Postpartum depression may appear to be the baby blues at first — but the signs and symptoms are more intense and longer lasting, eventually interfering with your ability to function. In addition to the signs and symptoms listed above, you may experience :

  • Constant fatigue
  • Lack of joy in life
  • A sense of emotional numbness or failure
  • Withdrawal from family and friends
  • Lack of concern for yourself or your baby
  • Excessive concern for your baby
  • Less interest in sex
  • Severe mood swings
  • Impaired thinking or concentration
  • Insomnia

With postpartum psychosis — a rare condition that develops within the first six weeks after delivery — the signs and symptoms are even more severe. In addition to the signs and symptoms listed above, you may experience :

  • Fear of harming yourself or your baby
  • Confusion and disorientation
  • Hallucinations and delusions
  • Paranoia

Diagnosis:
To distinguish between a short-term case of the baby blues and a more severe form of depression, your doctor may ask you to complete a depression-screening questionnaire. Blood tests can help your doctor determine whether an underactive thyroid is contributing to your signs and symptoms.

Complication :
Left untreated, postpartum depression can last for up to a year or longer — taking a toll on the entire family. Untreated postpartum depression can interfere with mother-child bonding and cause family distress. Children of mothers with untreated postpartum depression are more likely to have behavioral problems, including sleeping and eating difficulties, temper tantrums and hyperactivity. Delays in language development are common as well.

Treatment:
Treatment and recovery time vary, depending on the severity of your depression and your individual needs.

Baby blues
The baby blues usually fade on their own within a few days to weeks. In the meantime, get as much rest as you can. Accept help from family and friends. Connect with other new moms. If you have an underactive thyroid, your doctor may prescribe thyroid medication.

Postpartum depression
Postpartum depression is often treated with counseling and medication.

  • Counseling. It may help to talk through your concerns with a psychiatrist, psychologist or other mental health professional. Through counseling, you can find better ways to cope with your feelings, solve problems and set realistic goals.
  • Antidepressants. Antidepressants are a proven treatment for postpartum depression. If you're breast-feeding, it's important to know that any medication you take will enter your breast milk. Some antidepressants can be used during breast-feeding with little risk to your baby. But several antidepressants raise concerns for the baby, and various others have not been adequately tested to fully assess the risk. Work with your doctor to weigh the potential risks and benefits as you choose the treatment that's right for you.
  • Hormone therapy. Estrogen replacement may help counteract the rapid drop in estrogen that accompanies childbirth. However, estrogen therapy after childbirth may decrease milk production and increase the risk of developing blood clots in the leg or lungs. As with antidepressants, weigh the potential risks and benefits of hormone therapy with your doctor.

With appropriate treatment, postpartum depression usually goes away within a few months. Some women have lingering symptoms for months or years.

Postpartum psychosis
Postpartum psychosis requires immediate treatment — often in the hospital. When your safety is assured, treatment may begin with antidepressants or hormone therapy. Other options may include :

  • Antipsychotic agents. These medications are typically used to treat psychotic disorders, such as schizophrenia. But they can also treat the psychosis that may accompany extreme cases of depression.
  • Lithium. This mood stabilizer — generally used to treat bipolar disorder — can help balance mood swings. It's not recommended for women who are breast-feeding, however.
  • Electroconvulsive therapy. This therapy applies a small amount of electrical current to your brain to produce brain waves similar to those that occur during a seizure. The chemical changes triggered by the electrical currents can reduce the symptoms of depression — especially when other treatments have failed or when you need immediate results.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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