The postpartum period is generally a joyful time for mothers. While there can be difficulties and stressors as they adapt to changes in their bodies while caring for a newborn, most women have a positive and happy experience. Some women, however, will have a markedly different course and will experience feelings of sadness or hopelessness and may ultimately be diagnosed with Postpartum Depression (PPD).
PPD is a medical condition that affects 5-9% of women in the United States. The symptoms can begin as early as a few days after delivery, but may not become evident for a few weeks or months. There are physical symptoms as well as alterations in mood. Physical symptoms include changes in sleep habits or appetite (too much or too little), extreme lack of energy, and persistent gastrointestinal complaints such as nausea, diarrhea, and abdominal pain. Changes in mood can involve feelings of anger, guilt, irritability, or anxiety. Some women may feel overwhelmed and experience feelings of inadequacy or an inability to care for the child, or even a sense of being a failure as a mother. Occasionally, women will have obsessive thoughts of harming themselves or the baby.
It is thought that PPD is caused by the combination of physical and emotional changes that women experience after delivery. While not fully understood why some women experience PPD and others do not, risk factors include: history of mental health disorders, marital stressors, single mothers, substance abuse history, unhealthy or sick infants, and lack of a social support system.
One of the most difficult aspects in the diagnosis of PPD is that most, if not all, of these symptoms are commonly experienced by women during this period. Furthermore, women may interpret their feelings as abnormal or shameful, leading them to hide their thoughts from others, which causes further isolation and exacerbation of symptoms.
Differentiating postpartum depression from normal feelings after delivery is best accomplished by a health professional. Women should be screened by their obstetrician at postpartum visits. Screening consists of asking a series of questions that can identify women who may be experiencing PPD. Mild symptoms may be managed by the obstetrician or the woman’s primary care physician. Women with more serious symptoms can be referred to mental health professionals for further and management.
Women with mild symptoms are managed with individual therapy or support groups. Those with more severe symptoms may require the addition of medications. Symptoms will generally improve after 4-6 weeks or treatment. Duration of therapy is highly individualized and depends on severity of symptoms and response to treatment. Most women will recovery completely, while a small number will continue to experience depressive symptoms outside the postpartum period.