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Postpartum Depression

By Ilyene Barsky, ACSW, LCSW

Postpartum depression (PPD) is a real and common occurrence that is often misunderstood, misdiagnosed, or overlooked. Many underestimate the seriousness of PPD and dismiss it as the "baby blues" which is a temporary and short-lived condition.

The majority of new mothers are not prepared for any severe depression and most baby care books barely touch upon it. A mother who has had babies before may have experienced PPD, but even for her and especially for a new mother, it usually comes as a complete surprise. And when it hits, it is terrifying. The woman often feels embarrassed, ashamed, and tremendously guilty.

PPD can happen to virtually any women regardless of age, race, religion, level of education, or socioeconomic background. It is important to remember that the woman suffering from PPD is only a human being caught in the midst of an emotional illness. It it imperative that educators, counselors, etc., be able to distinguish the differences between transient "baby blues" and chronic, debilitating PPD.

Fifty to eighty percent of all women delivering in U.S. hospitals may experience "baby blues." Symptoms include fatigue, unprovoked crying, anxiety, confusion, and disorientation. No specific treatment for this condition is considered necessary by healthcare professionals. The "baby blues" are believed to be caused by a dramatic drop in hormone levels that accompany childbirth. Most importantly, the "baby blues" are transient in nature and self-limiting.

Like the "baby blues," PPD is a hormonally and biochemical induced reaction to the body's upheaval in the giving birth. However, unlike the "baby blues" which usually has an early onset (within the first two weeks postpartum), PPD can occur anytime within the first year postpartum. Whereas the "baby blues" begin and end suddenly, the onset of PPD is usually slow and insidious.

PPD may begin as the "baby blues" and develop or it can have a later onset. Whereas the primary symptom of the "baby blues" is anxiety, PPD is marked primarily by depression. Symptoms include crying for no apparent reason, numbness, helplessness, frightening feelings and thoughts, over-concern for the baby or no feelings for the baby, insomnia, change in appetite, anger, anxiety, guilt, lack of interest in sex, an inability to concentrate, a compulsive need to talk or to withdraw, exaggerated highs or lows, feelings or inadequacy and an inability to cope with day to day activities.

The incidence of PPD in the mild to moderate range is estimated at 10 - 20% of all births. Healthcare professionals tend to minimize the importance and impact of this disorder. However, if left untreated, mild to moderate depression may become progressively severe.

It is impossible to accurately predict which women will become depressed after delivery. Some women seem to run a significantly higher risk than others.

The following factors indicate a higher than average risk:

  • depression and/or anxiety during pregnancy
  • an episode of PPD after a previous birth
  • a history of mood illness not related to childbearing
  • parents or siblings with histories of mood illness
  • an alcoholic, abusive or sociopathic father in the home while the woman was a child
  • separation from a parent during childhood
  • an unhappy or highly stressed childhood
  • an anxious personality stucture
  • an unwanted pregnancy
  • a long, difficult, or complicated labor
  • an unsupported labor
  • a birth experience that failed to fulfill unrealistic expectations
  • delivering a premature, compromised, or defective baby.

If a pregnancy woman is aware of having some of these factors in her personal history, she would consider herself at risk and seek counseling during both her pregnancy and the postpartum period.

The at risk woman requires superior nutrition, adequate rest, and above all, emotional and psychological support during and after the pregnancy.