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Women's Health

BEYOND THE BLUES When mood disturbances disable and persist By Dr. Carol A. MajorPublished: January, 2006

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WOMEN JANUARY 2006  Everyone expects the birth of a baby to bring joy to new parents. But for some new mothers, there can be despair, anxiety or even dangerous thoughts  symptoms of postpartum depression.  After having a baby, approximately 85% of women experience some type of mood disturbance. For most women, this disturbance is short-lived and mild; however, for about 10-15%, their mood disturbances are more disabling and persistent. These women are said to have postpartum depression.  Researchers think that the rapidly decreasing hormones of pregnancy (estrogen and progesterone) may lead to depression. Other factors that may also contribute include fatigue and exhaustion because of broken sleep patterns, stress due to changes in work and home routine, and feelings of loss of freedom, identity and body image.  Women with a prior history of depression have approximately a 25% risk of recurrent depression after delivery. Other risk factors for postpartum depression include: a personal or family history of depression or premenstrual dysphoric disorder (exaggerated mood swings connected to the menstrual cycle), history of substance abuse, limited social support, living alone, marital conflict, and ambivalence about the pregnancy. Medical conditions such as thyroid disease and anemia may also lead to mood disorders and should be ruled out as causes. What are some of the symptoms of postpartum depression?  •Feelings of sadness, irritability or restlessness  •Low self-esteem  •Apathy or social withdrawal  •Inability to experience pleasure  •Crying a lot  •Lack of energy or motivation  •Sleeping too much or too little  •Excessive emotional sensitivity  •Pessimistic thinking  •Impaired concentration  •Agitation  In addition, headaches, palpitations, chest pains and hyperventilation can also be symptoms of postpartum depression. If the symptoms go away quickly, there is no cause for alarm. However, symptoms lasting longer than two to three weeks may signal postpartum depression and should be addressed by a doctor. A lack of interest in the baby, hallucinations and delusions and suicidal or homicidal thought are serious signs. They warrant immediate psychiatric evaluation and treatment.  Postpartum depression should be suspected if a woman reports that she has not slept in two to three days, if she is losing weight rapidly, she cannot get out of bed, ignores basic grooming, or she makes strange or bizarre statements.  Having a baby is supposed to be the happiest time in a woman’s life. Many women, therefore, do not tell anyone about their symptoms because they feel embarrassed, ashamed or guilty. Even though most are aware of their symptoms, they will remain silent about their feelings of depression because of worries of being seen as a “bad” or “unfit” mother.  While postpartum depression cannot be prevented, the likelihood of it occurring can be reduced by following some basic tips such as: ask for help from family and friends; get as much rest as possible; eat on a regular basis; talk to people, especially other mothers; try not to spend a lot of time alone; get dressed and leave the house; and try to avoid major life changes during and immediately after the pregnancy.  If depression does develop, there are two common types of treatment  talk therapy and medication. Talking to a therapist, psychologist or a social worker can be very helpful. If talking does not seem to help, then antidepressant medication is an option. Selective serotonin uptake inhibitors (Prozac and Zoloft) are commonly used in patients with postpartum depression. The benefits of these medications are usually apparent within two to three weeks. Most patients are usually maintained on these agents for at least 12 months.  The use of antidepressants during breastfeeding has been extensively reviewed. Drugs and their metabolites do pass into the breast milk, but in most cases, infants tolerate this exposure without any problems. The benefits of taking antidepressants in cases of moderate to severe postpartum depression usually outweigh the theoretical risks of the newborn’s exposure.  Postpartum depression is a medical problem and no cause for shame. It is important to seek help if you are feeling the symptoms or if you see friends or family members suffering. With treatment, postpartum depression does not have to destroy the joy of starting a family.  Dr. Carol A. Major is an OB/GYN specializing in maternal-fetal medicine at UCI Medical Center, Orange County’s only university hospital, which has been named one of the nation’s best hospitals for gynecology by U.S. News & World Report. Information: www.ucihealth.com or call toll free 714.456.2911.

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