You've just had a baby, one of the most important and happiest events in your life. "What could make a woman happier than a new baby?" you wonder. So why are you so sad? Experts don't know the reason why for sure, but you're not alone. As many as 80% of women experience some mood disturbances after pregnancy ("postpartum"). They feel upset, alone, afraid or unloving toward their baby, and guilt for having these feelings.
Postpartum depression (also called PPD or postnatal depression) is a form of clinical depression that can affect women, and less frequently men, after childbirth. Studies report prevalence rates among women from 5% to 25%, but methodological differences among the studies make the actual prevalence rate unclear. For most women, the symptoms are mild and go away on their own. But 10-20% of women develop a more disabling form of postpartum depression mood disorder.
Treatment of Postpartum Depression
Numerous scientific studies and scholarly journal articles support the notion that postpartum depression is treatable using a variety of methods. If the cause of PPD can be identified, as described above under “social risk factors,” treatment should be aimed at mitigating the root cause of the problem, including increased partner support, additional help with childcare, cognitive therapy and so on.
Women need to be taken seriously when symptoms occur. This is a two-fold practice: First, the postpartum woman will want to trust her intuition about how she's feeling and believe that her symptoms are real enough to tell her significant other, a close friend and/or her medical practitioner; erring on the side of caution will go a long way in the treatment of PPD.
Second, the people in whom she confides must take her symptoms seriously as well, aiding her with treatment and support. Partners, friends and physicians may notice changes in a postpartum mother that she may not. Knowing that PPD is treatable with a variety of methods can make persistence in seeking treatment easier.
Self-Care at Home: While self-care cannot take the place of medical care in depression, there are things you can do to improve your mood and your ability to function at home.
•Surround yourself with supportive family members and friends; ask them for their help in caring for the baby.
•Take care of yourself. Get as much rest as you can. Nap when the baby naps.
•Try not to spend much time alone.
•Spend some time alone with your husband or partner.
•Take a shower and get dressed every day.
•Get out of the house. Take a walk, see a friend—just do something you enjoy. Get someone to take care of the baby if you can; if you can't, take the baby with you.
•Don't expect too much from yourself. Don't worry too much about the housework. Ask friends and family for help.
•Talk to other mothers. You can learn from each other, and their experiences can be reassuring.
•If the depression persists for longer than two weeks or is very deep, talk to your healthcare provider. Self-care alone is not recommended.
Medical Treatment: Treatment for postpartum depression depends on the form and how severe it is.
•Your healthcare provider may refer you for psychological help and individual or group therapy.
•Support groups are helpful.
•Marriage counseling may be part of your treatment plan.
•It's important for friends and family to understand the illness so they can help.
•Medications can be helpful.
For postpartum blues, no specific treatment may be necessary because the condition goes away by itself. If symptoms don't go away within 2 weeks, call your healthcare provider.
For postpartum depression, the severity of the illness will guide the healthcare provider in choosing treatment. Milder forms may be treated with psychological therapy. More severe forms may require medication. A combination is sometimes helpful.
Medications: There are various medications you can use to combat PPD. Consult your therapist or doctor when getting a prescription.
•While postpartum depression in the United States is rarely related to nutritional problems, it's probably a good idea to continue to take prenatal vitamins and iron after delivery.
•Antidepressants such as Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Celexa (citalopram), Lexapro (escitalopram) or Effexor (venlafaxine) may be given for as long as a year, possibly longer. Other medications that might be used include lithium or valproic acid (Depakote).
•Hormone therapy using Estrogen, often in combination with an antidepressant, sometimes helps with postpartum depression. Some women also need thyroid treatment.
Other still unproven therapies include the use of bright light and nutritional therapy (especially increasing omega-3 free fatty acids). If you're breastfeeding, medicine you take can be passed to your baby. As such, use antidepressants that can be used with little risk to your baby.
Nutrition: Proper nutrition may be a factor in preventing postpartum depression. Pregnant, nursing and postpartum women are strongly encouraged to seek the medical advice of their obstetrician or primary care physician regarding optimal nutrition during pregnancy and after birth.
The following nutritional information may be beneficial in achieving a well-balanced diet during and after pregnancy, but studies are needed to confirm their role in preventing postpartum depression:
•Omega-3 fatty acids: Some physicians agree that pregnant women have an increased need for omega-3 fatty acids and may recommend that pregnant women consume at least 1,000 mg (1 gram) of omega-3 oils everyday. This amount of oil can be obtained through any of the following examples (among many others): 2 teaspoons of walnut oil, 2–3 ounces cooked salmon, or a teaspoon of flaxseed oil.
•Protein: Along with omega-3s, protein also plays an important role in the diet of a pregnant woman. Physicians may recommend that nursing mothers ingest 71 grams of protein per day while non-nursing mothers need 46 grams. Protein can be found in a wide variety of foods. Some examples follow: 3 ounces of most meat products contain 25 grams of protein, 3 large eggs have approximately 19 grams and 3 ounces of Swiss cheese have about 15 grams.
•Hydration: One of the most important roles in any diet (especially for pregnant and nursing mothers) is that of hydration. Some in the medical community argue that dehydration can cause feelings of fatigue and anxiety. Physicians may recommend that pregnant women consume ten 8-ounce glasses of water every day. Mothers who are nursing are strongly urged to drink a tall glass of water, milk or juice before sitting down to breastfeed their child. Women should consult with their physicians about caffeine and alcohol consumption postpartum.
•Vitamins: A pregnant and postpartum woman should speak with her physician for information about for a daily prenatal/postnatal vitamin. Vitamins are not known to help prevent PPD but are considered by some physicians to be a beneficial part of proper nutrition.
•Appetite: If a woman finds herself with a loss of appetite or other eating disturbances, she should consult her physician. This may be a sign of postpartum depression and therefore should be discussed with a doctor
Other Therapy: Generally, psychotherapy and medications are used together. Psychotherapy alone may be effective in mild cases. Interpersonal psychotherapy (IPT) is an alternative to medication that may be appropriate for some women. IPT assists with social adjustments. It usually consists of 12 one-hour long sessions with a therapist. IPT has been shown to improve measures of depression in some women.
Teaching mothers skills such as controlling the baby's crying often reduces depressive symptoms during the first 2-4 months after delivery. If your symptoms can't be controlled with counseling or medicine and you're thinking about hurting yourself or your baby, then your doctor may consider putting you in the hospital.
Follow Up: Follow the recommendations of your healthcare provider. If he or she prescribes medication and/or counseling, be sure to follow through. If you're given medication, take it as directed. Do not stop taking your medication until you have talked to your healthcare provider.
Preventing Postpartum Depression
Early identification and intervention improves long term prognoses for most women. Some success with preemptive treatment has been found as well. A major part of prevention is being informed about the risk factors, and the medical community can play a key role in identifying and treating postpartum depression. Women should be screened by their physician to determine their risk for acquiring postpartum depression.
Too often, depressive symptoms are dismissed as normal for a woman who has just experienced childbirth. If you have had depression in the past, or have risk factors for depression, talk with your doctor before getting pregnant or early in your pregnancy. All new mothers should be screened for depressive disorders.
Postpartum depression usually goes away during the months after delivery. Some women have symptoms for months or years. If untreated, the illness can cause prolonged misery for the mother and her family. So go ahead and have yourself treated if you show any signs and symptoms of this condition.