You just had a baby. You should feel wonderful. Why do you feel so down? You are not alone. It is estimated that one in seven women experiences postpartum depression or anxiety. As many as 80 percent of women experience postpartum “blues.”
Not surprisingly, the immense emotional and physical changes that occur when your body brings new life into the world precipitate a roller coaster of emotions. You may be in pain. You are almost certainly deprived of sleep. Many women experience feelings of doubt about being a mother and whether they will be able to care for their child adequately, and they may find themselves crying, feeling anxious, or perhaps arguing with their partner or family. If these feelings are transient, lasting only a few days to a week and improving daily, they are considered postpartum “blues.”
However, if you have strong feelings of sadness, anxiety, or despair; trouble performing daily tasks for longer than a week; or are increasingly unable to function, you should seek treatment. The following are symptoms that should alert you to the possibility of postpartum depression:
- strong feelings of depression and anger
- feelings of sadness, doubt, guilt, or helplessness
- not being able to care for self or baby
- trouble doing tasks at home or on the job
- changes in appetite
- things that used to bring you pleasure no longer do
- intense concern and worry about the baby
- lack of interest in the baby
- anxiety or panic attacks
- fears of harming the baby
- thoughts of self-harm or suicide
- obsessive/compulsive behavior
There are many factors that contribute to these feelings:
- decrease in estrogen and progesterone sharply after birth
- possible thyroid hormone decrease
- sleep deprivation
- feelings of doubt about pregnancy, especially if unplanned or unsupported
- loss of freedom
- loss of old identity
- loss of pre-pregnancy shape, feeling unattractive
- premature birth, birth defect, coming home without baby
- breastfeeding problems
Some women who fit the following profile are at increased risk for postpartum depression:
- young age
- lower education
- h/o mood disorder
- psychosocial stress or lack of support
- complicated pregnancy or birth
- difficulty nursing or difficult baby
- separation from baby due to medical issues
What should you do if you suspect you may be suffering from postpartum depression?
- Get as much rest as possible.
- Don’t hesitate to ask for help from family and friends.
- Take special care of yourself by showering, dressing, and getting out of the house when possible.
- Talk things out with a support person. If you are having relationship difficulties or if your partner is also conflicted about the new baby, you may want to talk with another friend or family member for a different perspective.
- Finally, if these feelings persist, talk with your doctor.
What options are available for treatment?
- If your symptoms are mild to moderate, your doctor may recommend counseling or psychotherapy.
- It is often very helpful to talk with someone outside of your situation, to give you a sense of perspective and advice on stress reduction techniques.
- If your symptoms are severe, or you have a prior history of psychiatric conditions or psychosis, your doctor will recommend medication. The class of medications called Serotonin Reuptake Inhibitors (SSRIs) are commonly used. There is little secretion of these medications into your breast milk, and thus they have minimal effect on your baby. This class includes medications such as sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and fluoxetine (Prozac). You should anticipate improvement within one to three weeks, and the full effect is experienced by six to eight weeks.
On very rare occasions, a woman may experience postpartum psychosis (0.2 percent). This is very serious and requires immediate treatment in the hospital.
Treatment may include a combination of antidepressants, antipsychotics, mood stabilizers, and electroconvulsive treatment (ECT), if refractory to treatment. Risk factors include previous psychosis or bipolar disorder. Symptoms of psychosis include:
- delusions or strange beliefs
- hallucinations (seeing or hearing things that aren’t there)
- extreme irritability, hyperactivity
- decreased need for sleep
- paranoia or suspiciousness
If you are experiencing signs of depression or anxiety after the birth of your baby, don’t despair. Follow these recommendations and talk with loved ones and with your doctor about your feelings. These symptoms are not signs of weakness, and they do not mean you won’t be a good mother to your child. You have been through enormous emotional and physical changes in giving birth, and it is understandable that your body will display signs of this transition. Seek help if you need it. You will soon see that the future is bright and that becoming a mother is an awesome experience!
By Ingrid Skop, M.D.