Depressive feelings or psychological disturbances in the first few weeks or months after childbirth
- Sometimes runs in families
- Lack of emotional support and additional stressful life events are risk factors
- Age is not a significant factor
It is very common for a new mother to feel low or miserable during the first few days or weeks after childbirth. A new baby leads to major changes in lifestyle, and adjustments will need to be made. This mild mood change is commonly known as the “baby blues” and affects up to 8 in 10 women following the birth of a child.
More severe postpartum depression is a relatively common disorder in the first few weeks or months after childbirth and affects about 1 in 10 women. About 1 in 1,000 women develops a serious psychiatric condition known as postpartum psychosis that requires immediate treatment in hospital.
What are the causes?
Baby blues are thought to be caused by the sudden fall in hormone levels (particularly of oestrogen and progesterone) that occurs after a baby is born. These hormonal changes may also cause postpartum depression and possibly also postpartum psychosis.
Women who have suffered from depression before are at increased risk of becoming depressed after childbirth. Postpartum depression may run in families. Other factors, such as feelings of isolation and inadequacy and concerns about the new responsibilities of motherhood, can cause stress and contribute to depression. Lack of sleep due to caring for the baby, exhaustion from a long labour, or painful wounds, such as tears in the vagina or scars from a caesarean section, may aggravate the problem. Mothers who have had a difficult labour are more likely to experience postpartum depression. Extra stresses or problems with a partner can make feelings of depression worse. Some women experience anxiety after childbirth, and they may have panic attacks with palpitations and shortness of breath (see Anxiety disorders). If recur-rent panic attacks are untreated, they may lead to postpartum depression.
Although the precise cause of postpartum psychosis is not understood, a previous history of episodes of depression that alternate with episodes of mania (see Bipolar affective disorder) significantly increases the risk. Women who have close relatives with a medical history of bipolar affective disorder or severe depression are at greater risk of postpartum psychosis.
What are the symptoms?
The symptoms of baby blues start 3–10 days after giving birth. They are often worse by about day 5 and include:
Dramatic mood swings.
Tiredness and irritability.
Lack of concentration.
Postpartum depression may begin any time in the first 6 months after childbirth. The condition is similar to baby blues but much more severe, and, unlike baby blues, it can interfere with the mother’s ability to carry out day-to-day activities. The symptoms include:
Constantly feeling exhausted.
Having little interest or no interest at all in the new baby.
Sense of anticlimax.
Feeling inadequate and overwhelmed by new responsibilities.
Loss of appetite.
Loss of appetite.
The symptoms of postpartum psychosis usually develop rapidly about 2–3 weeks after childbirth. They often include:
Insomnia and overactivity.
Extreme mood swings from depression to mania.
False beliefs of being disliked and persecuted by people.
Sometimes, threats of suicide or of harming the baby may be made by women who develop symptoms of postpartum psychosis.
What can I do?
You should try to get as much support as possible from medical staff, friends, and family after childbirth. Make sure you are not left alone until you feel happy caring for your baby, and rest as much as possible. You may also wish to find out about local self-help groups or mother-and-baby groups.
Baby blues do not usually require medical treatment and, with emotional support and time, almost always disappear. If you develop severe depression and find it hard to carry out day-to-day activities and look after your baby, you should consult your doctor.
What might the doctor do?
If postpartum depression is interfering with your life and simple reassurance and support are not helping to relieve your symptoms, your doctor may prescribe antidepressant drugs and advise counselling.
If you have very severe postpartum depression or postpartum psychosis, you will need to be admitted to hospital. The hospital will make sure that your baby can stay with you. To treat severe depression, you may be given a higher dose of antidepressant drugs or a different type of antidepressant drug. Antipsychotic drugs are usually prescribed for post-partum psychosis, and psychotherapy, in which you are encouraged to talk freely about your feelings, may be recommended to help you to overcome your problem. You will also be offered practical help looking after your baby.
You may not be able to breast-feed while you are taking antidepressant or antipsychotic drugs because of the risk of the drugs passing into your breast milk and harming your baby.
What is the prognosis?
The mildest form of depression, baby blues, usually improves within a few weeks, especially if the mother is given reassurance and support. Postpartum depression is likely to start responding to antidepressant drugs within 2–4 weeks, but full recovery may take up to a year. Antipsychotic drugs are usually helpful for postpartum psychosis within 2–3 months. However, the drugs may need to be taken for a period of several months and long-term follow-up and support will be given.
Any form of depression may recur after subsequent pregnancies. Women who have an increased risk of developing either postpartum depression or psychosis will be offered extra support during and after future pregnancies. They will also be monitored for signs of depression and may be given hormone patches after birth to counter the sudden fall in their hormone levels.
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.
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