Postpartum Depression

After giving birth, the ‘baby blues’ is a short period of feeling down, emotional, and crying, typically lasting around two weeks. This is completely normal. Postpartum depression, on the other hand, is defined as depression lasting more than a few weeks or developing later.

It can start at any time in the year following childbirth and may begin gradually or suddenly, ranging from mild to severe. Expressing your feelings can be difficult. You might feel pressured to be happy and worry about being a “bad” parent. Remember, postpartum depression can affect anyone and is not your fault. It’s never too early or too late to seek help.

What Is Postnatal Depression?

Postpartum depression, also known as postnatal depression or the postpartum blues, is more common than you might think. I often see young women in my clinic struggling with depression after giving birth. Having a baby is an emotional time, and for some, it can be a real roller coaster. Feeling depressed is not something a new mother expects.

Fatigue

A woman may feel down or anxious after having a child for many reasons, with overwhelming fatigue being a major factor, especially if she has other children to care for. The key thing to remember is that most cases resolve over time, particularly with plenty of support.

Postpartum depression is defined as a mood disorder that begins after childbirth and lasts up to eight weeks (with some extending to a year). There are basically three degrees of this form of emotional lability:

1. Postpartum blues or the “baby blues” is a much milder form of depression that happens in the first week after birth. The new mother may feel anxious, irritable, and tearful, with frequent mood changes. This does not interfere with her ability to take care of her baby and usually resolves spontaneously within days or weeks.
2. Postpartum depression, the mother feels that she is unable to care for her baby with more severe symptoms of depression. The mother will feel emotionally detached from her child and family, she is finding it all too much and even the simple things like meal preparation and cleaning the house are just too much.
3. Postpartum psychosis is the most severe form of post partum depression; it is a much less common form with symptoms of agitation, confusion, delusion and even hallucination. I have seen a few cases over the years, with the mother having to spend some time in the unit away from her family. It is unfortunate, but the woman may even contemplate self-harm to herself or her child. These are severe and unusual cases however, and are much more rare and infrequently encountered than postpartum depression.

Symptoms of Postpartum Depression

• Anxiety
• Changes in appetite
• Difficulty in concentration
• Fatigue
• Frequent crying
• Intense worrying about baby
• Loss of interest
• Mood swings
• Withdrawal from family friends and activity
• In severe cases, thoughts of suicide or infanticide can be present.

What Causes Postpartum Depression?

• The exact cause of postpartum depression is unknown, but the rapid hormonal changes which accompany pregnancy and delivery may trigger it.
• I have found that the women who are most prone to PPD are the “perfectionists”, those who are prone to anxiety or have experienced major PMS mood swings prior to pregnancy. Please read my page on Depression, Stress and Anxiety.
• Athletes, corporate workers or women who have experienced major stress, hardship before pregnancy are more prone to PPD. I have verified this over and over in the clinic over twenty years.
• Adrenal Fatigue – If you can relate to this before your pregnancy, then you may well have a much higher risk for PPD in my clinical experience. Please read the page of Adrenal Fatigue. Our clinic has successfully treated women with PPD, and even those who were breastfeeding with postpartum depression most successfully with our adrenal fatigue program.

Hormonal Causes 

• At the beginning of pregnancy, progesterone is produced from the corpus luteum in the ovary, then starting from the seventh week of pregnancy the placenta produces high amounts of the progesterone hormone (about ten fold more than pre-pregnancy state), which helps to relax the uterus and prepare the mammary gland for lactation.
• After the delivery of the baby and expulsion of the placenta, the level of progesterone drops markedly returning to the pre-pregnancy level ^1,2. This dramatic shift in hormone levels may trigger the mood changes experienced in postpartum depression ^3,5. In some studies, metabolites of progesterone have been found to be lower in women with postnatal depression ². Some doctors advocate the use of hormones, although I am not a big fan of “hormone replacement therapy” personally. Progesterone supplementation may help control postpartum depression for some women. However, I believe this therapy should be reserved for severe cases.

References

1. Gilbert Evans, S.E., et al., 3alpha-reduced neuroactive steroids and their precursors during pregnancy and the postpartum period. Gynecol Endocrinol, 2005. 21(5): p. 268-79.
2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16373246
3. Nappi, R.E., et al., Serum allopregnanolone in women with postpartum “blues”. Obstet Gynecol, 2001. 97(1): p. 77-80.
4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11152912
5. Harris, B., et al., Maternity blues and major endocrine changes: Cardiff puerperal mood and hormone study II. Bmj, 1994. 308(6934): p. 949-53.
6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8173402
7. Chang, J., Y. Zhang, and L. Cui, [Impact of placental hormone withdrawal on postpartum depression]. Zhonghua Fu Chan Ke Za Zhi, 1995. 30(6): p. 342-4.
8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7555367
9. 5.         Bloch, M., et al., Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatry, 2000. 157(6): p. 924-30.
10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10831472