What You Need To Know About Postpartum Depression

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Having a baby is a time of great joy. But it can also be a time of anxiety and sadness for some women. So how do you know when it's something more than the baby blues?

We sat down with Andrea Bach Messel, APRN, CNM, certified nurse midwife at AdventHealth Altamonte Springs, and asked her to explain baby blues, postpartum depression, and what new depression screening guidelines mean for expectant and new moms.

Q.  What exactly are the baby blues?

A. You've just had a baby and instead of celebrating, you're crying, exhausted, and irritable. You may not have been expecting this, but these feelings are normal and are known as the "baby blues" or "postpartum blues."

Q. How long do they last? And, how many women are affected?

A. Postpartum blues have been reported to occur in up to 85% of women.  They usually occur in the first 10 days after giving birth, and peak at the fifth day. 

Q. So what causes the baby blues and what's the treatment?

A. There is no clear biologic measure that can be used to predict or make the diagnosis of postpartum blues.  Hormonal fluctuations, coupled with adjusting to new routines, and lack of sleep may all contribute to those symptoms we described above.

The good thing is the baby blues aren't an illness, and usually they go away on their own. Reassurance, support from family and friends, rest, and time are what is needed. Sleep deprivation can make the blues worse, so make an effort to rest whenever you can. Even a short nap can leave you feeling better.

Q. So how do you know when its a case of the baby blues or postpartum depression?

A. Although postpartum blues are common and generally don't require treatment, recognition is important because postpartum blues are risk factors for postpartum depression.

People often confuse the two, because the symptoms are often the same and may include:

  • Mood swings
  • Anxiety
  • Sadness
  • Irritability
  • Feeling overwhelmed
  • Crying
  • Reduced concentration
  • Appetite problems
  • Trouble sleeping

During the first weeks after giving birth, its normal to experience one or more of these symptoms.  But if you feel this way for three weeks or longer, call your doctor and seek professional support.

If you have a history of depression before or during pregnancy, you're at increased risk for postpartum depression. Getting help during pregnancy is crucial, so talk with your provider about your symptoms, medications you may be using or have used for depression or anxiety, and work out a plan for management during pregnancy.

Q. What is postpartum depression?

A. Postpartum depression may at first be mistaken for baby blues.  The signs and symptoms, which develop anywhere from within the first few weeks after giving birth up to 6 or even 12 months after birth, are often more intense and don't simply go away.

The diagnosis of postpartum depression includes at least two weeks of depressed mood or loss of interest or pleasure in activities you previously enjoyed. Additional symptoms include:

  • Sleep disturbances
  • Appetite changes
  • Loss of energy
  • Feelings of worthlessness or guilt
  • Diminished ability to think clearly, concentrate or make decisions
  • Thoughts of harming yourself or your baby

Moms who are depressed often have difficulty bonding with their baby, withdraw from family friends, or feel that they are not good mothers. Anxiety, often expressed as irritability or anger, is often diagnosed in women experiencing postpartum depression. 

Q. So, what is Postpartum Psychosis?

A. Postpartum psychosis occurs rarely, with rapid onset in the first two to four weeks after delivery.  Postpartum psychosis includes confused thinking, mood swings, obsessive thoughts, disorganized behavior, and poor judgment. Hallucinations, delusions and paranoia also can be present.  Untreated, postpartum psychosis can lead to life-threatening thoughts or behaviors, including attempts to harm yourself or your baby. Immediate treatment is needed. 

Q. How many American women are estimated to suffer from PPD?

A. According to a 2013 study published in the Journal of American Medical Association (JAMA) Psychiatry, approximately one in seven mothers suffer from PPD.

Q. What can be done?

A. In January 2016, the U.S. Preventive Services Task Force, reiterated its earlier recommendation that all adults aged 18 and older be screened for depression and for the first time, called particular attention to the screening of pregnant and postpartum women. The USPSTF noted that depression is common in postpartum and pregnant women and affects not only the woman but her child as well. 

Q. Must I wait until I have the baby before seeking treatment?
A. Untreated depression can harm both the mother and her child. Decisions to treat depression must weigh those risks against the risk of treatment. For example, the use of cognitive behavioral therapy (a type of psychotherapy) has been the most common treatment studied in pregnant women and has been found to be of benefit. 

Your OB-GYN and pediatrician should make it a practice to screen and treat postpartum depression, or to screen and refer you to an appropriate provider.

Learn more about our approach to your whole health at AdventHealth for Women.

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