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postpartum depression

Alternative Names
baby blues

Postpartum depression is a severe form of the "baby blues" that commonly occurs in a woman after having a baby. It comes on within the first six weeks after childbirth. The condition can become disabling. The woman may be unable to perform the activities of daily living.

What is going on in the body?
Many women experience some form of the "baby blues" following the birth of a child. Pregnancy and birth are accompanied by hormonal changes that can affect emotions. The round-the-clock job of caring for a new baby can seem overwhelming at times. Too little rest usually accompanies these physical and emotional stresses. For about 10% to15% of new mothers, the "baby blues" results in postpartum depression.

What are the signs and symptoms of the condition?
The signs and symptoms of post partum depression include:
  • feelings of sadness, hopelessness or gloom
  • loss of appetite
  • weight loss
  • difficulty sleeping
  • loss of energy
  • loss of interest in surroundings
  • excessive crying
  • withdrawal
  • fatigue
  • frequent headaches and other physical discomforts
  • anxiety
  • irritability
  • feelings of guilt
  • trouble concentrating
  • excessive concern over the baby
  • fear of harming the baby
  • excessive, severe mood swings
Many of these symptoms also occur in the "baby blues." However, symptoms are more intense and last for 3 to 6 months in postpartum depression.

What are the causes and risks of the condition?
Experts do not know the exact cause of postpartum depression. Some factors that may contribute include:
  • hormonal changes. Oestrogen and progesterone levels in the woman's body drop within hours after delivery.
  • stress. Caring for a newborn can be overwhelming. Physical exhaustion, lack of sleep, a baby with colic, unrealistic role expectations, and social isolation can all play a role in postpartum depression.
The following increase the risk for developing postpartum depression:
  • marital problems
  • previous history of depression
  • lack of support system
  • traumatic birth experience
  • early hospital discharge after childbirth
  • history of severe premenstrual syndrome
What can be done to prevent the condition?
There is no prevention for postpartum depression. However, there are things a woman can do to minimise the problem. These include:
  • getting adequate rest, nutrition and emotional support
  • asking for help with cooking or housework from family and friends. Some new mothers do not ask for help because they feel inadequate if they cannot do everything themselves.
  • sleeping when the baby sleeps. Women often make the mistake of trying to use the baby's nap times to clean or cook.
  • taking time for herself
  • getting regular exercise
How is the condition diagnosed?
There are several tools a woman can use to screen for postpartum depression. These are designed to help her recognise the signs and symptoms of the problem so she can seek help. This may include a list of questions such as:
  • Are you experiencing difficulty sleeping?
  • Do you feel anxious, tense or panicked much of the day?
  • Do you find yourself crying uncontrollably for unexplained reasons?
  • Is it difficult for you to concentrate?
  • Are you filled with self-doubt and lacking in self-esteem?
  • Have you experienced sudden changes in appetite?
  • Are you feeling totally exhausted and lacking in enthusiasm for things that once seemed pleasurable?
  • Do you feel more distant from your spouse or partner?
  • Do you often feel helpless, hopeless and unable to cope?
  • Are you over concerned about the health of your baby, constantly worrying about what could go wrong?
  • Do you feel like most days you are "out of control" or "going crazy"?
  • Do you ever think of hurting yourself or your baby?
If a woman answers yes to any of these questions, she could be experiencing a characteristic or behaviour that has been associated with postpartum depression. The doctor should be consulted.

Also, a woman's doctor can diagnose the condition based on her symptoms. Thyroid function tests may be done to rule out hypothyroidism. A full blood count, or FBC, can identify any anaemia that may be present. In some cases, accepting a diagnosis of depression can be difficult for a women. She may feel that she has failed because she is having difficulty adjusting to the demands of a new baby. These feelings may cause her to avoid seeking treatment.

What are the long-term effects of the condition?
Untreated, postpartum depression interferes with bonding between mother and infant. Serious depression may be accompanied by:
  • aggressive feelings toward the baby
  • loss of pride in the woman's person appearance and home
  • loss of appetite
  • withdrawal from others
  • suicidal tendencies
What are the risks to others?
In severe depression, there is a chance that the mother may harm or neglect the baby.

What are the treatments for the condition?
Treatment for post partum depression depends on the type and severity of the symptoms. Medications may include antidepressant and anti-anxiety medications, as well as the the hormone oestrogen. Psychotherapy can be an important tool to help the woman identify factors that contribute to her depression. Individual or family counselling and participation in a support group with other women who have experienced this condition may be helpful. Also, therapy may help the individual learn to communicate her feelings and ask for help when she needs it.

A woman with postpartum depression can also benefit from learning about coping mechanisms, including:
  • setting priorities for task, such as household tasks
  • decreasing concern with appearances, such as a tidy house, or personal looks
  • getting plenty of sleep and rest
  • arranging for relaxation time
  • accepting help when it is offered, and designating where help is needed. Friends and family can help with household chores, cooking, and shopping.
  • including others in care of the newborn when possible
What are the side effects of the treatments?
Antidepressant and anti-anxiety medications may cause mild side effects. These are usually temporary, and may include: What happens after treatment for the condition?
With medication, counselling and support, most cases of postpartum depression improve within 3-4 weeks.

How is the condition monitored?
A woman taking an antidepressant medication needs to have blood levels of the drug monitored frequently. Monitoring may continue with a doctor until symptoms have resolved.

Author: Gail Hendrickson, RN, BS
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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