Northwestern Medicine's Asher Center Publishes FAQs About Postpartum Depression

Along with the joy of welcoming a new baby into the world, many mothers feel sad, anxious, or afraid. These feelings can be indicative of the "baby blues" or of postpartum depression.

Baby Blues

About 70 to 80 percent of all new mothers experience the mild symptoms associated with baby blues within two to four days after birth. Symptoms include:
  • Frequent, prolonged crying for no clear reason
  • Trouble sleeping, eating, or making choices
  • Irritability or quick mood changes
  • Anxiety over ability to care for the baby

This can last a maximum of 10 days, and it resolves without treatment.

Postpartum Depression

Approximately 1 in 7 new mothers experience the more debilitating and longer lasting symptoms of postpartum depression. These symptoms can appear anytime during the first year after birth, but typically begin within three months postpartum.  The symptoms of postpartum depression must be present most of the day nearly every day for 2 continuous weeks and include five of the symptoms listed below, one of which must be either low or depressed mood OR loss of interest or pleasure:
  • Low or depressed mood
  • Loss of interest or pleasure in activities
  • Appetite changes—more often loss of appetite, others may notice an increase in appetite
  • Sleep disturbance—usually insomnia or disrupted sleep, even when the baby sleeps; others may have increased sleep
  • Poor energy
  • Excessive guilt
  • Feelings of worthlessness
  • Poor concentration or difficulty making decisions
  • Agitation or feelings of being slowed down

Postpartum depression can be treated with many types of therapy, but women have trouble identifying whether they have postpartum depression which can delay treatment. The attached questionnaire, the Edinburgh Postnatal Depression Scale questionnaire is used to screen for postpartum depression. A score of 10 or more indicates that you should speak with a health professional about postpartum depression, and a score of 5-9 indicates that you are at risk for developing the illness.

What are the baby blues?

The baby blues affect up to 75% of mothers shortly after delivery. The symptoms may include brief crying spells, bouts of irritability, nervousness, strong feelings of sadness or joy, headache, poor sleep, changes in eating habits, difficulty making decisions, and more intense emotional reactions. The baby blues usually start 2-4 days after birth, and go away within a few days or by 10 days after birth. No treatment is necessary.

What is postpartum depression?

Postpartum depression is a common illness. Women such as Princess Diana and Marie Osmond have experienced postpartum depression. It occurs in 10-15% (1 out of 8) new mothers. It tends to begin within 4 weeks after delivery but may occur up to several months after the baby is born. The symptoms of postpartum depression must be present most of the day nearly every day for 2 continuous weeks and include five of the symptoms listed below, one of which must be either low or depressed mood OR loss of interest or pleasure:

  • Low or depressed mood
  • Loss of interest or pleasure in activities
  • Appetite changes- more often loss of appetite; others may notice an increased appetite
  • Sleep disturbance-usually insomnia or disrupted sleep, even when the baby sleeps; others may have increased sleep
  • Poor energy
  • Excessive guilt
  • Feelings of worthlessness
  • Poor concentration or difficulty making decisions
  • Agitation or feelings of being slowed down

More severe symptoms could include thoughts of death or suicidal thoughts. Women may also experience increased anxiety or worrying, obsessional thoughts (repeated, unwanted or intrusive thoughts that are hard to ignore), and panic attacks.

Depression results when the stress from the environment is greater than the capacity of the person to cope. Anyone can develop depression. There are many treatments.

Who is at risk for postpartum depression?

Like most diseases, there is not one factor responsible for the development of depression. Women most likely to suffer the onset of a new episode of depression have a history of depression, significant life stressors, a negativistic style of thinking, and less social support than women who do not develop episodes. Research is being undertaken to explore the connection between the significant change in hormone levels shortly after delivery, which causes major physiological stress, and postpartum depression.

How can I be screened for postpartum depression?

Women can complete a self-rating questionnaire called the Edinburgh Postnatal Depression Scale to determine if they might have postpartum depression.

If your score is 10 or above, or if you have had recent thoughts of harming yourself, your baby, or anyone else, it is important for you to see your primary care provider or your mental health provider in the near future for a clinical assessment.

If your score is between 5-9, then you may wish to repeat this questionnaire in 2-4 weeks to determine if your symptoms have changed. Please call a physician for any questions.

What happens when depression is left untreated?

Women can remain untreated because they don't realize they have depression or because they have been discouraged from getting treatment. But, women with postpartum depression are not alone. With one out of eight postpartum women affected, this is the most common complication of childbearing. Without treatment, depression usually lasts 6-9 months. Women with untreated postpartum depression can experience ongoing difficulties with work and relationships. They may have problems taking care of things at home, getting along with others, doing their jobs, or doing things that used to be done easily. Other mothers have described a difficulty being able to enjoy their new baby, fears of harming their infant, or not being able to meet the needs of their child/children.

What are possible treatments for postpartum depression?

Treatments for postpartum depression are designed to address the woman’s management of the stress that she experiences. Stress can come from outside the person (such as an ill parent or child, or financial problems) or from inside (such as a chronic medical illness or a hereditary vulnerability to depression). Psychotherapy and/or antidepressant medications are established treatments. Cognitive behavior therapy and interpersonal therapy have been found helpful in treating this condition. These treatments encourage the woman to evaluate her situation and change the situations over which she has control. Antidepressant medications include the serotonin-selective reuptake inhibitors such as fluoxetine (prozac) and sertraline (zoloft), venlafaxine (effexor), which is a norepinephrine and serotonin reuptake inhibitor, and the tricyclic agents, an older class of antidepressants. Medications take a few weeks to work. They correct the core symptoms of dysregulation of depression. Other promising treatments are being evaluated in clinical trials. Bright light therapy is a treatment that restores biological rhythms (such as sleep and appetite problems) to normal by exposing the woman to bright light in the morning with a special light box. Acupuncture is another promising therapy. The role of estrogen as a treatment is being explored. We recommend that women consider these therapies and select those that are most consistent with their own values. 

Since women who have had one prior episode of postpartum depression have a 25% risk for another postpartum episode, it is important that they be monitored more closely and seek treatment immediately if symptoms occur, or that they be treated preventively before the episode begins.

Can women breastfeed and take antidepressants at the same time?

There are a number of benefits to breastfeeding. Many new mothers committed to breastfeeding their newborns struggle with the concern that the antidepressant medication, taken to alleviate the mother’s depression, may harm their baby. The decision to bottle feed the baby means that the benefits of breastfeeding will not be available to the baby. Breastfeeding while depressed means that the baby will be exposed to maternal depression. Women and health care practitioners must have information to help with this decision-making. 

The benefits and risks of breastfeeding while taking medications must be carefully considered and discussed with the physician. All medications are excreted in breast milk. Our group and other investigators have done research specifically focused on antidepressant levels in breastfed full-term healthy infants of mothers on antidepressant medications. Premature or ill newborns may have greater difficulty metabolizing (breaking down) drugs and may be at greater risk to having higher levels of antidepressant medication.

In a comparison study, data on blood samples taken from 337 mothers and 238 infants were reviewed, including drug levels for 15 antidepressants. Antidepressants identified that did not develop detectable or elevated blood levels in the breastfeeding infant included: nortriptyline, paroxetine or sertraline. However, lack of any measurable amount of antidepressant in the infant may not always predict the long term effects of the medication on the infant. One small study of infants (up to 30 months of age) exposed to the breast milk of mothers on tricyclic antidepressants found no developmental problems. The long term effects of infants exposed to serotonin reuptake inhibitors in the breast milk are still not known.

It is most ideal to choose the lowest effective dose of an antidepressant for lactating mothers and to carefully observe the breastfed infant before and during the mother’s treatment on antidepressant medication.

If I tell someone about my symptoms, will I be at risk for losing my baby?

The treatment goal is to promote and maintain a healthy mother-infant relationship and bonding. Treatment interventions focus on reducing the mother’s symptoms and increasing the mother’s support systems to allow the mother to continue to care for her infant. In cases of severe symptoms of impulses to harm one’s self or the baby, interventions would focus on the safety of both the mother and the infant until those impulses have resolved. Losing custody of a child is a serious issue that treatment professionals and society try to avoid. This is extremely uncommon in women with postpartum depression. The illness is treatable and rarely, if ever, results in the mother causing harm to her infant. 

What is postpartum psychosis?

Postpartum psychosis is much less common and affects 1-2 in 1000 women after having a baby. It typically presents within one week and up to four weeks after delivery. This condition is an emergency and  requires immediate clinical assessment and treatment.

Symptoms progress quickly from irritability and disrupted sleep, to symptoms of poor concentration, disorganized thinking, unusual behaviors, unusual or irrational beliefs, agitation, and rapid mood changes. A woman with postpartum psychosis may express significant feelings of guilt regarding her child or spouse. She may experience major difficulties caring for herself or others (children). Postpartum psychosis has been linked with an increased risk of harming self or others. Postpartum psychosis is most likely a manifestation of bipolar illness (manic depressive illness). Women with this disorder should be preventively treated in the postpartum period.

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Source: Northwestern University - Feinberg School of Medicine


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