Causes and Treatment of Post Partum Depression
The following article is by Tzipora Wolff, MD, Staff Physician at Bishvilaych Women’s Well Health Center
The post partum period is generally thought of as a happy and exciting time for new mothers. For those who have not experienced post partum depression, it is difficult to believe how sad and lonely this period of time can be for some women. The physical, psychological and hormonal changes, coupled with sleep deprivation following childbirth, make this period of time one of susceptibility to many mood disorders, the most common of which is post partum depression. This condition is seen in 8-15% of women after childbirth, and can occur any time within the first year after delivery. The onset is commonly within the first 6 months after childbirth. Similar to other forms of depression, PPD is characterized by sadness, tearfulness, feelings of guilt and inadequacy, difficulty with sleep and appetite, irritability, difficulty with memory, concentration and fatigue. The symptoms of depression should be distinguished from those of “post-partum blues” which affects 50-70% of new mothers, usually within 3-5 days of delivery. Women who suffer from post partum blues have milder symptoms which are transient, and resolve within two weeks. A woman whose symptoms persist for longer than two weeks should be evaluated for post partum depression. This condition is often under diagnosed due to the overlap of symptoms that new mothers experience such as fatigue, weight loss, sleeplessness and decreased libido which may be components of a depressive illness. It is important to recognize when a woman’s symptoms are not part of the “normal” post partum period. For example, if a woman cannot sleep when her baby is sleeping, or if she feels she needs to force herself to eat, and gets no enjoyment from her food, these are more likely to be depressive symptoms. Similarly, while fatigue and exhaustion are common, an inability to get out of bed in the morning and perform activities of daily living often signifies the presence of a clinical depression.
Women may be at higher risk for post partum depression due to genetic, biologic and environmental factors.
Regardless of the etiology, it is essential to diagnose this treatable disorder so that long term consequences don’t develop.
The treatment of post partum depression is similar to the treatment of a depressive episode in the non- post partum state. The different treatment modalities take into account the psychological factors, social factors and biological factors.
Biological factors are addressed directly by using somatic treatments such as promotion of adequate sleep, pharmacotherapy (ie. Antidepressant medication), light therapy and ECT (electroconvulsive therapy) in refractory cases. If medication is indicated, the choice of antidepressant is very individual and varies from woman to woman. A woman who wishes to continue breastfeeding may do so on certain antidepressant medications. The medications are usually continued for 2-4 weeks, before response can be assessed. If the medication is helpful, yet the response is incomplete, the dose can be increased. If there is no response after 4 weeks, a different drug is often tried. A referral to a psychiatrist is appropriate at this point. Since the response to treatment takes several weeks at a minimum, it is essential to detect and diagnose post partum depression early, in order to minimize the woman’s suffering and the detrimental effect on the entire family.
Psychological factors are addressed with individual and/or group psychotherapy aimed at reducing stress and depression. Marital therapy can be helpful, when indicated. Social factors, such as family discord, lack of education about postpartum mood disorders, and economic stressors, are addressed by psychotherapy and appropriate social services interventions.
The duration of treatment for a first episode of post partum depression is for 12 months. Women who have suffered from depression in the past may need an extended course of treatment. The prognosis with treatment is excellent. Most women are able to recover fully and continue to enjoy this exciting time in their family lives. Untreated, patients with post partum depression can progress to a chronic depression which may be more difficult to treat. This can affect the mother-child bonding and have adverse affects on her marriage and family life.
Information specific to observant Jewish women can be obtained through NITZA – The Israel Center for Maternal Health. This organization was founded in 1997 to support and financially assist women across Israel suffering from the devastating effects of Postpartum Depression and its related syndromes. For information about NITZA contact: (02) 533-2810 or nitzappd@013.net or visit our their website at www.nitza.org.
General information about depression during and after pregnancy can be obtained by contacting the National Women’s Health Information Center (NWHIC) at 1-800-994-9662.