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Frequently Asked Questions : About Postpartum Depression

Research | About Postpartum Depression

What are the baby blues?
What is postpartum depression?
Who is at risk for postpartum depression?
How can I be screened for postpartum depression?
What happens when depression is left untreated?
What are possible treatments for postpartum depression?
Won’t the antidepressant medication harm my baby?
Can women breast-feed and take anti-depressants at the same time?
If the antidepressent is supposed to help my sleep disturbance and “knocks me out”, will I sleep through my baby’s cry?
The depressive symptoms are no longer present. Can I stop taking my antidepressant medication?
If I tell someone about my thoughts or symptoms, won’t I be at risk for losing my baby?
What is postpartum psychosis?

Q. What are the baby blues?

A. The baby blues affect up to 75% of mothers shortly after the 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, making difficult 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.

Q. What is postpartum depression?

A. 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. Any one can develop depression. There are many treatments.
 

Q. Who is at risk for postpartum depression?

A. 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 major drop in hormone levels shortly after delivery, which causes major physiological stress, and postpartum depression.

Q. How can I be screened for postpartum depression?

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

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 us or see your physician for any questions.

Q. What happens when depression is left untreated?

A. 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! At one out of eight women, 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.

Q. What are possible treatments for postpartum depression?

A. 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 (some right here in Pittsburgh, which has the largest research Center in the country at UPMC). 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.

Treatment studies are available at the WBHC.

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.

Q. Won’t the antidepressant medication harm my baby?  Can women breast-feed and take anti-depressants at the same time?

A. There are a number of benefits to breastfeeding. Many new mothers committed to breastfeeding their newborns struggle with their 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 in fact, 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: nortiptyline, 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) 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 antidepressant dose for lactating mothers and to carefully observe the breastfed infant before and during the mother’s treatment on antidepressant medication.

Q. If the antidepressent is supposed to help my sleep disturbance and “knocks me out”, will I sleep through my baby’s cry?

A. The antidepressant medication will help improve the mother’s disturbed sleep patterns but will not be over-sedating that the woman cannot wake and respond to her infant’s needs. Antidepressants are not sedatives, but medications that correct the dysregulation symptoms of this mood disorder as well as the symptom of depression itself. They are not addicting.

Q. The depressive symptoms are no longer present. Can I stop taking my antidepressant medication?

A. Often, women may treat their antidepressant medication as they would a decongestant or pain reliever. The symptoms are no longer present; the medication is no longer needed. However, with antidepressant medication, symptoms reduce and resolve when the medication is actively working. If the medication is stopped, the symptoms may return. Another possible complication is that the woman may experience uncomfortable physical withdrawal symptoms if she stops the medication abruptly. These symptoms are not because the medication is addicting (like alcohol or heroin), but because sudden stopping of any drug that has multiple effects on the body means that the body must readjust. These symptoms feel like mild flu and are not life-threatening.

When women have reached the effective dose of their medication, it is important to address the possible tapering/discontinuing plan of the medication at that time. Generally, from the time the woman has reached an effective dose of medication, discontinuation would be considered 9 months to a year later. If this is a recurring depression, the woman and her physician may discuss longer term medication treatment.

Q. If I tell someone about my thoughts or symptoms, won’t I be at risk for losing my baby?

A. 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 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. Sadly, Andrea Yates had postpartum psychosis (not depression) and we hope that her terrible tragedy will bring more attention to mothers in America, who have a high risk for psychiatric complications of childbearing.

Q. What is postpartum psychosis?

A. Postpartum psychosis is much less common and affects 1-2 in 1000 women after having a baby. It typically presents within 1 week and up to 4 weeks after delivery. This condition is an emergency and women will require immediate clinical assessment and treatment.

Symptoms progress quickly from irritability and problems falling asleep, to symptoms of poor concentration, disorganized thinking, unusual behaviors, unusual or irrational beliefs, agitation, and rapid mood changes. They may express significant feelings of guilt regarding her child or spouse. Women 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.

© 2003 Women's Behavioral HealthCARE