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Postpartum Depression (PPD)

Postpartum Depression (PPD) is a mood disorder that can affect women, and in smaller numbers men, after the birth of their child. The video provides patient testimony and information on the signs and symptoms of postpartum depression and reinforces the importance of seeking help and treatment from a health professional.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Postnatal Depression
  • PPD (Postpartum Depression)

What is Postpartum Depression? (Definition/Background Information)

  • Postpartum Depression (PPD) is a mood disorder that can affect women, and a smaller number of men, after the birth of their child. It is also known as Postnatal Depression
  • A large number of women have, what is called as “baby blues”, right after childbirth. These are usually known to last from a few days to a couple of weeks (maximum) after the child is born
  • These feelings of sadness and mood swings, which should fade within a few weeks, when they linger, it could be termed as Postpartum Depression. The condition is described as a complication of giving birth
  • Postpartum Depression can start right after birth or within a year of the child’s birth. It most commonly starts 1-3 weeks after delivery
  • The condition may also manifest in the form of anxiety, when the mother over-worries about the health and well-being of the infant

Postpartum mood disorders are classified into the following types (based on increasing severity of the condition):

  • Postpartum blues or baby blues (seen in about 75% of the cases)
  • Postpartum Depression (about 15% of the cases)
  • Postpartum psychosis (only about 0.1% of the cases)

Who gets Postpartum Depression? (Age and Sex Distribution)

  • More women are diagnosed with Postpartum Depression, but men can also be affected
  • Women under 20 years of age are more prone to develop the condition
  • The condition is reported to affect nearly 1 in 7 women after childbirth

What are the Risk Factors for Postpartum Depression? (Predisposing Factors)

The risk factors for Postpartum Depression could include:

  • Family or personal history of mental illness such as depression, anxiety, bipolar disorder, premenstrual dysphoric disorder (PMDD)
  • Past history of Postpartum Depression
  • Delivery or pregnancy difficulties (complications such as preterm or premature birth)
  • Stressors such as financial or marital problems
  • Unplanned or complicated pregnancy
  • Lack of social support
  • Having low self-esteem
  • Not breastfeeding the child (for various reasons)
  • Single parents
  • Women who under 20 years old

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Postpartum Depression? (Etiology)

The exact cause of Postpartum Depression is presently unknown, but there are many factors that can lead to development of the condition. These include:

  • Hormonal imbalance: There is a sharp drop in estrogen and progesterone hormones post-delivery, taking place within a few days
  • Problems related to the thyroid gland
  • Difficulty or unable to breastfeed
  • Lifestyle and relationship changes leading to emotional distress
  • A difficult or sick infant
  • Lack of sleep
  • Changes in parental/social roles: Having the responsibility of caring for another life, or having to care for more than one child
  • For men, it can be changes in lifestyle and/or financial concerns
  • Absence of spousal or social support

What are the Signs and Symptoms of Postpartum Depression?

The signs and symptoms of Postpartum Depression may vary from individual to another and can be mild or severe. These include:

  • Feeling sad or anxious constantly; crying excessively
  • Feeling irritable and angry
  • Feelings of guilt and emptiness
  • Having unusual or extreme fears
  • Not wanting to socialize and staying at home in seclusion
  • Losing interest in things or activities that used to be previously pleasurable
  • Not being able to interact or connect with the baby
  • Thinking about harming self or the baby
  • Eating or sleeping problems
  • Feeling extreme tiredness
  • Not trusting oneself to care and love the baby
  • Being unable to accomplish everyday tasks, such as cleaning, cooking, or keeping up with personal hygiene
  • Unable to feel loved and supported; feeling despondent
  • Low self-esteem and hopelessness
  • Some individuals may be hyperactive or experience manic syndrome
  • Men may experience mood swings, loss of sleep and appetite, feelings of sadness, and depression. These are generally noted in young fathers with a history of depression, especially those without a job or adequate financial and social support.

In some rare cases, women post-delivery of their child may develop a more severe form of Postpartum Depression, called postpartum psychosis, with magnified signs and symptoms (above) and life-threatening behaviors.

How is Postpartum Depression Diagnosed?

A diagnosis of Postpartum Depression is made mostly by evaluating the mother’s personal and family history and on performing a physical examination. Some other diagnostic tools include:

  • Many healthcare providers use certain questionnaires that are required to be taken by women after birth, to identify Postpartum Depression early. One of the most commonly used questionnaire is the Edinburgh Postnatal Depression Scale (EPDS). This is a questionnaire with 10 questions that can easily detect potential Postpartum Depression
  • Women who are aware of the symptoms can also talk to their physicians about it
  • One other criterion for diagnosis is that the symptoms should have started within 4 week of delivery
  • The healthcare provider may recommend other tests and exams, based on their evaluation of the individual

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Postpartum Depression?

A few complications of Postpartum Depression could include:

  • It is important to treat Postpartum Depression. If it is left untreated, it can become a major clinical depression
  • Severe anxiety and panic attacks
  • Also, once women have Postpartum Depression, it is more likely for them to develop depression again, during the course of their lives
  • Having the condition does not only impact the depressed person, but it may impact the whole family
  • Difficulty in establishing a good bonding with one’s child; feeding issues including child neglect
  • It can be more difficult to interact with the baby, causing future issues for the infant. These can range from behavioral problems to speech delays
  • Women with Postpartum Depression may withdraw from their partners and family, causing relationships to become strained
  • Increased risk for child obesity and developmental disorders that may affect the child’s mental health
  • Thoughts of suicide that may be recurrent

How is Postpartum Depression Treated?

Women with Postpartum Depression should look for proper support and advice. This can be through physicians, therapists, or by joining certain support groups. Medication or alternative medicine can be used depending on the individual and the level of care required. Some women may require hospitalization in order to undergo treatment.

Common treatment methods used include:

  • Counseling
  • Antidepressants for anxiety or depression, as prescribed by the attending healthcare provider
  • Hormonal therapy
  • Psychotherapy
  • Electroconvulsive therapy (ECT)
  • Diet: Maintaining a healthy diet, drinking plenty of liquids, and eating foods that contain ingredients, such as Omega 3 (found in fish, eggs, and flex seed oil), proteins (found in meats, nuts, and beans), and regularly taking their prenatal/postnatal vitamin supplement
  • Exercise
  • Women should try to sleep when the baby sleeps
  • Accepting help from family and friends and taking the time to do something that will bring personal pleasure
  • Having realistic expectations; the condition may take a little time to improve and get better

How can Postpartum Depression be Prevented?

  • A healthy lifestyle with proper diet and physical activity may help in minimizing the risk for Postpartum Depression
  • Planned pregnancy can lead to less stressor, including having adequate family and financial support
  • Education: Knowing the symptoms may not help prevent Postpartum Depression, but it will help with early diagnoses and possibly quicker recovery
  • Inform the physician if there is a prior history of the condition, so that close monitor and timely help may be provided, as needed
  • Regular follow-up with one’s healthcare provider, especially if the signs and symptoms do not subside or get worse

What is the Prognosis of Postpartum Depression? (Outcomes/Resolutions)

The outcomes are improved if Postpartum Depression treatment (counseling, support of family, and medications) is undertaken as early as possible. In most cases, the condition may last for a maximum of 12 months after birth of the child.

Additional and Relevant Useful Information for Postpartum Depression:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/emotional-well-being/

What are some Useful Resources for Additional Information?

American Psychiatric Association
1000 Wilson Boulevard Suite 1825 Arlington, VA 22209
Toll-Free: 1 (888) 35-PSYCH or 1 (888) 357-7924
Email: apa@psych.org
Website: http://www.psychiatry.org

National Institute of Mental Health (NIMH)
6001 Executive Boulevard Rockville, MD 20892
Phone: (301) 443-4513
Toll-Free: (866) 615-6464
Fax: (301) 443-4279
Email: nimhinfo@nih.gov
Website: http://www.nimh.nih.gov

References and Information Sources used for the Article:

http://www.mayoclinic.com/health/postpartum-depression/DS00546 (accessed on 04/15/13)

http://www.postpartum.net/Get-the-Facts.aspx (accessed on 04/15/13)

http://www.acog.org/~/media/For%20Patients/faq091.pdf?dmc=1&ts=20130415T1226390382 (accessed on 04/15/13)

Helpful Peer-Reviewed Medical Articles:

DelRosario, G. A., Chang, A. C., & Lee, E. D. (2013). Postpartum depression: symptoms, diagnosis, and treatment approaches. JAAPA, 26(2), 50-54.

Ellsworth-Bowers, E. R., & Corwin, E. J. (2012). Nutrition and the psychoneuroimmunology of postpartum depression. Nutr Res Rev, 25(1), 180-192. doi: 10.1017/S0954422412000091

Patel, M., Bailey, R. K., Jabeen, S., Ali, S., Barker, N. C., & Osiezagha, K. (2012). Postpartum depression: a review. J Health Care Poor Underserved, 23(2), 534-542. doi: 10.1353/hpu.2012.0037

Skalkidou, A., Hellgren, C., Comasco, E., Sylven, S., & Sundstrom Poromaa, I. (2012). Biological aspects of postpartum depression. Womens Health (Lond Engl), 8(6), 659-672. doi: 10.2217/whe.12.55

Postpartum, D., & Action, T. C. (2015). Heterogeneity of postpartum depression: a latent class analysis. The lancet. Psychiatry, 2(1), 59.

Mollard, E. (2015). Women's health locus of control during pregnancy may predict risk for postpartum depression. Evidence Based Nursing, 18(3), 73-73.

Latendresse, G., Wong, B., Dyer, J., Wilson, B., Baksh, L., & Hogue, C. (2015). Duration of Maternal Stress and Depression: Predictors of Newborn Admission to Neonatal Intensive Care Unit and Postpartum Depression. Nursing research, 64(5), 331-341.

Beck, C. T. (2001). Predictors of postpartum depression: an update. Nursing research, 50(5), 275-285.

Beck, C. T., & Gable, R. K. (2000). Postpartum Depression Screening Scale: development and psychometric testing. Nursing research49(5), 272-282.

Robertson, E., Grace, S., Wallington, T., & Stewart, D. E. (2004). Antenatal risk factors for postpartum depression: a synthesis of recent literature. General hospital psychiatry, 26(4), 289-295.

O'hara, M. W., Stuart, S., Gorman, L. L., & Wenzel, A. (2000). Efficacy of interpersonal psychotherapy for postpartum depression. Archives of general psychiatry, 57(11), 1039-1045.

Wisner, K. L., Parry, B. L., & Piontek, C. M. (2002). Postpartum depression. New England Journal of Medicine347(3), 194-199.

Miller, L. J. (2002). Postpartum depression. Jama, 287(6), 762-765.

Grace, S. L., Evindar, A., & Stewart, D. E. (2003). The effect of postpartum depression on child cognitive development and behavior: a review and critical analysis of the literature. Archives of Women’s Mental Health, 6(4), 263-274.

Paulson, J. F., Dauber, S., & Leiferman, J. A. (2006). Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior. Pediatrics118(2), 659-668.