Do I have Postpartum Depression? (“Abigail’s* Story”)

Many women want to know what postpartum depression is and what the symptoms are. During the first week after the birth of a child, many women experience a brief period of feeling overwhelmed and tearful. In fact, up to 80% of women experience these symptoms and they are typically referred to as the “baby blues.” The onset of these symptoms usually occurs within the first week after giving birth. The predominant symptoms include fluctuating mood, tearfulness and anxiety. These symptoms typically peak in the fourth or fifth day after delivery and may last for a few hours or a few days, but resolve spontaneously within two weeks of delivery. Up to 10 to 15% of women will present with more significant depressive symptoms that constitute postpartum depression. It is important to be able to distinguish between the minor postpartum depression-like symptoms that resolve on their own shortly after delivery, and the more serious, lingering post partum depression symptoms that require prompt treatment to ensure the health and well-being of both mother and newborn.

Abigail had a baby boy 8 months ago. She was tearful by the time she left the hospital and continued to feel a sense of sadness and emptiness even after she returned home. She felt unable to care for her son, and felt that he would be better off in someone else’s care. She avoided interacting with her son as much as possible. Despite having significant help, and not having to deal with her son’s day-to-day care, Abigail felt unable to do anything else. Things that she usually enjoyed, such as reading a magazine or watching her favorite TV show, she no longer had any desire to do. She was unable to fall asleep at night and had lost her appetite. Although Abigail was a successful lawyer, she could not make simple decisions and became overwhelmed when forced to. She described feeling a sense of emptiness that she had never experienced before. Abigail was suffering from post partum depression.

Women experiencing postpartum depression symptoms usually complain of depressed mood, tearfulness, irritability, loss of interest in their usual activities, insomnia, fatigue, loss of appetite, and ambivalent or negative feelings towards their baby. They will often have doubts or concerns about their ability to care for their baby. In some cases, postpartum depression symptoms can even include passive suicidal thoughts.

A more severe version of Abigail’s story is the following:

As her symptoms worsened, Abigail began to have disturbing thoughts about harming her baby. These were thoughts over which she had no control. She would often think about throwing her baby out of the window, or down the stairs. She scared herself with these thoughts and was embarrassed to share them with anyone else, so she began to avoid stairwells and windows. Her anxiety, as well as her sense of guilt, increased tremendously. For several weeks, Abigail tried to battle her symptoms and hoped that they would get better on their own. At some point, her husband suggested that she seek help and despite not even knowing the severity of her symptoms, was able to convince her to make an appointment. Abigail was seen for a consultation and soon thereafter she started on antidepressant medication and began therapy for her postpartum depression symptoms. Abigail responded very well to treatment, and was able to enjoy her baby in a way that she did not know was possible. Abigail is currently tapering off her postpartum depression medication in anticipation of getting pregnant again, something that she thought she would never have the desire to do.

Women with postpartum depression can experience intrusive, obsessive thoughts that frequently involve the baby and can often be violent in nature. For example, a mother may have thoughts about smothering her infant. Women are very distressed by these thoughts and usually go out of their way to ensure their child’s safety. These thoughts are very disturbing to women experiencing them and should be brought to the attention of their OB/GYN or referred to a psychiatrist immediately. A small percentage (0.1 to 0.2%) of women suffering from postpartum depression will go on to have postpartum psychosis. These symptoms usually begin within the first two weeks of birth and involve agitation and irritability, depressed or elated mood, delusions and disorganized behavior. Delusional beliefs are common and often center on the infant. Auditory hallucinations may instruct the mother to harm herself or her infant. These are often the cases reported in the media that have unfortunate outcomes if the mother does not immediately seek help. It is important for new mothers who experience the symptoms of postpartum depression or postpartum psychosis to understand that that they are not to blame for their condition, and that seeking medical advice early on can reduce and alleviate future symptoms.

Postpartum depression is a treatable condition. Treatment can improve the emotional health of the mother, as well as her ability to function. Post partum depression treatment can also improve the quality of life of the infant and other members of the family. Medication is almost always indicated and treatment with psychotherapy can dramatically improve treatment response. If a woman is treated for postpartum depression, it is recommended that she continue treatment with medication for nine months after she is symptom free to prevent the relapse of postpartum depression symptoms. It is important for friends and family to understand this recommendation, as it often involves delaying future family-planning until a woman is able to successfully get off medication. By fully treating postpartum depression and allowing a woman to get off medication, the chance of having a successful future pregnancy is increased. Any woman with a history of postpartum depression is at an increased risk of having postpartum depression for future pregnancies. Depending on the severity of her postpartum depression symptoms, it is currently recommended that women with a history start treatment with an antidepressant medication at 36 weeks of pregnancy. Because most of the medications take four to six weeks to take effect, by starting the medication four weeks prior to delivery, we increase the chances that the medication will be effective at the time of delivery, which is when a woman is most at risk for severe postpartum depression. Each case must be evaluated on an individual basis, and multiple factors need to be taken into account, including a woman’s desire to breast-feed after delivery. There are medications that are considered safe during breast feeding, and each woman needs to make a decision for herself as to what her comfort level is.

Postpartum depression typically emerges during the first few postpartum months but may occur at any point after delivery. The symptoms include:

Depressed or sad mood
Change in appetite
Difficulty falling or staying asleep (other than interruptions of caring for a newborn)
Loss of interest in usual activities
Difficulty concentrating
Feelings of guilt
Feelings of worthlessness or incompetence
Suicidal thoughts
Thoughts of harming the baby (which can be unwanted and intrusive)

Women may also experience significant anxiety. In milder cases, it may be difficult to distinguish symptoms of post partum depression from symptoms that occur in the postpartum period in the absence of depression. The Edinburgh Postnatal Depression Scale can be used to identify women at risk for postpartum depression. A score of 12 or greater on the scale, or an affirmative answer to question 10 (presence of suicidal ideation), raises concern and these women should immediately be evaluated by a mental health professional.

For a consultation with Dr. Naomi Greenblatt to discuss your case, please call The Rocking Chair at (201) 308-5325 .

* Pseudonym