Postpartum Depression: Diagnosis and Treatment

The birth of a child is generally a joyous occasion. Many new moms are thrilled that so many precious moments are yet to come. Milestones like walking and talking, birthdays and graduations and family fun. But, for some mothers, the moments and days and weeks after giving birth aren’t always filled with joy. In fact, five to ten percent of all women who give birth suffer from postpartum depression.

What is it?

Postpartum depression is a serious mood disorder that occurs in the first few weeks after delivery.

Stephen Ferrando, M.D., the Director of Psychiatry at Westchester Medical Center in Valhalla and Chairman of Psychiatry at New York Medical College, notes that postpartum depression, which sets in several days to weeks after giving birth, is different from postpartum blues, which typically surfaces right after giving birth and only lasts a few days. Ferrando says postpartum depression “occurs gradually or all of a sudden about four to six weeks after delivery.” The mother, who may not have seemed troubled at first, can become depressed, anxious, indifferent and irritable. Women with postpartum depression can feel hopeless and even feel like causing harm to themselves or to the baby, which Ferrando says is clear evidence of the disorder. “It’s not clear why the change in mood happens,” he adds.

Some women, who may have experienced stress before the baby’s arrival, can be profoundly affected. “The woman may have had struggles prior to giving birth,” he says. Typical family stresses such as strain in a relationship with one’s partner, loss or hiatus from a job or concerns about breastfeeding, having a “colicky” baby, sleep loss and childcare can all contribute to the occurrence of postpartum depression.

Postpartum depression doesn’t just affect women who have just had their first child – it can happen to women who have had more than one child as well. Women who have had one episode are at risk after subsequent pregnancies.

Hormonal changes early on after giving birth, such as the fall of estrogen levels, may also play a role, says Ferrando. “It’s a combination of biology and stress.”

How is it treated?

Treatment for postpartum depression isn’t specialized. Ferrando says treatment consists of a combination of psychotherapy and anti-depressants, typically administered for four to six months and then discontinued if the woman shows clear improvement.

“Treatment can be extended for someone with a history of depression,” he says. The medications offered for treatment, which often include such drugs as Zoloft, Lexapro or Paxil, do impact the mother’s breast milk supply to some extent. “Most women elect to stop breastfeeding if drugs are part of their treatment,” Ferrando says.

Women who suffer from postpartum depression often feel scared and desperate, Ferrando explains, but because of their state of mind they cannot be relied on to seek help from a friend or family member. “The social support piece is critical,” he notes. “Families often don’t realize the gravity of the situation which is why it’s so important to pay close attention to the signs of irritability and anxiety and get someone help as soon as it’s clear they need it.”

Women should seek help from their primary practitioner or obstetrician. Additionally, emergency rooms are equipped to deal with postpartum mothers, Ferrando explains, especially for high-risk situations or women with a lack of access to healthcare. If you feel a new mother is suffering postpartum depression speak to her family or other close friends. She may need assistance in getting the proper help.

Stephen Ferrando, M.D., is the Director of Psychiatry at Westchester Medical Center in Valhalla and Chairman of Psychiatry at New York Medical College.

Julie Schneyer is a Westchester-based freelance writer.

The National Institute of Mental Health (NIMH) advises if you or someone you know is in crisis:

•Call your doctor.

•Call 911 for emergency services or go to the nearest emergency room.

For more information on mental health visit the NIMH website, nimh.nih.gov.