Depression After Childbirth
Why and What Can Be Done
I am a psychiatrist and a new father. While I have treated depression in women throughout my career, it is now more than ever that I can genuinely appreciate the important role that a happy, healthy mother plays in facing the challenges of having a new family. It is for this reason that I find it unfortunate that the first weeks after delivery, the postpartum period, is a time in which new mothers are particularly vulnerable to the development of a form of depression known as postpartum depression (PPD).
PPD is a medical condition that is common, affecting perhaps 10 to 20% of mothers giving birth. PPD differs from normal sadness or stress in that people with PPD suffer a broad range of symptoms in addition to low mood including decreased interest in previously fun activities, changes in sleep and appetite, fatigue, difficulty thinking or concentrating, changes in motor activity that may leave them feeling slowed down, inappropriate feelings of guilt, and even suicidal thoughts. While we do not know exactly what causes PPD, it tends to run in families with daughters and sisters of women with PPD being more likely to be affected after they have their own children. Other influences that place women at higher risk include difficult pregnancy and difficult delivery, a prior history of depression/PPD, stress experienced in personal relationships, stress with finances or a confounding physical illness. None of these influences are sufficient to cause PPD, however, and researchers continue to try and identify the underlying cause.
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Despite our limited knowledge regarding the causes of PPD, hope can be found in the fact that there are effective treatments that can alleviate the suffering of women with this illness. We do know that, if left untreated, PPD may last up to a year and can have a devastating impact on mothers and their families. Education plays a large role in the diagnosis of PPD since many women excuse the symptoms that they are experiencing as a normal response to the new stresses of motherhood. To the contrary, PPD is far from normal and women who think they are suffering from PPD should discuss this issue with their physicians. Obstetricians should become familiar with the symptoms and screen for PPD at follow-up appointments. A simple 10-question quiz can help doctors check for postpartum depression. It is called the Edinburgh Postnatal Depression Scale. The copy to the right can be shared with doctors that are not familiar with this tool. A score of 9 to 12 points indicates a woman needs further evaluation.
The treatments for PPD include antidepressant medication therapy and individual/group talk therapy. Most women can find a treatment that will effectively alleviate their symptoms. For women who decide to forgo medication and/or psychotherapy, an experimental treatment called repetitive transcranial magnetic stimulation (rTMS) may provide relief from PPD. rTMS is a novel therapy to treat depression that has already been approved in Canada and now is in the process of seeking approval from the Food and Drug Administration in the United States that involves the use of a magnet to stimulate the mood centers in the brain. Information regarding the rTMS device and how it works in depression can be found on the internet at Neuronetics.com. The treatment is simple and well-tolerated, and hopefully will come to market in the very near future to help women with PPD who do not want to take medication.
In conclusion, PPD is a problem that can be conquered through education and understanding. While the academic community continues to face the daunting task of discovering the underlying cause, there is enough known to help the women who suffer from PPD. The illness is easily diagnosed and treated if it is recognized. Women should develop an understanding of PPD, and make it a point to teach their friends and sisters about the symptoms and treatment. Obstetricians and nurse midwives should learn to recognize PPD and to refer their patients for treatment, as well as provide family/community education to give support to the women who are suffering. The academic community has a responsibility to continue in their efforts to understand the causes, develop new treatments, and to educate the public through publications and appearances in public forums. Every mother deserves the chance to be happy during a period that should be one of the happiest in their lives. Together we can secure that opportunity.
