Information About Postpartum
Please note that reading this information is not a substitute
for getting a professional evaluation and appropriate treatment.
If you feel you or a family member has a problem, please seek
Risk Factors for Post Partum Disorders (PPD) include the first
birth of a child, prior PPD episodes, a personal history of mood
disorder such as depression or bipolar disorder, anxiety disorders
or a family history of these disorders. PDD tends to run in families.
Hormonal imbalances may also be involved. The causes of postpartum
disorders are still not well understood, but they probably include
genetic, hormonal, cultural and psychological factors. For example,
after birth both estrogen and progesterone drop rapidly 24 to
48 hours after birth. These hormonal changes and others may trigger
symptoms in some women, so treatment may include an estrogen patch
or other forms of estrogen therapy. In addition, problems with
thyroid functioning (such as hypothyroidism) may be associated
with some symptoms. Thyroid hormones (for example, thyroxine)
are often used in conjunction with anti-depressants or mood stabilizers.
disorders are usually divided into the following three categories.
Baby Blues: Probably every new mother
experiences the baby blues to some extent. However, official estimates
of its occurrence are 70% to 85% of all women. The typical onset
is generally a few hours to about 3-4 days after birth. Symptoms
may last several days to about two weeks. The average duration
is about 12 days, but the worst period is usually around seven
days after birth. The symptoms include mood swings, exhaustion,
irritability, anger, crying for no reason, anxiety, insomnia,
appetite disturbance and lack of interest in personal care or
care of the baby. The baby blues are time limited and will go
away with no formal treatment. However, social support from the
father of the child and other family members can go a long way
towards helping the mother cope with the symptoms. In addition,
support groups are often very helpful. If you think you have the
"baby blues," I would recommend that you visit the sites
below. If these symptoms do not go away, it is important to get
a complete medical evaluation as soon as possible.
Online support group
lighter shade of blue
Postpartum Depression (PD): This occurs
in about 10%-20% of new mothers, but this may be a low estimate
as only about 25% of women with PD seek treatment. Onset may
be a few days or weeks after birth, but rarely it may develop
up to a year after birth. Symptoms of PD may be similar to those
of the baby blues except that they are much more extreme and may
last for months. These include depressed mood, anhedonia (inability
to feel pleasure), fatigue, feelings of guilt or worthlessness,
intrusive thoughts (often about the baby), sleep disturbance,
thoughts of suicide, fear for the wellbeing of the baby, difficulty
with thinking or concentrating, extreme mood swings, loss of libido
(interest in sex), feelings of guilt or low self-esteem. The
important point about postpartum depression is that you must get
appropriate medical evaluation and treatment as soon as possible.
Treatment Options: If the depression is mild, anti-depressants
may not be necessary (you and your physician will decide this
together). However, it is probably wise to undergo psychotherapy
with someone who specializes in depressive disorders or PPD.
If the symptoms of depression are more severe or last more
than a few weeks, anti-depressant medications are often used.
These days, the most commonly used anti-depressants for PD are
the Selective Serotonin Reuptake Inhibitors (SSRI). These medications
tend to have less side effects and drug interactions with other
medications than the older anti-depressants. For example, Zoloft
(Sertraline) tends to be a popular choice because it seems to
have few effects on infants whose mothers are breastfeeding.
Other SSRI drugs include Prozac (Fluoxetine) and Celexa (citalopram
hydrobromide). Tricyclic antidepressants (TCA, a older generation
of anti-depressants) may be used, but these are more lethal in
overdose, are more likely to cause weight gain, and generally
have more side effects than the SSRI drugs. However, they are
a treatment option if SSRI do not work, and some persons may actually
find them to be more effective than SSRIs. Examples of some popular
TCA drugs are Elavil (Amitriptyline), Tofranil (Imipramine), and
Welbutrin (Bupropion) is a so called atypical anti-depressant
because its chemical action appears to be different than other
anti-depressants. Some advantages of Wellbutrin are that it tends
not to cause weight gain, it is a more stimulating and it tends
to be less likely to induce a manic episode in women with a bipolar
predisposition. However, Wellbutrin should not be used by women
who have a history of seizure disorders or eating disorders.
If you are breastfeeding, be sure to check with your physician
before taking any anti-depressant drugs. Also, almost all of the
anti-depressant drugs may induce a manic episode in some women,
so you should carefully discuss your and your family's history
with your physician.
If you have a previous history of bipolar disorder, or experience
extreme mood swings, your physician may prescribe a mood stabilizer.
Please see the list of some commonly used mood stabilizers below.
Most of these are actually anti-seizure medications but they have
been found to be very effective in controlling mood swings.
* Carbamazepine (Tegretol)
* Divalproex (Depakote, Depakene, Valproate, Valproic Acid, appears
to besuperior for "rapid cyclers")
* Gabapentin (Neurontin)
* Lamotrigine (Lamictal)
* Lithium (most often used for classical manic symptoms)
* Topamax (topiramate-may cause less weight gain)
Go here for
information about these and other medications
In cases of severe depression or acute suicidal risk, electro-convulsive
therapy (ECT) may be an appropriate treatment option. Although
this may be a controversial treatment method, it tends to be very
effective and usually does not have many long term severe side
information about depression
Postpartum Psychosis (PPP): This is
the most severe of all of the PPD and has a prevalence of about
1 or 2 in a thousand births. The symptoms may be similar to postpartum
depression (severe insomnia, anxiety and agitation, suicidal
and homicidal thoughts, bizarre feelings and behaviors), except
that the person experiences psychotic episodes. These may include
auditory hallucinations. For example, you or your family member
may hear voices when no else one is there. Sometimes the voices
are derogatory or command the mother to hurt herself or her baby.
The mother may also have delusional beliefs, which are fixed ideas
that are not true and are inconsistent with reality. Typically
these are of a religious type. For example, the mother may think
child is possessed, or the devil or Christ. The onset for PPP
is usually within three months after birth. Infanticide, although
rare, is most common with this type of psychosis. Treatment for
PPP typically invloves anti-psychotic medications. A commonly
used anti-psychotic medications is Zyprexa (Olanzapine), which
is also FDA approved as a stand alone drug for Bipolar I disorder.
It tends to treat all three symptoms of PPP-depression-mood swings
and psychosis. Other so-called atypical anti-psychotic medications
are also often used, including Risperidal (Risperidone),
Seroquel (Quetiapine) and Clozaril (Clozapine). Sometimes the
older "typical" anti-psychotic medications such as Haldol
(Haloperidol) may be used but these tend to have more side-effects.
The risk of postpartum psychosis increases if the mother had
a postpartum depression or if she had a postpartum psychosis The
risk of recoccurence is about 30% to 50% after each delivery.
Some professionals believe that postpartum psychosis is a bipolar
spectrum disorder and up to 80% of cases have either had a prior
bipolar episode or may have a latent predisposition for this disorder.
Thus some physicians automatically use a mood stabilizer with
PPP even in the absence of mood swings. In a similar vein, in
order to prevent PPP, early treatment in women with prior episodes
may include psychotherapy, anti-depressants, mood stabilizers
or other medications right after birth, before actually symptoms
Having treated a number of women with PPP myself, I would like
to share that it is an extremely serous disorder and requires
immediate attention and treatment. Often the mother may not have
any insight that there is something wrong with her or she may
continue to believe that the delusions are not real no matter
what you say to her. That is way family intervention is very important.
The risk of suicide
increases with either postpartum depression or postpartum psychosis.
Although these are the most common postpartum disoders, researchers
are finding that other mental conditions may also first appear
after birth as well. These include obsessive-compulsive disorder,
panic disorders and other anxiety disorders. My own opionion is
that many other mental disoders may first appear after birth,
but little research has ben done in this area so far.
information about suicide
about PD and PPP