Seventy to 80 percent of new mothers experience mild "maternity blues" that begin on or about the third day following delivery. Symptoms include tearfulness, sleeplessness, tension, anxiety, frequent mood changes, and anger. They come and go for a day to a week, and then disappear. Some 10 to 20 percent of new mothers, however, move into a full clinical depression, lasting two to eight weeks, but sometimes as long as a year. In addition to the usual symptoms of major depression, women suffering from postpartum depression feel that they are unable to care for their infants. Very rarely - in about 1 or 2 out of 1,000 previously-normal women - the depressive symptoms precede an acute psychosis. Most of the psychoses appear within two weeks of childbirth and disappear within two months, although they can continue longer. As with premenstrual syndrome, very little is known about psychiatric illnesses that develop following childbirth and whether or not they differ from depressions and psychoses that occur at other times. In addition to the dramatic hormonal shifts that take place following childbirth, stressful life events, marital problems, fear of mothering, overly high expectations of motherhood, and lack of social supports may influence whether a woman progresses from the blues to a clinical depression. According to some theories, women who become depressed postpartum may be struggling with internal conflicts regarding the nurturing they received from their own mothers. Depressive symptoms during the pregnancy may predict the appearance of these symptoms following childbirth, and previous psychiatric problems also may be a risk factor.
Women who are at risk tend to share the following characteristics:
- A previous history of depression or anxiety
- Manic-depressive syndrome
- An unwanted pregnancy
- A significant personal loss within two years
- Divorce or separation
- Background of child abuse or neglect
- Unsupportive family
- Traumatic birth experience
- Very high expectations of birth or parenthood
Of course, not all women at risk will develop postpartum depression. Indeed, the disorder usually hits women who have no reason to expect it to happen to them.
Treatment of moderate to severe postpartum depression includes antidepressants, lithium, electoconvulsive therapy (ECT), or antipsychotics, depending on the nature of the symptoms and diagnosis. Because these drugs pass through breast milk to the child, check with your physician about the advisability of breastfeeding at the same time. Psychotherapy for the woman and her family can be very helpful in enhancing coping skills, educating them on caring for a newborn, and providing support.
New mothers and their families should never take for granted mood or behavior changes following childbirth. Always consult a psychiatrist or other mental health professional when depressive symptoms continue or worsen; when the new mother feels or expresses a wish to harm herself, or feels or expresses a fear that she will harm the child; or when she becomes suspicious or begins to act in an unusual, bizarre manner. If bad moods, stress, and conflicts plague the pregnancy, try to head off the probable later depression by getting help before the baby is born. Be assertive; if a doctor does not take the symptoms seriously, get a second opinion.