Postpartum Depression Is Real

By Dwenda Gjerdingen, M.D., M.S.

Brooke Shields received media attention recently for her bout with postpartum depression, a condition believed to affect between 10 and 20 percent of all women who have a child. Nearly half of all cases are thought to go unreported possibly because of misunderstandings about what postpartum depression is and how it can be treated. Fortunately, several effective treatment options are available for new mothers sidelined by this condition.

Diagnosis and symptoms

Postpartum depression is a major depressive disorder that begins within the first four weeks after delivering a baby. Some experts believe the depression can begin within several months after delivery. Postpartum depression is often missed by physicians because many women have only one checkup after they deliver their babies, and physicians do not routinely ask them about changes in mood during the visit. Some women also do not report their symptoms because they think the sadness is their fault.

You are said to have postpartum depression if you have five or more of the following symptoms occurring most days for at least two weeks (you must have at least one of the first two symptoms):

• depressed mood
• decreased sense of pleasure
• difficulty sleeping
• unusual tiredness
• change in appetite
• low self-esteem
• difficulty concentrating
• slowed motor function or agitation
• thoughts of death or self-harm.

Causes

Hormonal changes are believed to be partly responsible for post-partum depression, but researchers have yet to determine precisely how mothers' hormones affect their mood. Changes in your life after delivering a baby may also contribute. You may feel tired and overwhelmed by your new role as a mother, or guilty for returning to work.

Treatment

Treatment for postpartum depression is similar to that for other major depression. Physicians may prescribe anti-depressant medication, recommend talk therapy, or both, depending on the severity of your case. Other treatments, such as support groups, the addition of exercise to your daily routine, or dietary changes may complement your physician's prescribed treatment.

To lessen the effect of postpartum depression, you can take preventive measures. If you experienced postpartum depression after a prior pregnancy, you are more likely to experience it again, so let your physician know, and be ready to recognize the symptoms. You also can try to minimize the stress you experience after pregnancy by delaying your return to work or reducing the hours you work. Your partner can be valuable in recognizing the symptoms and dividing the responsibilities of caring for a new baby, such as late night feedings or changings.

Research

Researchers at the University of Minnesota are currently exploring ways to effectively screen women for postpartum depression at well- child checkups. Women in the study are asked to answer screening questionnaires and if the questionnaire reveals depression, participants are offered treatment from a primary care provider, a mental health professional, and a case manager who supports the women in their treatment. Through this study, the researchers hope to identify women whose symptoms might otherwise go unreported and determine if treatment from several professionals is an effective way to treat postpartum depression.

Dwenda Gjerdingen, M.D., M.S., is a professor in the Department of Family Medicine and Community Health at the University of Minnesota Medical School and a family physician at the University of Minnesota Physicians Bethesda Clinic.

Health Talk & You is an educational service of the University of Minnesota. Advice presented here should not take the place of an examination by a health-care professional. For more health-related information, go to http://www.healthtalk.umn.edu/.