Understanding Postpartum Depression -- Diagnosis and Treatment

How Do I Know If I Have Postpartum Depression?

Despite the fact that postpartum depression has long been known, many experts believe it is not being properly diagnosed. As knowledge about postpartum depression grows, more health care providers are looking for risk factors in their patients as early as their first prenatal care visit. If a woman is at risk, her health care provider can evaluate her moods throughout the pregnancy. After a woman gives birth, she and those close to her should watch for signs and symptoms of depression. Her health care provider should look for such signs at her six-week postpartum visit, as well.

If you experience the symptoms of postpartum depression, your health care provider will evaluate the severity of your symptoms, including asking about whether you have thoughts harming yourself or your baby. Your health care provider will also ask about other mood-related symptoms to determine whether you are suffering from postpartum depression or another condition, such as bipolar disorder or postpartum psychosis.. Your thyroid levels also may be checked to make sure it is functioning normally. Hypothyroidism can cause the same symptoms as postpartum depression.

What Are the Treatments for Postpartum Depression?

Postpartum depression (PPD) sometimes goes away on its own within three months of giving birth. But if it interferes with your normal functioning at any time, or if "the blues" lasts longer than two weeks, you should seek treatment. About 90% of women who have postpartum depression can be treated successfully with medication or a combination of medication and psychotherapy. Participation in a support group may also be helpful. In cases of severe postpartum depression or postpartum psychosis, hospitalization may be necessary. Sometimes, if symptoms are especially severe, electroconvulsive (ECT) therapy may be used to treat severe depressions with hallucinations (false perceptions) or delusions (false beliefs) or overwhelming suicidal thoughts.

It is best to seek treatment as soon as possible. If it's detected late or not at all, the condition may worsen. Also, experts have found that children can be affected by a parent's untreated PPD. Such children may be more prone to sleep disturbances, impaired cognitive development, insecurity, and frequent temper tantrums.

While you are recovering from postpartum depression, you will probably see an improvement from month to month. Be aware that your symptoms may flare up before a menstrual period because of fluctuations in your hormones.

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Medications for Postpartum Depression

The first step in treatment is to resolve immediate problems such as sleep and appetite changes. Antidepressants are usually quite effective for this. You and your doctor will need to make a careful decision about the use and choice of antidepressants if you are breastfeeding. Some antidepressants are secreted in small amounts in breast milk. Other medications, such as lithium, are more controversial in breastfeeding because of concerns that they may cause infant toxicity, although there is debate if lithium poses a real risk. Talk to your health care provider to determine if the benefits of antidepressant therapy outweigh the risk. If you take an antidepressant, you will probably be advised to take it for at least six months to a year to avoid a relapse and then either taper it off or continue it longer depending on your symptoms and history.

Also, if you have had a previous episode of postpartum depression, your health care provider may suggest you take preventive medicine shortly after the baby is born or during pregnancy. Most antidepressants do not pose any major risks to a developing fetus, although all medications have potential risks. Some antidepressants including the selective serotonin reuptake inhibitors Celexa, Paxil, Zoloft, and Prozac have been associated with cardiac and cranial defects when taken early in the pregnancy. Older reports that some tricyclic antidepressants may cause limb deformities have not been confirmed in larger, more modern studies.

Many women who have given birth do not want to become pregnant again right away. However, if you are being treated for postpartum depression, you may want to choose a contraception method other than birth control pills, which may sometimes aggravate the symptoms of depression. Talk with your health care provider to decide which contraception method is best for you.

 

Psychotherapy and Postpartum Depression

Psychotherapy, or talk therapy, is commonly prescribed alone or with antidepressants to treat PPD. Your health care provider can refer you to a qualified mental health professional who specializes in treating postpartum depression. A therapist can give emotional support and help you understand your feelings and develop realistic goals, which are critical to overcoming postpartum depression.

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Postpartum Depression Support Groups

Support groups may be very helpful if you are experiencing PPD. They may provide useful information and ideas about how to cope better with day-to-day stresses.

Living With Postpartum Depression

While recovering from postpartum depression, try to take time for yourself. Get out of the house every day, even if it's just for a walk around the block. Reach out to supportive family and friends for both emotional and household help. Don't try to do everything yourself. Consider joining a new mothers support group or starting one in your area.

Exercise and Postpartum Depression

Exercise can help lift your spirits. Once you've recovered physically from giving birth, try to get some exercise every day. One study has shown that vigorous exercise after recovering from childbirth is associated with an increased feeling of well-being. Your health care provider can help you plan an exercise program that's right for you.

WebMD Medical Reference Reviewed by Traci C. Johnson, MD on April 11, 2018

Sources

SOURCES: 

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed. 2000. 

Stewart, D. Journal of Clinical Psychiatry, 2004

The Journal of the American Medical Association. “Recommendations for Screening Depression in Adults,” Vol. 315, No. 4, January 26, 2016.

Wisner K. et al, New England Journal of Medicine, 2002.

Bérard A, BMJ Open, Jan. 12, 2017.

 

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