It's easy to assume that the weeks after giving birth are joyous ones for the new mother, but many women experience emotional lows — often referred to as “the baby blues” — in the postpartum period, says UCLA psychiatrist Vivien K. Burt, MD, founder and co-director of the outpatient Women's Life Center at UCLA.
And for 10-to-15 percent of women, what at first seems to be the blues evolves into a major episode of depression. Dr. Burt says that early identification and treatment of women with postpartum depression are essential to the well-being of both mother and child.
“Postpartum can be a highly vulnerable period when women experience frequent mood swings and are emotionally hypersensitive,” Dr. Burt says. “It's important for people in the woman's life to offer support and reassurance. In most cases, postpartum blues resolves within two weeks or less. But postpartum depression is something different. New mothers with postpartum depression may experience a great deal of anxiety, become agitated, worry excessively and have trouble bonding with the baby. Unlike the blues, postpartum depression lasts many months, and this condition requires and responds to active treatment.”
Given the importance of intervening quickly to assist women experiencing postpartum depression, it is important for obstetrician/gynecologists to closely assess the mental health of their pregnant and postpartum patients, notes UCLAOB/GYN Rashmi Rao, MD, who specializes in maternal-fetal medicine. “Unfortunately, more than half of women experiencing postpartum depression will go undiagnosed, so at UCLA it is our goal to screen our patients at every visit,” Dr. Rao says.
Dr. Rao explains that the dramatic changes occurring over a relatively short period of time make women particularly susceptible to depression both during pregnancy and in the first several weeks after the delivery. “She has immense physiologic changes, and then abrupt changes in hormone levels right after delivery. On top of all of that, she suddenly has an infant who is completely dependent on her and requires attention at least every two hours, which makes for very little sleep,” Dr. Rao says.
Depressive symptoms can show themselves at any time prior to delivery, Dr. Rao notes, so it is important for OB/GYNs and their patients to be alert to any warning signs. In addition, they should be aware of other factors that increase a woman's depression risk, such as a family or personal history of depression, stressful or traumatic life events, poor social or partner support and low self-esteem. “This is a time when women are in regular contact with us and are motivated because they know they have a baby to care for,” Dr. Rao says. “We have a unique opportunity to identify when something is wrong and make sure it's not ignored.”
Treatment for postpartum depression usually includes medication, along with psychotherapy to help the woman develop coping skills. “Often, postpartum depression is dismissed as the blues by well-meaning family members,” Dr. Rao says. “Many new mothers feel guilty — they believe that they should be delighted at this time in their lives, and they are ashamed that they are so exhausted, anxious and depressed that they are unable to connect with their babies and other children at home. The shame and stigma so often associated with postpartum depression frequently prevents women from getting the help they need. The reality is that postpartum depression is not a rare condition, and when appropriately treated patients can recover and move forward to be healthy, wonderful, fully functioning and productive mothers.”