12 March 2004

Postpartum depression: not just 'baby blues'

Many a new mother struggles with sadness, anxiety, even crying jags just after giving birth. For most, these feelings will disappear in a few days.

Many a new mother struggles with sadness, anxiety, even crying jags just after giving birth. For most, these feelings will disappear in a few days.

However, for many every year, the feelings won't go away and will probably get worse.

Those are the 13 percent of new mothers who suffer from postpartum depression, says an article in today's issue of The New England Journal of Medicine.

"We wrote this article to make people aware that this is a major health problem," says lead author Dr. Katherine Wisner, a professor of psychiatry, paediatrics, obstetrics and gynaecology at the University of Pittsburgh School of Medicine.

Don’t suffer in silence
"Women don't need to suffer with this illness. Treatment is available and effective," says Wisner, who worked at the University of Louisville School of Medicine when the article was written.

Wisner and her colleagues recommend doctors make patients aware of the symptoms of depression during and after pregnancy, and that they screen the women for depression using a 10-question test.

If depression is diagnosed, Wisner says, there are several treatment options. One is psychotherapy. Another is medication. Wisner says many of the newer antidepressants, like Zoloftl, can even be used by breast-feeding women.

Different to “baby blues”
Dr Boris Petrikovsky, chairman of the department of obstetrics and gynaecology at Nassau University Medical Center in East Meadow, N.Y., says postpartum depression can go undiagnosed because it is difficult to distinguish from the more common "baby blues."

Between 40 percent and 85 percent of all women experience the "baby blues," which usually lift quickly without intervention, says Ana Rivas-Vazquez, a psychologist with Baptist Health South Florida in Miami. They cause feelings of sadness, irritability, confusion and anxiety, and peak around the fourth day after delivery.

"If it's not gone by day 10 postpartum, it's not the blues, it's depression," Wisner says.

Postpartum psychosis
In rare cases, postpartum depression can progress to postpartum psychosis, a very serious illness that needs immediate treatment. If a new mother shows signs of hostility toward her baby or has thoughts of harming the baby, Petrikovsky says he immediately refers them to a psychiatrist.

Last March, a Texas woman, Andrea Yates, was sentenced to life in prison after she was convicted of drowning her five children in a bathtub. Her lawyers had argued Yates was a victim, too -- of postpartum depression, which drove her to commit the killings.

Petrikovsky says it's important for doctors to get to know their patients, so they can be on the lookout for signs of trouble. He also feels it would be wise for doctors to have a nurse call patients two weeks or so after delivery to see how they're feeling.

Who is at risk?
Those most at risk for postpartum depression are women who have had previous episodes of depression and those with poor or abusive relationships with their spouse, says Rivas-Vazquez.

The most important thing for women to know is that having postpartum depression doesn't mean they aren't good mothers, says Rivas-Vazquez. She says that women often don't seek treatment because they feel guilty about their depression.

"Postpartum depression is a frequent condition that is very treatable, and it shouldn't have any negative connotations," Rivas-Vazquez says

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