Postpartum Depression

Definition

Postpartum depression occurs in 8-15% of postpartum women, 3-6 months after childbirth. Depressed mothers have less social interaction with children. It is a condition similar to major and minor depression and necessitates medical treatment.


Causes

* Biochemical changes due to childbirth.
* Strong association with previous psychological problems.
* History of depression: 30% recurrence rate.



Diagnosis

According to the American Psychiatric Association, a woman suffering from postpartum depression demonstrates at least five of following symptoms:

1. Depressed mood most of the day.
2. Markedly diminished interest or pleasure in all, or almost all, activities.
3. Significant weight loss or weight gain when not dieting, or decrease or increase in appetite.
4. Insomnia or hypersomnia.
5. Psychomotor agitation or retardation.
6. Fatigue or loss of energy.
7. Feelings of worthlessness or excessive or inappropriate guilt.
8. Diminished ability to think or concentrate.
9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt



Treatment

Mild to moderate depression can be treated with psychotherapy. Severe, chronic or recurrent depression can be treated with antidepressants and psychotherapy. For patients with suicidal ideation or suicide attempts, hospitalization and psychotherapy are needed.

1. Antidepressant Medications
Once medication is taken and is effective after a six-week trial period, it must be taken regularly for 6 to 12 months. In cases of recurrent depression, long-term maintenance of medication is the most effective way of treating and preventing depression. When discontinuing antidepressants, dosage is gradually decreased. Dosage of antidepressants is adjusted for each individual patient.

* Tricyclic antidepressants (TCAs)
TCAs are early antidepressants from the 1960s. They are as effective as the newer antidepressants, but have less tolerable side effects. The action mechanism of TCAs affects two brain chemicals: norepinephrine and serotonin. TCAs, such as amitriptyline (Elavil), nortriptyline (Pamelor), desipramine (Norpramin), and imipramine (Tofranil) are still commonly prescribed as a second or third line of treatment for depression. The most common side effects are dry mouth and constipation. Bladder problems, change in sex drive, weight gain, blurred vision, dizziness, drowsiness, and rapid heard rate also may occur.

* Monoamine oxidase inhibitors (MAOIs)
MAOIs, such as Phenelzine (Nardil), Tranylcypromine (Parnate), and isocarboxazid (Marplan) have been used for major depression, panic disorder and bipolar disorder (manic depressive disorder) since the 1960s. MAOIs are used as the last resort when other antidepressants are not effective. Dietary restrictions are required because it may have interactions with certain foods, including cheeses, pickles, beverages (wines), and with medications, including decongestants and antidepressants, especially SSRIs. This interaction can increase blood pressure sharply, which can lead to a stroke. Interaction with SSRIs can cause serotonin syndrome.

* Selective serotonin reuptake inhibitors (SSRIs)
SSRIs have fewer side effects, less toxicity, and yield a lower suicide risk than the older antidepressants (TCAs, MAOIs). SSRIs primarily affect one neurotransmitter(serotonin), while old antidepressant TCAs affect both serotonin and norepinephrine in the brain. Fluoxetine(Prozac), sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil), and citalopram (Celexa) are the most commonly used SSRIs. Side effects may include sexual problems, headache, nausea, nervousness, insomnia and agitation; however, they are usually temporary after a short period of time. Sexual problems can be common in both men and women, but reversible. When SSRIs are combined with other medications that affect serotonin, such as an MAOI, it can lead to serotonin syndrome.

* Other antidepressants
Venlafaxine (Effexor), Nefazadone (Serzone), Mirtazepine (Remeron), bupropion (Wellbutrin), are examples of other antidepressants that may be used to treat postpartum depression.


2. Counseling and psychotherapy
Psychotherapy alone may be an effective treatment for postpartum depression; but psychotherapy, accompanied by antidepressants, is a more effective in treatment.

3. Electroconvulsive therapy (ECT)
ECT is effective for pregnant and postpartum women with depression, especially psychotic depression, who have not responded to antidepressants or who cannot take medications. ECT is relatively safe, not painful, but recommended only when other treatments have failed.

4. Group therapy, light therapy, hormone therapy
Depression After Delivery, Inc. is a national, nonprofit organization that provides support for women with ante and postpartum depression. Women and families coping with mental health issues associated with childbearing, both during pregnancy and post partum, should call 1-800-944-4773 for more information, referral to support groups, telephone support, and more.