Understanding Postpartum Depression -- Diagnosis and Treatment

How Do I Know If I Have Postpartum Depression?

Despite the fact that postpartum depression has been known about for a long time, many experts believe it isn’t being properly diagnosed. As knowledge about postpartum depression grows, more health care professionals are looking for risk factors in their patients as early as their first prenatal care visit.

If a woman is at risk, their doctor can evaluate their moods throughout the pregnancy. After a woman gives birth, they and those close to them should watch for symptoms of depression. Their doctor should look for such signs at their 6- week postpartum visit, as well.

There’s no blood test or body scan that shows you have this mood disorder. Instead, your doctor will ask certain questions about your state of mind. The most common PPD screening tests are:

• Edinburgh Postnatal Depression Scale (EPDS). Many doctors think of this as the best way to check for PPD. It’s a list of 10 short statements. For each one, you’ll say how often you’ve felt that way in the past 7 days. They include things like “I have been anxious or worried for no good reason” and “The thought of harming myself has occurred to me.”
• 2-Question Patient Health Questionnaire (PHQ-2). Although it’s short, this is thought to be a good first screen of women who may have PPD. You’ll be asked how often, over the past 2 weeks, you’ve felt little interest or pleasure in doing things or down, depressed, or helpless. You’ll have four answer choices that range from “Not at all” to “Nearly every day.”
• 9-Question Patient Health Questionnaire (PHQ-9). If the PHQ-2 shows that you may be depressed, your doctor will ask about other symptoms, like sleep and appetite changes, trouble focusing and low energy. The more often you have them, the more likely it is you’re depressed.

If you have symptoms of postpartum depression, your doctor will evaluate their severity, including asking about whether you have thoughts of harming yourself or your baby. They’ll also ask about other mood-related symptoms to determine whether you have postpartum depression or another condition, such as bipolar disorder or postpartum psychosis. Your thyroid levels also may be checked to make sure the gland is working the way it should. Hypothyroidism can cause the same symptoms as postpartum depression.

What Are the Treatments for Postpartum Depression?

Postpartum depression sometimes goes away on its own within 3 months of giving birth. But if it interferes with your everyday life at any time, or if "the blues" last longer than 2 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. 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 get worse. Also, experts have found that children can be affected by a parent's untreated PPD. They may be more prone to sleep disturbances, impaired cognitive development, insecurity, and frequent temper tantrums.

While you’re recovering from postpartum depression, you’ll 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.

Medications for Postpartum Depression

The first step in treatment is to resolve immediate problems such as sleep and appetite changes. Antidepressants are usually very effective for this.

You and your doctor will need to make a careful decision about the use and choice of antidepressants if you’re 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 about whether lithium poses a real risk.

Talk to your doctor to determine if the benefits of antidepressant therapy outweigh the risk. If you take an antidepressant, you’ll probably be advised to take it for at least 6 months to a year to avoid a relapse and then to taper it off or continue it, depending on your symptoms and history.

Also, if you’ve had a previous episode of postpartum depression, your doctor may suggest that you take preventive medicine shortly after the baby is born or during pregnancy.

Most antidepressants don’t 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 don’t want to become pregnant again right away. However, if you’re being treated for postpartum depression, you may want to choose a contraception method other than birth control pills, which may aggravate the symptoms of depression. Talk with your doctor 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 postpartum depression. Your doctor can refer you to a qualified mental health professional who specializes in treating postpartum depression.

You’ll meet with a counselor on a regular basis to talk. They’ll ask about your life, and it’s important that you answer honestly. You won’t be judged for what you tell, and whatever you talk about will be just between the two of you.

Your counselor will teach you how to look at some things differently and how to change certain habits to help yourself feel better. There are two common types of therapy for women with postpartum depression:

• Cognitive behavioral therapy. You and your counselor work together to identify, then change, thoughts and behaviors that are harmful to your mental health.
• Interpersonal therapy. Your therapist helps you better understand how you behave in your relationships and how to work through any problems.

Postpartum Depression Support Groups

Support groups may be very helpful if you have PPD. They may provide useful information and ideas about how to handle 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 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 doctor can help you plan an exercise program that's right for you.

Complementary and Alternative Postpartum Depression Treatments

You may not want to take a prescription drug, especially if you’re breastfeeding. Talk to your doctor about whether you should try any of these therapies, either instead of or along with standard medical treatment:

• Yoga. In one study of depressed new moms, more than three-quarters of them who did yoga twice a week for 8 weeks got better.
• Massage. It may have a positive effect on postpartum depression. Although more studies are needed, findings suggest that massage helps improve symptoms.
• Relaxation training. Techniques like deep breathing, guided imagery, and self-hypnosis can teach you to soothe yourself. More than a dozen studies have shown that relaxation training can help you recover from depression.
• Meditation. Learning to meditate lets you “exist in the moment.” You focus on your breathing and let go of your thoughts. It might help you with your depression.

Study results on herbal and dietary supplements like St. John’s wort are mixed. Acupuncture and light therapy have not been shown to be effective with postpartum depression.

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