Anxiety, Depression, and the Postpartum Period

ANXIETY, DEPRESSION, AND THE POSTPARTUM PERIOD

Although pregnancy and childbirth are usually joyous times, depression to some degree is actually common in the postpartum period. There is a wide spectrum of response to pregnancy and delivery, ranging from mild postpartum blues to postpartum depression (Table 11.2). Approximately 70% to 80% of women report feeling sad, anxious, or angry beginning 2–4 days after birth. These postpartumblues may come and go throughout the day, are usuallymild, and abate within 1 to 2 weeks. Supportive care and reassurance are helpful in ensuring that symptoms are self-limited. Approximately 10% to 15% of new mothers ex-perience postpartum depression (PPD), which is a more serious disorder and usually requires medication and counseling. PPD differs from postpartum blues in the sever-ity and duration of symptoms. Women with PPD have pro-nounced feelings of sadness, anxiety, and despair that interfere with activities of daily living. These symptoms do not abate, but instead worsen over several weeks. Postpartum psychosis is the most severe form of men-tal derangement and is most common in women with preexisting disorders, such as manic–depressive illness or schizophrenia. This condition should be considered a medical emergency and the patient should be referred for immediate, often inpatient, treatment.

While the exact cause of PPD is unknown, several associated factors have been identified. The normal hor-monal fluctuations that occur following birth may trigger depression in some women. Women who have a personal or family history of depression or anxiety may be more likely to develop PPD. Acute stressors, including those specific to motherhood (childcare), or other stressors (e.g., death of a family member) may contribute to the development of PPD. Having a child with a difficult tem-perament or health issues may lead the mother to doubt her ability to care for her newborn, which can lead to depres-sion. The age of the mother may influence susceptibility to PPD, with younger women more likely to experience depression than older women. Toxins, poor diet, crowded living conditions, low socioeconomic status, and low social support may also play a role. A strong predictor of PPD isdepression during pregnancy. It is estimated that half of allcases of PPD may begin during pregnancy. PPD may also be a continuation of a depressive disorder that existed prior to pregnancy, rather than a new disorder.

Treatment must be tailored to the patient’s individ-ual situation. Postpartum blues do not require treatment other than support and reassurance. Women with PPD should receive mental health counseling and medica-tion, if warranted. Effective therapies for the treatment of PPD include cognitive-behavioral and interpersonal therapies.