Department of Psychiatry
Penn Behavioral Health

Penn Center for Women's Behavioral Wellness

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Postpartum

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After delivery, most women experience what are called "mood swings." They may feel happy one minute and sad and tearful the next. They may feel overwhelmed or mildly depressed, lack concentration, and find that they cannot sleep well even when the baby is asleep. As many as 8 out of 10 new mothers will experience some or all of these symptoms. If you experience these symptoms, you have what is commonly referred to as the "baby blues." The "blues" are considered to be a normal part of early motherhood and are usually resolved by approximately 10 days after delivery. Although the "blues" are thought of as normal, some women will experience more severe or prolonged symptoms of depression, or onset of panic, anxiety or repetitive worries and behaviors which make it more difficult to enjoy their new baby or life in general.



Postpartum Depression

Postpartum depression is more serious than the "baby blues" and occurs in at least 1 out 10 women after delivery. It is not clear why some women get depressed and other don't, but there are biological, psychological and social factors that appear to increase the risk that a woman will experience depression during pregnancy and/or the postpartum period.

Risk factors for postpartum depression include:

  • Previous history of depression
  • Family history of depression or bipolar disorder
  • History of severe PMS or PMDD
  • Perception of having few social supports
  • Marital difficulties

Here are some of the symptoms of postpartum depression:

  • Loss of interest or pleasure in life
  • Loss of appetite
  • Decreased energy and motivation
  • Difficulty falling asleep or staying asleep
  • Early morning awakening
  • Sleeping more than usual
  • Increased crying or tearfulness
  • Feeling worthless, hopeless or overly guilty
  • Restlessness, irritability or anxiety
  • Unexplained weight gain/ loss
  • Thoughts of death
  • Worries about harming the baby

postpartum depressionMany women who are depressed after pregnancy were also depressed during their pregnancy, particularly during the third trimester. It is difficult sometimes to know whether a woman is depressed because many of the symptoms of depression can also be normal for pregnancy and the postpartum period. For example, most women are uncomfortable later in pregnancy and have difficulty sleeping and/or feel tired. In the postpartum period, the baby frequently awakens the mother so that she is tired and more likely to feel overwhelmed and irritable. However, loss of interest or pleasure or low mood are not "normal" for pregnancy and could indicate that a woman is suffering from clinical depression.

Postpartum depression can be treated with talk therapy and/or medication. Women who are having difficulty functioning because of their symptoms should contact their doctor right away to discuss how they feel. Most women with postpartum depression do not become suicidal, however it is not uncommon for women with postpartum depression to have unpleasant thoughts that the may do something to harm their child or children. While these thoughts are upsetting, the vast majority of women do not act upon these thoughts. Women who have made a plan to harm themselves or their child should tell their family immediately and go to the nearest emergency room for a more rapid evaluation. Many women with postpartum depression will also have symptoms of anxiety that may need to be treated with anti-anxiety medication. However, both anxiety and depression are responsive to treatment with a particular type of talk therapy known as cognitive behavior therapy (CBT). During CBT a woman learns how to identify feelings and thoughts and to understand how the way she thinks leads her to feel depressed, happy, anxious or calm. Typically, a woman begins to feel better after 4-6 sessions of CBT.

No one knows how long an episode of postpartum depression will last if not treated, but research has shown that postpartum depression can have negative effects upon the woman's baby and her family.

Negative effects of postpartum depression can include:

  • Infant development delays (mainly cognitive delays)
  • Poor readiness for school
  • Childhood depression (if mother’s depression goes on for years)
  • Marital problems
  • Decreased mother-infant bonding
  • Decreased maternal self-esteem
  • Decreased maternal productivity

Since no one can tell a woman how long she will experience PPD, it is important for her to seek treatment as soon as she begins to question whether she is depressed. Often women are depressed for months, even years, before seeking help. Many new mothers worry that they will be viewed as "weak" or "incompetent" if they ask for help. It takes great strength for a woman to admit to herself that she could use professional help in order to improve. Depression and anxiety are never a sign of weak character, only that the brain is having difficulty functioning at an optimum level. If a pregnant or postpartum woman thought she had a medical problem that could affect her baby, she would never hesitate to seek help. Depression and anxiety which are medical problems related to the brain should receive no less attention than a urinary tract infection or gestational diabetes.





Postpartum Psychosis

Postpartum Psychosis occurs rarely (2 out of 1,000 new mothers) but always requires immediate treatment. Women who are psychotic may begin to think and act in ways that are very unusual for them. They may have strange thoughts that others are planning to harm them, that they have special powers, or that the baby is evil. They may talk very quickly or more than usual, have a decreased need for sleep or food, complain of racing thoughts or appear agitated. When these symptoms occur, a woman needs to see her doctor right away or go to the nearest emergency room. Women with postpartum psychosis are at higher risk for harming themselves and/or their children, thus, emergency care is crucial.





Panic Disorder

Panic Disorder occurs in up to 3 out of every 100 people, almost twice as often in women than men. Some women who have had panic attacks before they got pregnant may experience fewer panic symptoms during their pregnancy only to notice an increase in symptoms within a few weeks after delivery. Some women will experience panic attacks for the very first time after delivery. A person who is having a panic attack will experience a period of intense fear or discomfort during which 4 or more of the following symptoms occur suddenly:

  • Palpitations, pounding heart
  • Trembling or shaking
  • Sensations of being smothered
  • Nausea or stomach discomfort
  • Feelings that things around you aren’t real
  • Fear of going crazy
  • Numbness or tingling sensations
  • Sweating
  • Chest pain or discomfort
  • Feeling dizzy or faint
  • Fear of losing control
  • Fear of dying

**Many people will have only 1 or 2 panic attacks in their lifetime and not require treatment. If they occur more frequently or are distressing, treatment can be very helpful. **





Repetitive Worries and Behaviors

Repetitive Worries and Behaviors can develop during pregnancy and after delivery. Often these worries involve the health and well-being of the infant or cleanliness and order of the household. It is natural for mothers to worry whether their babies are clean, healthy and safe. It is also normal to feel the need to check on the baby a number of times during the day. However, sometimes these concerns and behaviors become excessive and the mother may even worry that she herself may lose control and do something to harm the baby. These thoughts are very frightening and many women may feel too embarrassed or ashamed to admit that they are having them. Most pediatricians, obstetricians and psychiatrists know that these mothers do not want to harm their child and will understand how distressing these thoughts can be.

If you have developed any of these symptoms it is important to remember that this is not something you brought upon yourself, and it does not reflect a personal weakness or an inability to cope. Support groups, individual therapy, behavior therapy and medications, if necessary, are available to help you begin to feel like yourself again.




 

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