Postpartum Depression Management

By Alison Heyerdahl

Being a new mom is tough. Period. Your body has undergone the most dramatic shift of your entire life and you have a new person who is totally dependent on you for every single one of their needs.  The responsibility, demanding schedule, and hormone changes can be overwhelming, to say the least.  

It has been found that up to 80% of women experience "baby blues" postpartum.  This condition starts within the first few days of giving birth, peaks on the fifth day, and usually resolves within two weeks.  It is thought that the baby blues are a result of dramatic hormonal shifts that occur directly after childbirth.  Symptoms include crying episodes, poor sleep patterns, irritability, anxiety, and feelings of depression.  This should not be confused with postpartum depression, a more severe and persistent condition that requires medical intervention.

While the stats and prevalence of postpartum (or perinatal) depression vary, the American College of Obstetrics and Gynecologists, (ACOG, 2015), defines perinatal depression as “any major or minor depressive episode during pregnancy or in the first year after childbirth.”  It is estimated that around one in seven women will suffer from postpartum depression in their lifetime.  They do not distinguish the perinatal (or pregnancy) depression as a separate disorder, and state that the depressive episode can occur during pregnancy or start within four weeks after delivery.  Symptoms of postpartum depression include:

• An extremely depressed mood

• Loss of interest in previously enjoyable activities

• Thoughts of death or suicide

• Feelings of hopelessness, helplessness, or worthlessness

• Thoughts of harming yourself or others

• A lack of interest in taking care of yourself or your baby.

Risk factors associated with postpartum depression include:

• Experiencing the “baby blues” after delivery

• A prior history of depression or a major depressive episode

• Symptoms of depression during your pregnancy

• A family history of depression

• Stressful or traumatic life events (physical, psychological, sexual abuse, or other trauma)

• Financial or relationship issues

• An unwanted pregnancy

• Difficulties with breastfeeding

• Having a baby with special needs

If you suspect that you may have postpartum depression, visit your healthcare provider immediately.  They will conduct a screening process to verify that you do indeed have the condition.   Screening for postpartum depression involves completing a form, followed up by a face-to-face interview with your healthcare provider to determine the presence and severity of the condition. 

What treatment options are available for postpartum depression?

Nonpharmacological treatment

Nonpharmacological modalities (those that don’t use drugs) are the first choice of treatment for mild to moderate postpartum depression.  Psychological and behavioral therapies which include counseling, Cognitive Behavioural Therapy (CBT), interpersonal psychotherapy (IPT), and partner-assisted IPT have proven to be effective.   Treatment is dictated by the chief symptoms that you may be experiencing.  For example, if you are feeling overwhelmed and anxious, you may respond well to a cognitive-behavioral intervention (e.g. stress management, problem-solving, and goal setting).  Your counselor (or psychologist) may also help you by developing a Postpartum Depression Action Plan.  If your depression is not improving with these treatment modalities, your doctor may consider pharmacologic treatment.

Pharmacologic Treatments

Women with more severe and persistent symptoms and who don't respond well to psychological or behavioral therapies may require medication.  Anti-depressants such as Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly used to treat postpartum depression.  Other antidepressants are available on the market and have also been found to be effective.  Doctors will generally start you on a low dose and increase it as necessary, because any side effects may be a barrier to compliance.  Furthermore, a low dose is preferable if you are breastfeeding.  Even if depressive symptoms subside, antidepressant therapy may continue for 6 – 9 months and then be tapered off slowly to prevent withdrawal symptoms. 

Call your doctor immediately if you experience any of the following side effects with antidepressant therapy:

• Headaches

• Nausea

• Nervousness

• Tremor

• Decreased libido

• Sustained hypertension

Your doctor may decide to review your medication dose or try you on another medication.

Take-Aways

The birth of a baby is one of the most life-changing events you will experience.  Hormonal shifts and the responsibility of caring for a new person can be overwhelming but can feel near-impossible if depression occurs.  Remember that postpartum depression is no one's fault, and can affect any woman regardless of age, culture, or education.  Treatments available for postpartum depression include psychological and behavioral therapies in addition to pharmacological interventions which have proven to be effective.  Call your doctor immediately if you suspect you may be suffering from postpartum depression.