Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
You've just had a baby, one of the most important and happiest events in your life. "What could make a woman happier than a new baby?" you wonder. So why are you so sad?
We don't know for sure, but you are not alone. The fact is that as many as 80% of women experience some mood disturbances in the time after pregnancy (known as the postpartum period). They may feel anxious, upset, alone, afraid, or unloving toward their baby, and guilt for having these feelings.
For most women, the symptoms are mild and go away on their own. But statistics indicate that 10%-20% of women develop a more disabling form of mood disorder called postpartum depression (PPD).
Charlotte Perkins Gilman, a prominent American writer and sociologist, wrote about her own struggles with postpartum depression in the 19th and 20th centuries. Tragic, infamous cases that involved a claim of postpartum depression or psychosis include those of mothers Andrea Yates and Susan Smith, each of whom killed their children.
The "baby blues" are a passing state of heightened emotions that occurs in about half of women who have recently given birth.
This state peaks three to five days after delivery and lasts from several days to
A woman with the blues may cry more easily than usual and may have trouble sleeping or feel irritable, sad, and "on edge" emotionally.
Because baby blues are so common, expected, and go away without treatment or without interfering with the mother's ability to function, they are not considered an illness.
Postpartum blues do not interfere with a woman's ability to care for her baby.
The tendency to develop postpartum blues is unrelated to a previous mental illness and is not caused by stress. However,
stress and a history of depression may influence whether the blues go on to become major depression.
Postpartum depression is significant, often called clinical depression that occurs soon after having a baby. Some health professionals call it postpartum nonpsychotic depression.
This condition occurs in about 10%-20% of women, usually within a few months of delivery.
Risk factors for postpartum depression include previous major depression, psychosocial stress, inadequate social support, and previous premenstrual dysphoric disorder (see premenstrual syndrome for more information).
Symptoms include depressed mood, tearfulness, inability to enjoy pleasurable activities, trouble sleeping, fatigue, appetite problems, thoughts
of suicide, feelings of inadequacy as a parent, and impaired concentration.
If you experience postpartum depression, you may worry about the baby's health and well-being. You may have negative thoughts about the baby and fears about harming the infant (although women who have these thoughts rarely act on them).
Postpartum depression interferes with a woman's ability to care for her baby.
When a woman with severe postpartum depression becomes suicidal, she may consider killing her infant and young children, not from anger, but from a desire not to abandon them.
Postpartum (puerperal) psychosis is the most serious postpartum disorder. It requires immediate treatment.
This condition is rare. A woman with this condition experiences psychotic symptoms within
three weeks of giving birth. These include false beliefs (delusions), hallucinations (seeing or hearing things that are not there), or both.
This condition is associated with mood disorders such as depression, bipolar disorder, or psychosis.
Symptoms can include inability to sleep, agitation, and mood swings.
A woman experiencing psychosis can appear well temporarily, fooling health professionals and caregivers into thinking that she has recovered, but she can continue to be severely depressed and ill even after brief periods of seeming well.
Women who harbor thoughts of hurting their infants are more likely to act on them if they have postpartum psychosis.
If untreated, postpartum psychotic depression has a high likelihood of coming back after the postpartum period and also after the birth of other children.
Early treatment of postpartum depression (PPD) is important for you, your baby, and the rest of your family. The sooner you start, the more quickly you will recover, and the less your depression will affect your baby. Babies of depressed mothers can be less attached to their mothers and lag behind developmentally in behavior and mental ability.1
Treatment choices for postpartum depression include:
Counseling for both you and your partner. Cognitive-behavioral therapy helps you take charge of the way you think and feel. Interpersonal counseling is also a good treatment choice for postpartum depression. (You may find a counselor who offers both cognitive-behavioral therapy and interpersonal counseling.) Interpersonal counseling focuses on relationships and the personal changes that come with having a new baby. It gives you emotional support and helps with problem solving and goal setting. For your partner, counseling may help with the demands of having a new baby. It can also help your partner support you.