FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

DAUGHTER IS AT SLIGHTLY HIGHER RISK FOR POSTPARTUM DEPRESSION

Question: My daughter is about to have her first baby. I'm worried about postpartum depression because she had a mild episode of depression a couple of years ago, and I read that this increases the likelihood that she will have depression after the birth of her child. Is this correct? What should I look for to identify the start of depression?

Answer: Your concern is valid, since several studies have shown that women who have previously had depression or other conditions that fall under the medical category of "disturbance of mood" are at increased risk of having depression after delivery. Fortunately, the risk of postpartum depression is relatively small. Some studies place the incidence as low as 3 percent. Your daughter's chance of developing a depressive episode is probably about 10 percent, the most commonly cited figure for those who've had a previous bout of depression.

Now, I'll try to help you and your daughter and the rest of her family identify the signs of postpartum depression. The events of pregnancy, delivery and the six or so weeks immediately following the baby's birth are times of intense physical and emotional change. The physical changes are obvious and important, but equally important are the accompanying hormonal and social changes. All of these events have bearing on the mother's emotional state.

Fifty to 80 percent of new mothers experience unexpectedly intense mood states a condition called "Baby Blues." The new mother may weep without severe sadness or good cause; she may also have episodes of great joy. The "Mom" is not persistently sad, just very emotional. This typically occurs 2 to 10 days after delivery and lasts for only a day or two. Overall judgment is rarely impaired, so this condition poses little risk to the baby or the mother.

"Baby Blues" is probably an emotional response to the tremendous changes a mother's physiology undergoes after delivery. The hormone levels from the pituitary, thyroid and adrenal glands change more dramatically than at any other time of life. These hormonal changes, other physical changes and the responsibility of caring for a newborn baby are enough to make anyone emotional and weepy. I'm surprised that only 80 percent of women report this phenomena.

"Baby Blues" is easy to distinguish from postpartum depression. In baby blues the "feeling low" mood passes quickly and is not accompanied by the other classic signs of depression: decreased appetite, feelings of guilt, irritability and hopelessness. Sleeplessness accompanies both depression and the responsibilities of caring for a new baby, so it isn't a useful way to differentiate between the two conditions.

Postpartum depression has all the characteristic signs of depression. These usually start anywhere from about two weeks to as late as two months after delivery. The symptoms are also persistent rather than passing in a day of two.

Postpartum depression is a potentially serious condition for the mother and baby. Although harm to the baby is not very common, new mothers with this condition often have difficulty in providing the desired care and nurturing. It's important that the correct diagnosis be made so that effective treatments can be used. Medication and counseling along with family support are usually successful. In only the most severe cases is hospitalization needed.

It is not uncommon for the new mother to have other types of emotional disorders. Anxiety and panic attacks are relatively frequent. Considerably less common are psychotic illnesses with loss of contact with reality.

Overall, your daughter's risk of emotional illness after delivery isn't particularly high. She is certainly fortunate in that she has a concerned and supportive family.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.