Many new moms expect to be basking in baby bliss but instead feel exhausted, weepy and experience extreme mood swings. But where do the hormonal changes and lack of sleep end and a serious case of post-partum depression begin?
On January 26, 2016, the United States Preventive Services Task Force released new guidelines recommending that all women be screened for depression during pregnancy and after giving birth. The new guidelines will hopefully be a major step in bringing recognition to the oft-ignored epidemic of postpartum depression.
Most Women Experience the Post-Baby Blues
There is a difference between the "post-baby blues" and full-blown postpartum depression. The "post-baby blues" is a term used to describe a brief and mild period of sadness in the days following birth. This condition is common, affects 50 to 80 percent of new mothers, and typically subsides without treatment.
But for 10 to 15 percent of new mothers, giving birth ushers in a devastating turn toward clinical depression, for which medical help is required. This is likely a low estimate, due to women frequently not seeking help and providers often dismissing the need for treatment.
When to Seek Medical Attention
Postpartum depression (officially called “major depressive disorder with peripartum onset”) is defined as a major depressive episode that begins either during pregnancy or in the four weeks following birth, according to the American Psychiatric Association.
It can be extremely difficult to distinguish normal adjustment to having a newborn from major depression. Many of the symptoms are extreme versions of normal experiences for a new mother, so it is important to consider context.
If a new mother is feeling a little sad, this is generally nothing to be too concerned about. However, if a new mother is experiencing extreme mood swings, has trouble concentrating, has a general lack of interest in anything or even thoughts of harming herself or her baby, it is important that she seek help immediately.
If you are unsure of whom to call, your OB or midwife can usually make recommendations for support groups, therapists and other resources.
Having a Plan Is a Key to Prevention
Prevention can go a long way toward staving off postpartum depression. New York-based midwife Anne Margolis of Home Sweet Homebirth sits down with all of her patients before the birth and has them take out a calendar and plan for at least six weeks of being “off duty,” during which their only responsibilities are to heal, breast-feed, take care of their new baby and take care of themselves.
Margolis assists her patients in organizing the support they will need from friends and family. Her approach is backed up by research: Strong social support is consistently found to be a key factor in preventing postpartum depression.
While there is no one treatment that fits all women, if you or someone close to you is suffering, being able to recognize the warning signs as early as possible and getting good advice from your health care provider can help you make the best possible decisions when facing postpartum depression.
Here are four ways you can help treat the issue.
1. Saving Your Placenta
In many cultures throughout the world women consume their placentas to aid in postpartum recovery. In recent years, this ancient practice has been growing in popularity in the United States, and many women believe that consuming their placenta (in pill form) protects them from postpartum depression.
Few scientific studies have been done on placenta consumption; so much of the evidence in favor of this practice is anecdotal. However, according to Margolis, “In 21 years of practice, all but one of my patients who chose to eat their placentas have had positive experiences with this.
Even those with histories of depression did not struggle with postpartum depression. This is not scientific evidence, but it does appear to help without apparent risk or harm.”
2. An Herbal Remedy That Might Help
If you’re interested in trying a supplement, make sure to speak with your doctor first to see if it’s safe for you and your baby. One of the most widely used herbs is St. John’s wort. It is often effective in treating mild to moderate depression as long as it’s taken regularly, and it rarely causes side effects, according to the National Institutes of Health.
Although a small amount of the active compounds have been found in the breast milk of mothers taking this herb, no negative effects have been observed, and it’s considered to be relatively safe for breast-feeding mothers. Make sure to speak with your doctor if you are considering trying St. John’s wort, as it interacts poorly with many medications.
Some evidence suggests that vitamin and/or mineral depletion might contribute to postpartum depression. However, a Cochrane review found the research to be inconclusive.
3. Talk Therapy
The good news is that, according to the American Psychological Association, talk therapy is the best place to start. Many women find this support enough to alleviate their depression, and the benefits come without the potential risks of taking supplements or antidepressant medication.
4. Prescription Medication
Maybe you’ve tried psychotherapy and supplements and have plenty of supportive people around you, but you just aren’t feeling any better. Maybe you just don’t have the energy to do any of the things you know might help. For women with more severe depression or who are not responding to other treatments, antidepressants are worth considering.
This is an extremely complex and personal question, and there are no definitive answers. Breast-feeding mothers facing depression can have a particularly challenging time weighing out the risks of untreated depression versus risks associated with antidepressants.
The benefits of breast-feeding as well as the risks of untreated maternal depression might outweigh the potential impact of the exposure. Untreated persistent maternal depression is associated with cognitive and emotional delays for the child.
However, short-term maternal depression doesn’t seem to have the same negative outcomes, so the imperative is to get the support you need as quickly as possible. Infants of breast-feeding mothers who are taking antidepressants are exposed to small amounts of the medication.
It is not yet clear what the long-term effects of this exposure might be, and it is important to note that the research on this topic remains inconclusive. Personal factors must be considered, and you and your health care provider will ultimately need to make the choice that is best for you.