The Post-Partum Blues
It is common for new moms to experience the blues, but when symptoms persist, Dr. Esther Oh says it may be a sign of postpartum depression.
by DR. ESTHER OH
Sarah, a 31 year-old Korean American woman, was referred to the mental health center by her obstetrician. Three weeks earlier, she had delivered a healthy baby boy, but this new mother was now showing symptoms of sadness, fatigue, erratic sleep and loss of interest in activities. After Sarah began having disturbing thoughts of ramming her car into a building and killing her son, she asked her husband to drive her to the clinic.
She told the doctor at the clinic that she had not showered or changed her clothes in a week, and repeatedly claimed she was a horrible mother and should end her life. Sarah’s husband noted this was not the woman he fell in love with; the woman he described was happy, caring and excited to be a mother.
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Sarah’s case illustrates how, as much joy as a new child brings, the postpartum period can be a chaotic time. Right after birth, women experience an abrupt decline in their levels of estrogen and progesterone, hormones responsible for regulating mood. As a result, many new mothers are susceptible to drastic mood changes during this period. Your risk increases when dealing with stressful life events, interpersonal problems, an infant with health issues, a prior history of depression, family history of depression, an unplanned pregnancy and poor social support.
Between 50 to 85 percent of new mothers experience a common and short-lived state of mood symptoms called the postpartum blues. Women often report mild symptoms of tearfulness, anxiety, irritability, mood swings and sleep disturbance that usually start three days after delivery and spontaneously resolve by the second week. Most women suffering from postpartum blues improve with validation and reassurance that they’re doing a great job and assistance in caring for their child during this stressful period.
If postpartum blues symptoms worsen or persist for more than two weeks, the mother may be developing postpartum depression, which affects 20 percent of new moms. It looks very similar to clinical depression, with a depressed mood most of the day, loss of interest in activities, fatigue,anxiety, poor concentration, trouble sleeping and feelings of worthlessness. Some women may express thoughts of death or suicide. They may obsess over the health of their baby even after constant reassurance by others. It can be common to have unwanted, intrusive thoughts and images of harming their infant.
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Rarely, new mothers can experience postpartum psychosis, which occurs in one to two women per 1,000 births. It is very rare, but considered a serious psychiatric emergency. Women with a history of bipolar disorder or previous history of postpartum psychosis are at higher risk for this illness. Psychotic symptoms often appear within three weeks postpartum. Symptoms include mood swings, confusion, agitation, bizarre behavior, paranoia and poor sleep. Women can have delusional thoughts, such as the belief that breast milk is poisonous to the baby, and even hallucinations where the mother hears voices telling her to kill her baby. Postpartum psychosis is important to identify immediately because it can lead to suicide or infanticide if left untreated.
Though it is common for postpartum women to develop depressive symptoms, many of these women are improperly diagnosed and/or treated. Some convince themselves that their symptoms are “normal for women with babies.” Other women feel guilty for having such negative emotions during this time that should be joyful and are ashamed to seek help. What these mothers don’t realize is that their own mental health can significantly impact their baby’s physical and emotional development. Depressed or psychotic mothers have difficulty bonding with their baby and are less responsive to their baby’s needs.
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Treatment usually starts with increasing a mother’s support system and education about depression and/or psychosis. More help around the house and getting adequate sleep can reduce the risk for such symptoms. Psychotherapy can be helpful in different forms: couples therapy for those having martial conflicts; individual therapy to work on personal issues; and group therapy to learn from other mothers dealing with the same issues as yourself. If medication is needed, anti-depressants such as Zoloft, Wellbutrin, Prozac and Effexor can be very effective at treating depression.
If you are suffering from psychotic symptoms, anti-psychotic medications such as Risperdal, Zyprexa or Haldol may be used to treat delusions and hallucinations. Because many of these medications can pass into the breast milk, some women may choose to substitute with formula milk during treatment.
In Sarah’s case, after being diagnosed with postpartum depression, she underwent individual therapy and started Zoloft. Her depression resolved within two months, though she remains on the same treatment plan—therapy and Zoloft—because of the risk of relapse, especially during times of stress. Sarah reports that she is enjoying her life as a mother, and that her son is happy and healthy.
This article was published in the April 2014 issue of KoreAm. Subscribe today! To purchase a single issue copy of the April issue, click the “Buy Now” button below. (U.S. customers only. Expect delivery in 5-7 business days).
