We are expecting our second baby in a few months. I had the baby blues after our first child was born; he had severe colic and kept me awake a lot. I am wondering what the risks are for me to get postpartum depression after the birth of our next child?
Postpartum depression (PPD) is a very important condition to identify or prevent early on. If undiagnosed or left untreated, it not only affects the mom, but it has major future implications for the child such as cognitive, social, and behavioral issues.
There are typically three types of this condition. The first and less severe form is also known as baby blues or postpartum exhaustion. It is quite common and is marked by moodiness, anxiety, sadness, irritability, crying more often, sleeping poorly, and having trouble concentrating. Obviously, almost all moms experience major disruptions of sleep, energy, and appetite after the birth of a baby. The degree of these challenges determines what next steps need to be taken.
The second type of PPD is more severe and affects close to one in ten moms after they give birth. These moms may become extra sad, feel guilty for no reason, become hopeless, and experience insomnia and loss of appetite. They do not enjoy life at all, do not look forward to the future, are anxious, feel worthless, are always extremely tired, see themselves as inadequate, experience mood swings, and may even become withdrawn.
These symptoms, unlike baby blues, arrive within one month after birth and are of a longer duration. Although PPD is thought to be due to a sudden drop of estrogen and progesterone after birth, some other medical conditions must also be ruled out (for example unstable blood pressure and thyroid disease).
PPD may even occur as long as 6-12 months after the birth. This is important to know because both the mom and her doctor may be less likely to consider this diagnosis so long after the birth. In fact, research shows that many moms fall through the cracks and are often diagnosed late or not at all, especially if the mom feels guilty about being sad and wants to maintain a brave face.
The third and worst form of postpartum depression is really a state of psychosis and is more common if there is also a history of bipolar disease. These moms may experience hallucinations, confusion, paranoia, and thoughts of harm to themselves and even the new baby. Tragically, attention was brought to this issue a few years ago when a family doctor in Toronto parked her Mercedes SUV in a no parking zone by the entrance to an underground train station, ran down the stairs with her baby in her arms, and flung herself and the baby in front of an oncoming train. Needless to say, this was front page news and fuelled speculation as to how it may have been prevented.
The diagnosis of PPD can be done at home by using a questionnaire called the Edinburgh Postpartum Scale (One can Google this and follow the instructions, which are simple and specific.). It consists of ten questions; a score of 13 or higher tells the mom or doctor that PPD may indeed be the diagnosis. Many new electronic health records prompt doctors to routinely administer this scale when a mom comes in for baby checkups in the first year.
If there is a history of the following situations a mom may be at an increased risk for PPD: depression during the pregnancy, a past history of PPD, lack of social support, an unwanted pregnancy, marital problems, lower socioeconomic status, and multiple pregnancies (such as twins or triplets).
If left untreated or if diagnosis is missed PPD has a major long term impact on the child. These babies later in life may be more prone to language delays, ADHD, sleep problems, eating difficulties, temper tantrums, and cognitive delays. The Canadian Pediatric Society has a position statement on the impact of a depressed mom on a child (See www.cps.ca and search under position statements by the Psychosocial Committee.).
Treatment may involve cognitive behavioral therapy. I often suggest a best-seller book on this topic, Feeling Good by Dr. David Burns, M.D., to depressed patients in my clinic. I am encouraged by research showing that using the book was as good as using Prozac in patients with a milder form of depression.
Group support and counselling may also help, but for a number of moms antidepressants are indicated, usually the SSRIs (Selective Serotonin Reuptake Inhibitors) class. Most of these medications have side effects and one has to consult with experts as to the safety of use during lactation (see www.motherrisk.com).
For those moms who want to try alternative therapies, one can consider the use of massage, acupuncture, omega-3 fatty acids, Vitamin B supplements, and St. John’s wort. However, many of these therapies have not been shown to work consistently enough to become a standard of care.
Some midwives feed the placenta to the mother - a practice known as placenta encapsulation - in the belief that it may reduce the odds of PPD. A number of midwife websites offer explanations as to why some moms are encouraged to eat the placenta.
Common sense lifestyle habits such as proper sleep, exercise, eating as much fresh produce as possible, and intentionally making time for a spouse and oneself may also help. For some moms, however, it is hard to live by the motto “The best way to care for your baby is to first take care of yourself”. (See www.fitpregnancy.com for more information).
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