This might come as a surprise, but postpartum depression (PPD) is the number-one complication of childbearing. Experts estimate it strikes at least one in 10 women, with approximately 400,000 new cases each year in the United States.

PPD doesn’t discriminate by age, race, ethnicity, or income. It affects our sisters, mothers, wives, daughters, coworkers, neighbors, and friends. Celebrities, including Brooke Shields and Gwyneth Paltrow, have described their PPD experiences, helping to raise awareness of the disorder among the general public.

Anyone who has had a baby is at risk for PPD. The good news is that detected and acknowledged, the disorder can be treated effectively. Women don’t need to suffer in silence. Help is available.

PPD is a quiet, unending epidemic that plays out in homes all over America, punctuated by occasional dramatic cases that make headlines. Actually, PPD is one disorder in a broad spectrum of adjustment disorders that arise during the postpartum period, which range from the common, self-limiting postpartum blues (“baby blues”) lasting just a few days or weeks, to the rare but severe postpartum psychosis.

PPD is distinctly different from both the “baby blues” and psychosis. Generally, it’s defined as severe depression lasting beyond 4 to 6 weeks during the weeks or months after delivery. (See the table below).

Use this table to help differentiate baby blues from a more serious type of postpartum disorder.

Characteristic	”Baby blues”	Postpartum depression
Onset	1 week after delivery	2 to 12 months after delivery
Duration	Resolves spontaneously within 7 to 10 days	Weeks, months, or longer
Emotional Features	Crying Feelings of sadness, possibly alternating with happy feelings Sense of being overwhelmed	Crying Feeling of overwhelming sadness, helplessness, and worthlessness Feeling of loss of control Intensive or excessive worry Forgetfulness Inability to focus or concentrate Possible anxiety, panic attacks, and obsessive-compulsive behaviors Feeling of disconnected from baby
Sleep Pattern	Feels tired, but can sleep when baby sleeps	Feel tired, but can’t fall asleep within 30 minutes of retiring or wakes up in middle of night and can’t fall back to sleep
Health care	Resolves spontaneously without intervention	Makes multiple visits to healthcare providers for self or baby
Danger	Low risk	May be suicidal May have thoughts of harming self or baby

Key signs and symptoms of PPD include sadness, excessive worry, feeling disconnected from the baby, forgetfulness, inability to focus or concentrate, anger, fear, guilt, grief, inability to fall asleep, waking during the night and having trouble falling back to sleep, exhaustion, and multiple physical complaints. Some women report they feel numb or that they’re in a fog, or describe a sinking feeling or a sense that they can’t “snap out of it.” Some may express the feeling that “if this is what motherhood is like, I want out.” Some women may feel ashamed or embarrassed about these feelings.

Anxiety commonly accompanies PPD, with some women experiencing panic attacks or obsessive-compulsive behaviors. In other cases, PPD patients have recurring symptoms (similar to those seen in post-traumatic stress disorder) related to trauma during delivery. Typically, symptoms arise within 4 weeks of delivery but may be delayed for up to 12 months postpartum. PPD prevalence appears to peak around 3 months postpartum.

It’s hard to predict who will develop PPD. Factors that may increase risk include:

• history of depression before or during pregnancy
• preexisting anxiety or mental illness
• lack of social support
• childcare stress
• life stress
• low self-esteem
• fatigue
• difficult infant temperament
• single marital status
• unplanned or unwanted pregnancy
• young age.

References:

Beck CT, Indman P. The many faces of postpartum depression. JOGNN. 2005;34(5):569-576.

Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-786.

Dennis C, Chung-Lee L. Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review. Birth. 2006;33(4):323-331.

Dennis C-L, Hodnett ED. Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database of Systematic Reviews. 2007;4;Art. No.: CD006116. DOI: 10.1002/14651858.CD006116.pub2.

Earls MF, Committee on Psychosocial Aspects of Child and Family Health American Academy of Pediatrics. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2010 Nov;126(5):1032-1039. http://pediatrics.aappublications.org/cgi/content/abstract/126/5/1032. Accessed November 26, 2010.

Gaynes B, Gavin N, Melzer-Brody S, et al. Perinatal depression: prevalence, screening accuracy, and screening outcomes. Agency for Healthcare Research and Quality. February 2005. Evidence Report/Technology Assessment: Number 119:1-8. www.ahrq.gov/clinic/epcsums/peridepsum.pdf Accessed November 9, 2010.

Hale TW. Medications and Mothers’ Milk: A Manual of Lactational Pharmacology. (13th ed.). Amarillo, Texas: Pharmasoft Medical Publishing; 2008.

Levy LB, O’Hara MW. Psychotherapeutic interventions for depressed, low-income women: a review of the literature. Clin Psychol Rev. 2010 Dec; 30(8): 934-950.

Olson AL, Dietrich AJ, Prazar G, Hurley J. Brief maternal depression screening at well-child visits. Pediatrics. 2006;118(1):207-216.

Sit DKY, Wisner KL. Identification of postpartum depression. Clin Obstet Gynecol. 2009; 52(3):456-468.

article taken from http://www.americannursetoday.com/article.aspx?id=7306)