Postpartum depression: More than 'baby blues'
By Christy Oglesby
ATLANTA, Georgia (CNN) -- The recognition of postpartum depression as a legitimate health problem has been an evolutionary process -- about 50 years in the making. But the number of support groups and developing treatments for the disorder attest to its validity and seriousness, doctors and therapists said.
It was about half a century ago that physicians began recognizing patterns in the depression that some women experienced after childbirth, said Paul Appelbaum, president-elect of the American Psychiatric Association.
The seemingly unexplained crying, mood swings and irritability, or "baby blues" that about 70 percent of women experience after childbirth is not clinical depression and generally stops after two weeks, he said.
But about 10 to 20 percent of new mothers are diagnosed with postpartum depression, said Appelbaum, who specializes in the disorder. And 1 or 2 out of 1,000 will experience psychosis with that depression, he explained. A part of that psychosis might include auditory hallucinations.
"Women might hear voices that tell them to harm themselves or their babies," he added, "or they might hear voices that say the baby is possessed by the devil and they have to kill the baby to kill the devil."
Women who have experienced postpartum depression have a 50 percent chance of developing it again with a subsequent birth, Appelbaum said, and those who endured severe manifestations of the disorder might want to consider not having additional children.
The symptoms of postpartum depression are not unlike most depression disorders, Appelbaum said. Had a woman not given birth recently, but exhibited signs of depression, the diagnosis would be depression.
A woman may have more than baby blues if her despair lasts longer than two weeks or starts a month or two after delivery. Symptoms of the disorder include loss of appetite, difficulty sleeping or staying asleep, absence of interest in her newborn and lack of interest in day-to-day routines.
Postpartum depression is distinguished from the baby blues both by its duration and the debilitating effects of indifference the mother has about herself and her children.
Treatment usually includes using antidepressants, depending on whether the mother is nursing, and undergoing individual or group therapy, Appelbaum said. However, if a woman experiences postpartum psychosis, drug therapies should be the first line of treatment, Appelbaum added.
There is strong, but not conclusive evidence that postpartum depression is linked to hormonal changes after childbirth, Appelbaum said. That evidence includes emotional changes some women experience during their menstrual cycles and the correlation between hormonal fluctuations and the onset of depression.
How to help
Karen Kleiman, author of "The Postpartum Husband," divides advice for husbands and family members into two categories -- practical and emotional.
Practical advice includes helping with chores and the children so women do not feel overwhelmed. Emotional support may include being available during teary outbursts or simply listening.
"But before you do anything, check it out, ask," said Kleiman, who is the director of the Postpartum Stress Center in Rosemont, Pennsylvania. Husbands should ask their wives if they want to be left alone or comforted when crying and ask if they want their mothers to visit to help with the house and baby.
"It's important to ask because what they might think is a good idea, might not be what the wife wants."
And be careful about what you say, Kleiman cautioned. Telling a woman to snap out of her sadness or that she should be grateful for having a baby can be detrimental, she said. Women need to feel that their families accept their feelings and fears as valid.
Kleiman also encourages men to participate in therapy with their wives.
"Otherwise," she said, "they are at home and they have no idea what is going on."
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