More than baby blues: postpartum depression

Most women experience mood changes after giving birth, sometimes called “postpartum blues”. Understandable, since rapid hormonal shifts take place, and having a baby is a dramatic life change that requires immediate adjustment. For the vast majority, these mood changes are short-lived and mild. However, 10-15% suffer a more serious form of depression; and a very small proportion--around 0.2%-- experience psychotic symptoms following childbirth.

Who is at risk for postpartum depression?

Certain circumstantial factors can be important[i]. Women who do not have a good support system or live alone, are in difficult marriages or intimate relationships, have experienced recent trauma such as a death in the family or a recent job loss, or are having financial problems, are more likely to experience postpartum depression.

Other individual factors increase the risk of postpartum depression, such as a younger age; having other children, especially twins or a child with special needs; a previous personal history of depression; family history of depression; or depression during the pregnancy itself. Gestational diabetes (diabetes that occurs during pregnancy) is also associated with postpartum depression. But women at the highest risk of all are those who have experienced postpartum depression or psychosis following a previous pregnancy: 90% are likely to experience it again.

How to tell if it’s just post-partum blues

Most women have fluctuating moods, tearfulness, irritability, and anxiety right after giving birth. This typically lasts for a few days, perhaps up to 2 weeks. Most importantly, the symptoms do not interfere with the woman’s ability to function, or to care for her newborn.

Women whose symptoms are more severe than this, especially if they last beyond 2 weeks, should contact a professional.

Causes and symptoms of postpartum depression

Specific causes of postpartum depression are unknown[ii]. What’s known is that during pregnancy estrogen and progesterone (female reproductive hormones) increase tenfold, and then drop sharply right after delivery. It takes only 3 days for these hormones to return to what they were before pregnancy-- that’s pretty quick!

While depression symptoms that follow the delivery of a baby are given a different name (“postpartum”), they are not too different from symptoms of other forms of major depression. These include: depressed mood, tearfulness, lack of pleasure from things previously enjoyed, insomnia, fatigue, appetite disturbance, suicidal thoughts, and recurrent thoughts of death. But the distinguishing feature of postpartum depression is that the mother is unable to function, which may place both her and her infant at risk. She might also worry obsessively over the health of the baby, or may have ambivalent or negative feelings towards her newborn, and may even have thoughts about harming her baby.

Postpartum psychosis, the most severe form of postpartum depression, is rare. It typically manifests rapidly, as early as 2 to 3 days or within the first 2 weeks following childbirth. Symptoms can resemble those of bipolar disorder, and include restlessness and insomnia, irritability, rapidly shifting depressed or elated mood, and erratic behavior. There may also be delusions related to the baby (e.g. the infant is dying, or is Satan), or the mother may hear voices instructing her to harm herself or her baby. This is clearly a serious and dangerous condition.

How is postpartum depression typically assessed and treated?

Postpartum depression is seen by many as a “normal” consequence of childbirth[iii].  Unfortunately, this may cause some women to delay reporting depression symptoms for several months before seeking treatment. If left untreated, symptoms can last a year or longer. There is potential for damage to the relationship between mother and baby, or between the mother and her partner, and the infant's social and educational development might also be compromised. For women with postpartum psychosis, there is an elevated risk of infanticide or suicide. For these reasons, some experts advocate that all pregnant women should be assessed for depression just before and after childbirth.

When women seek treatment, assessment of postpartum depression begins with blood work, including factors that might be causing or contributing to the symptoms, such as thyroid dysfunction or anemia. Other screening tools, such as questionnaires, might also be used to determine if a woman is showing postpartum depression symptoms.

For mild to moderate symptoms, non-drug treatments can be appealing to mothers who are nursing or who wish to avoid taking medications. These can include support groups, cognitive-behavioral therapy or group psychotherapy.

For more serious symptoms, or when there is an insufficient response to non-drug treatments, antidepressants are typically recommended. Medication can also be used in conjunction with non-drug therapies.

The most severe cases, especially postpartum psychosis, are considered psychiatric emergencies and in-patient hospitalization may be required. Mood stabilizers, antipsychotic and anti-anxiety drugs might be used, and possibly electroconvulsive therapy, especially for women with thoughts of suicide.

An integrative approach to depression

Homeopathic care is an option for those with postpartum depression that is not life-threatening who prefer to avoid pharmaceuticals or have experienced unwanted side effects from them. It also complements therapy well: homeopathic remedies can trigger a physiological shift, helping to “unstick” patterns of thought and emotions, while therapy can bring needed understanding and increased self-awareness and coping skills.

We begin with a conversation to explore the course of the depression, the daily pattern, as well as the “modalities”, or things in the environment or that you can do that seem to make it worse or better. All of these factors point to a single homeopathic medicine that matches the specific pattern of the depression. Because postpartum depression is associated with hormonal disruption, the chosen homeopathic remedy would likely be one that targets the endocrine system. The aim of homeopathic care is significant reduction or resolution of the symptoms.

Call for a free 15-minute consultation or schedule one on the online scheduler to learn more about how homeopathy can help you or a loved one with postpartum depression.

[i] Ghaedrahmati, M, A Kazemi G Kheirabadi A Ebrahimi M Bahrami (2017) “Postpartum depression risk factors: a narrative review” Journal of Education and Health Promotion 6(60): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5561681/

[ii] Joy, S, P Mattingly H Templeton (2019) “Postpartum depression”: https://reference.medscape.com/article/271662-overview#a6

[iii] Fitelson, E, S Kim A Scott Baker K Leight (2011) “Treatment of postpartum depression: clinical, psychological and pharmacological options” International Journal of Women’s Health 3: 1–14: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039003/