The "baby blues" (or maternity blues) occur in a significant number of women. The baby blues manifest within the first few days, but rarely more than a week postpartum. A mother with the blues is moody, sensitive and overly reactive to her baby and environment. With time, these symptoms abate without further intervention. When symptoms persist longer than one week, the clinician should inquire about symptoms of depression. Finally, it is important to note that any woman who experiences the baby blues is at twice the risk for developing PPD over the subsequent weeks to months.
The baby is 18 months old and I am still depressed. Is this still postpartum depression?
Postpartum depression usually occurs within one year of birth. However, undiagnosed, untreated, or improperly treated, PPD can continue for up to two years before it will spontaneously resolve. Even then, a smaller percentage of women will not recover without treatment. Late onset symptoms are seen in women who develop PPD after weaning the infant late in the postpartum course. Another possible reason for chronic symptoms can be hypothyroidism and should be looked for in women who do not respond to standard treatment.
How long do perinatal mood disorders last? Will they go away on their own?
Left untreated, PMD can persist for up to two years. Even at two years, some depressed women will not recover and continue with chronic symptoms. When adequately treated, most women can achieve positive response to treatment in two to four weeks and complete remission in six to eight weeks from starting treatment.
Does being depressed mean that I can't be a good mother?
It is not uncommon for depressed mothers to feel guilt and shame about their depression. This guilt and shame will often manifest as insecurities about the ability to mother. Depressed mothers need to know that PMD is a medical illness like any other medical condition. It is not their "fault" and is not a reflection of being a "bad" mother. Mothers with PMD who are responding to treatment are perfectly capable of taking care of their child and can be as "good" a mother as any other woman.
Is postpartum depression common after pregnancy?
About 10 percent to 20 percent of women who deliver an infant will develop PPD. This percentage is fairly constant in different countries that have been studied. There seems to be a connection between maternity blues and PPD although they are clearly different conditions. Women who experience maternity blues have a 20 percent chance of having PPD, while women who do not have maternity blues run about a 10 percent chance.
If I have had PMD before, will I get it again with another pregnancy? How about at other times in my life?
If a woman experiences PMD she has about a 50 percent to 60 percent chance of having PMD in a subsequent pregnancy. What happens to a woman who has had PPD at other times in her life is not currently clear. A significant number may develop recurrent depression unrelated to pregnancy. Times of hormonal change, such as postpartum and the perimenopause periods, may be times of increased risk for depression for these women. A smaller percentage may go on to develop bipolar disorder, where a person has "high" and "depressive" phases in their life, unrelated to the postpartum state. There are some women, however, who experience depression only in the postpartum period.
Is it normal to have trouble sleeping after giving birth?
Of course it's normal. Young infants are on their own schedule and require attention 24 hours a day. They sleep for only short periods of time, which is when the mother can rest. Mothers with PPD have intrinsic problems with sleep as a symptom of their illness. While a mother who is not depressed can sleep whenever her baby sleeps, the postpartum depressed mother is unable to sleep, even when the baby is sleeping, and even when someone else is caring for the child. This specific inability to sleep is a good indication that a mother may be suffering from PMD.
Perinatal mood disorders are treatable. But first you have to ask for help.
The questions were compiled by Ricardo J. Fernandez, MD, ABPN, DFAPA who is a member of the NJ Working Group on postpartum depression and is also the Medical Director at Princeton Family Care Associates in Princeton, N.J., and an Associate Clinical Professor, Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Piscataway, NJ.