Postpartum Depression, the baby Blues or a nasty color much deeper?

There’s an old joke that asks, “Why did God make babies so cute?”

Answer: “So you wouldn’t throw ‘em out the window.”

While this may be funny on the surface, there is an ominous overtone that isn’t very funny at all. The joke underscores how much hard work there is in having a baby and raising a baby, but there is redemption in it because it’s all worth it. In Obstetrics, this has become the least funny joke of all, because there is a condition in new Moms that goes way past the Baby Blues she gets from saying goodbye to her old way of life; this condition, postpartum depression, is true mental illness. Thankfully, it is temporary and treatable.

Postpartum depression, what is it?

Postpartum depression (after birth depression) is a mysterious illness that is true clinical depression. It can occur in up to 14% of all new Momsⁱ. It usually begins any time during the first year after delivery, even as soon as three weeks after. It can occur in not just first-time Moms, but even after subsequent pregnanciesⁱⁱ.

What causes it?

Its cause is unknown, but it seems to be related to hormonal changes, a pre-disposition for depression (having had depression before), and emotional difficulties with the usual problems of finance or marriage or adjustments in lifestyle due to the baby. It begs the question, though, of what would make a mother reject the idea of motherhood or even want to harm herself or the baby? We are all products of evolution, but what evolutionary advantage can be gleaned from postpartum depression? Could it be that when we all lived together in clans that postpartum depression was a way to select out the babies better mothered by surrogates in the group? No one knows.

What are some of the symptoms?

Symptoms include difficulty bonding, crying for no reason, sadness or a feeling of helplessness, disinterest in sex, and guilt for not being happy with the baby or babies.

What helps?

For those who are not too far gone into their depression, keeping busy, doing fun things, exercising, and socializing with caring family and friends will help get them through it, as long as it’s monitored by a healthcare professional.

What if YOU have it? What if YOU are too far gone into the depression?

This is serious stuff. In fact, it is so serious that it is considered an official part of your medical record to take a depression screening questionnaire at your postpartum visit with your doctor or midwife. Such a screen will tell your doctor if you are at risk or even if you are in danger. “Too far gone” is a trashy phrase that simply indicates you are in danger. For this, treatment with prescribed antidepressants will be necessary.

Yikes! Aren’t those “drugs”?! What if I’m breastfeeding?

Yes, antidepressants are drugs, and with any drug there is a risk vs. benefit tally you and your doctor must consider. You must also consider whether the drug gets into your breast milk, and if so, is there any risk to your baby (usually not)? But the biggest risk is not treating it at all. There is a suicide risk to postpartum depression if it suddenly blooms into a full-blown psychosis—no matter how sweet you are, how smart or educated you are, or how much you know about depression. You can be at risk for having horrible delusions that lead you into thinking dangerous thoughts that really aren’t “you” at all. Don’t leave your family with that person. You need to get back to feeling yourself again. And if it’s medication that is necessary, then so be it.

What are some of the most commonly prescribed antidepressants?

Of the preferred antidepressants in breast-feeding women are Nortriptyline (Generic Pamelor, Aventyl), Paroxetine (Generic Paxil, Pexeva, Seroxat, Brisdelle), and Sertraline (Zoloft) due to their negligible seapage into breastmilk. Fluoxetine (Generic Prozac), on the other hand, ends of with levels in the breastmilk that are higher than in a mother’s blood, so it is to be avoided.

Do Dads get postpartum depression?

Dads are simple creatures. Their reactive emotions are usually due to not accepting the “new world order” of world-with-baby or not recognizing that “family” means everyone works hard for it. But a bluesy Dad with a Mom who has postpartum depression is not a good combination. It may be necessary for family counseling in addition to treating Mom’s depression.

Fret not!

Postpartum depression is treatable, even its most severe forms. And it doesn’t mean you need to be treated forever. But it needs to be identified, and the sooner the better. Baby Blues is just being bummed out. Postpartum depression is a disease, but it can be treated. You have a whole life ahead of you with your family. Start it off by being vigilant to the things that can conspire against you through no fault of your own.

Thank you for reading!

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