Postpartum - Is it the Blues or is it Depression?

Postpartum blues diminish with time but depression, characterized by increasing withdrawal and inability to cope, gets progressively worse.  The blues are associated with hormonal shifts, sleep deprivation and impending lactation and are more likely to occur in those who are not physically up to par especially if the birth was debilitating.  The natural suppression of the maternal hypothalamic-pituitary-adrenal axis in the immediate postpartum may cause emotional instability until full function resumes in about ten days.  A parent who hemorrhaged may have the blues on and off due to anemia and exhaustion.  If there is no medical history of emotional problems, the cause may be due to the mother’s current health status.  Ask your midwife or doctor to check your hemoglobin and have them review your diet to recommend supplements as needed. The blues can affect anyone struggling with postpartum adjustments including loss.  Having regular outings with family and friends to get time away from home and the usual routine is helpful.  The mother should be able to get some physical and emotional space and to get the baby off of her body for a while.

Postpartum depression develops at 10 days after the birth or later and tends to worsen with time. Postpartum depression affects the mother and has been shown to negatively impact child development as depressed parents do less relating with their infant. This causes the infant to have less positive facial expressions and have more eating and sleeping disorders.  What appears to be postpartum depression may be caused by a thyroid imbalance.  Postpartum thyroiditis can lead to hypothyroidism characterized by fatigue and depression. Ask your midwife or doctor to screen for thyroid problems. 

There are four predisposing factors to postpartum depression.  Psychiatric factors include negative birth experience, history of psychiatric disorders, low self esteem or stressful life events.  Demographic factors include age, marriage status, economic difficulties and decreased access to medical or social assistance.  Relationship factors include poor support in childhood, separation from parents in childhood, poor support in pregnancy, history of abuse or poor relationship with partner. Lastly, cultural factors include lack of community support, spirituality or clear role definition in culture.  Additional predictors include challenging infant temperament, prenatal anxiety or an unwanted or unplanned pregnancy. 

In addition to counseling, treatments include allopathic and natural remedies.  If the mother is on Zoloft or Prozac, her serotonin reserves can become depleted. Foods containing the amino acid tryptophan, omega fatty acids, vitamins B6, B2, B3, folic acid and magnesium can help restore serotonin.  Coffee, alcohol, chocolate and cigarettes must be strictly avoided.  Postpartum psychosis characterized by manic or depressive episodes of confusion or disorientation, delusional thinking and suicidal or infanticidal thoughts require expert and immediate treatment.  Mothers with a history of bipolar disorder are particularly at risk. Call 911 immediately and seek emergency care.