By David Joel Miller
Is this postpartum depression or just the baby blues?
The idea that a woman can get sad, blue, even depressed as a result of giving birth has been around for a long time. Professionals have struggled with what this is and how to be helpful and we continue to struggle with those issues.
We knew that depression around the time of delivery causes a lot of suffering for the mother. Sometimes it becomes a problem for the father and other family members. And yes, we now know that having a depressed mother, immediately after birth, or later in childhood, can affect the child, possible for the rest of that child’s life.
There has been a reluctance to keep creating new disorders for each and every cause of depression. One way out of this dilemma has been to keep the same set of symptoms for depression regardless of what has caused the depression.
For depression, there is a list of specifiers for types. Most of those specifiers have to do with the way the symptoms present. Some people eat more and some eat less and so on.
Only two causes have gotten their own specifiers, seasonal pattern as in seasonal affective disorder and Postpartum Depression. Postpartum Depression is now called Peripartum Depression to also include depression that sets in before the birth of the child.
Symptoms of Peripartum Depression.
Symptoms of Peripartum depression are very similar to the symptoms of other forms of depression. Sleep disturbance, if it is over and above that caused by having a newborn who cries when it has needs, is one symptom. Changes in appetite and loss of interest in things that used to make you happy are other common signs this is depression and not just the normal getting used to being a parent.
Feeling hopeless or like a bad mother are serious symptoms of a depression. Some women will become much more irritable or anxious than before the pregnancy. You may also feel numbed out or disconnected from life and from those around you. Worrying, excessively about the child’s safety can also be a symptom of a mental health issue.
The new DSM (DSM-5) reports the frequency of Peripartum Depression at 3% to 6% of all women. The sheer fact that it gets its own separate specifiers suggests to me that the rate of women with depression during and after the birth of a child is higher than any 6%.
Some studies have followed women for the first year after the birth of the first child and they find significant stress and higher rates of depression over that year time period.
Research studies have reported that rates of “Baby Blues” those brief episodes of sadness that occur during and after pregnancy can run as high as 80% in some populations.
One reason for the discrepancy in the numbers is that we used to talk about mood disorders and treat Depression and Bipolar as part of the same mood disorder family. These two conditions have gotten a divorce and are now living in separate chapters in the new DSM-5. While Postpartum or Peripartum depression may only get 6% the new Peripartum Bipolar Disorder should also have some numbers. So far I have not seen any statistics on the number of women who develop Peripartum Bipolar Disorder but the new DSM-5 clearly allows for this possibility.
Some of these cases in which a woman develops symptoms during and after pregnancy also reach the point of having delusional or psychotic features. In these cases, the mother may believe there is something wrong with the child, that the child is evil or a similar delusion. Women who develop psychosis after the birth of one child have a risk (from 30% to 50%) of having psychotic symptoms during each pregnancy thereafter.
Another reason the rates of Peripartum Depression may be understated is that some women do not develop symptoms quickly enough to get the diagnoses in the first 4 to 6 weeks. After that, the diagnoses will probably be Major Depression and the Peripartum specific will get left off.
Those milder cases of sadness that happen during pregnancy and after delivery, the things that are popularly called baby blues, they most likely will not get a diagnosis at all. For a while there was a study of something called Minor Depression, there was even a set of proposed symptoms for minor depression in the older DSM-4. That has now been dropped.
While some cases of baby blues may not get the official nod of a diagnosis of “with Peripartum onset,” they need treatment. If you have been sad or depressed during pregnancy or afterward, consider getting professional help. Let the professional worry about what the correct diagnosis code should be.
If you have ever thought that your child was cursed or evil, get help fast before you harm that child and yourself.
What causes a woman to be at high risk for Peripartum or Postpartum Depression? There are at least 7 factors that put you at risk for postpartum depression. More on those factors in a coming blog post.
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