Treatment of Postpartum Depression

Treatment for postpartum depression is very similar to treatment for depression and other mood disorders. Hospitalization may be necessary in cases where the mother is suicidal or feels they may harm their baby. Postpartum depression can be treated with antidepressants, usually in combination with therapy or a support group. Selective serotonin reuptake inhibitors are one option for antidepressants, as are tricyclics. Both of these medications are thought to be safe for women who are breastfeeding. This can often be a conflict for mothers. Some mothers may be concerned about the way the medication affects their breastfeeding baby, and some medications may be unsafe for breastfeeding babies. Because of this, some women may need to choose between breastfeeding and taking their medication. This is challenging because breastfeeding is good for the baby and helps the baby and the mother to bond. For a women who may already be experiencing worry and anxiety about how well they are caring for their baby, taking medications that make it so they must stop breastfeeding may feel like a failure to them. However, it is important for people to take the medications that help them function best.

Some new mothers may choose to use herbal medicine as one way to treat their symptoms. St. John's wort, which helps with depression, and kava, which helps with insomnia and anxiety, are both used to treat postpartum depression. Other new mothers may choose to use traditional Chinese medicine which utilizes herbs and roots to treat abnormal symptoms. Treatment by Chinese medicine is personalized, so it will vary from person to person. Omega 3 fatty acids have also been used as a treatment for depression. Both infant and maternal massage has been used as a treatment for postpartum depression. People experiencing postpartum depression may also want to use aromatherapy using essential oils. Acupuncture is another common complementary or alternative treatment.

Signs and Symptoms of Postpartum Depression

There is a large overlap in the signs and symptoms of depression and postpartum depression. According to the center for disease control (CDC), some signs of depression a person might have whether or not it is related to childbirth are persistent feelings of sadness, anxiety or emptiness, hopelessness and pessimism, and feelings of guilt, worthlessness, or helplessness. Furthermore, the depressed person may experience loss of interest in the hobbies and activities they used to find fulfilling, lose energy, or have difficulty focusing and making decisions.A common symptom is either an increase or decrease in appetite. There may be aches and pains that aren't getting better with treatment. Finally, there may be self harm, thoughts of suicide, or suicide attempts.

According to the CDC some symptoms that are more specific to postpartum depression are crying more often than usual, feelings of anger, withdrawal from family and friends, feelings of numbness or not being able to bond with one's baby, worrying about hurting the baby, and feeling guilty about how one is caring for the baby.

There are a few very common and destructive misconceptions and myths about the signs and symptoms of postpartum depression.One harmful misconception is that signs and symptoms will always begin about three months after the birth of the child. This is problematic, because in many cases signs and symptoms don't show up until later; some mothers may not show symptoms until up to a year after birth of their child.

Another myth is that excessive crying and sadness is always a sign and symptom of postpartum depression. However, for many mothers, they experience anger, numbness, anxiety, or other emotions or experiences that don't lead them to cry and aren't necessarily sadness.

Furthermore, media depictions of postpartum depression tend to sensationalize  the signs and symptoms and focus of excessive sadness and constant crying. Most destructively, the media focuses on stories of mothers who have harmed their babies. This adds to the stress a mother who is experiencing postpartum depression is experiencing and may make them even more hesitant to seek help.

http://www.womenshealthmag.com/health/postpartum-depression-myths

http://www.empowher.com/postpartum-depression/content/postpartum-depression-myths-and-misconceptions-keep-women-seeking-help?page=0,1

http://www.cdc.gov/reproductivehealth/depression/

Diagnosis of Postpartum Depression

When diagnosing postpartum depression it is important to have a holistic understanding of the person experiencing symptoms experience. Elements such as socioeconomic class, race and ethnicity, religions, culture, and sexual orientation play a role in the way people experience postpartum depression as well as the resources they have access to. Because of this, it is incredibly important to take all of these elements into account when diagnosing postpartum depression. The person diagnosing postpartum depression in a patient should either perform or request a general physical examination to see if there are physical illnesses that could contribute to mental health issues. Often this includes blood tests to determine whether or not the mother has an underactive thyroid. Under-active thyroid often contributes to depressive symptoms. Diagnosing postpartum depression also involves doing general intake questions or a depression questionnaire which may include questions about the mother's mood, substance use, mental health history and suicidal thoughts.

It is important when diagnosing postpartum depression that the symptoms are very similar to the “baby blues.” It is extremely common for mothers to feel sadness, anxiety, irritability, confusion, and crying more frequently then they are used to. However, this normally peaks around day four and resolves around day ten. This is also important in terms of patient education. A mother may be experiencing these symptoms but not seek help because she thinks these symptoms will pass and are too common to need medical assistance. 

Another barrier in terms of diagnosis is that mothers may feel shame or embarrassment around their symptoms. Motherhood is often idealized, so feeling anything other than joy or experiencing anything other than bonding with their baby may be a difficult experience to communicate.

http://www.mayoclinic.org/diseases-conditions/postpartum-depression/basics/tests-diagnosis/con-20029130

http://www.medicinenet.com/postpartum_depression/page3.htm

http://www.cdc.gov/reproductivehealth/depression/

Etiology and Pathophysiology of Postpartum Depression

Postpartum depression is characterized by many different symptoms such as depressed mood and lack of interest in normal, daily activities, disturbances in sleep and appetite, lack of energy, and suicidal thoughts or actions. This can be challenging for healthcare professionals because changes in appetite and sleep which lead to lack of energy are extremely common because of the nature of having a new member of the family to take care of. 

The risk of depression is increased within the first year of childbirth, with adolescents being more susceptible to postpartum depression than other women. People who have experienced depression before are more likely to experience postpartum depression. Social factors play a major role in the likelihood of a person experiencing postpartum depression. Women who have low levels of education, little social support such as the lack of a partner, women experiencing poverty and women who abuse drugs or alcohol are more likely to experience postpartum depression than other women. Another factor is the pregnancy and delivery itself. Unplanned pregnancy, problems during pregnancy and delivery, and the mode of delivery have been argued as factors that can contribute to postpartum depression.

Postpartum depression not only affects the mother and her well-being, but affects the wellbeing of the child. Infancy is a crucial time for development, and if the mother does not have the capacity to bond with her baby, the child will experience developmental delays. Furthermore, postpartum depression increases instances of infanticide and infant neglect.

One conflict medical professionals face when evaluating the etiology and pathophysiology of depression in new mothers is the tension between the positive and adverse effects of psychotropic medication. While giving a mother psychotropic medication decreases the risk of suicide, infanticide, substance abuse, and malnutrition, there may be adverse side effects for a fetus or child that is exposed to these drugs. However, there are also adverse side effects for the child if their mother's bonding with the child is disrupted during this crucial developmental stage.  

http://www.sciencedirect.com/science/article/pii/S0896627308005886

http://www.medscape.com/viewarticle/775406

http://dareallalucedoula.com/postpartum-support-for-new-moms/more-than-just-the-baby-blues-all-about-pnd-postnatal-depression/