Mental Health

Not Just the Baby Blues: An Interview on Postpartum Depression with William Beardslee, MD

William Beardslee, MD is the Academic Chairman of the Department of Psychiatry at Children’s Hospital in Boston and Gardner Monks Professor of Child Psychiatry at Harvard Medical School. Dr. Beardslee has a longstanding research interest in the development of children at risk because of severe parental mental illness. Currently, he directs the Preventive Intervention Project, an NIMH funded study to explore the effects of a clinician-facilitated, family-based preventive intervention designed to enhance resiliency and family understanding for children of parents with affective disorder. He is also one of the three Principal Investigators of Family Connections, a program to develop a model for strengthening families in the face of depression in Early Head Start and Head Start, and is the principal investigator of the Boston site of a new prevention-of-depression trial for children at double risk because their parents are depressed and they themselves are already manifesting symptoms of depression. Dr. Beardslee served on the Board of the National Mental Health Association and currently serves on the Carter Center Task Force on Mental Health and on the Advisory Board of the Depression Bipolar Support Alliance. He is also the author of Out of the Darkened Room: When a Parent Is Depressed. Recently, we talked with Dr. Beardslee about postpartum depression.

Q. What types of mental health conditions do women experience after giving birth?

A. Because women are most likely to experience depression during the primary reproductive years (25 to 45), they are especially vulnerable to developing depression during pregnancy and after childbirth. Women’s experiences after giving birth may range from what some refer to as the normal “baby blues” to the more serious condition of postpartum depression (PPD). And in rare and very severe cases, women may experience a condition called postpartum psychosis.

Q. How common are “the baby blues”?

A. Mothers commonly experience what is called “the baby blues,” referring to mood swings caused by the hormonal fluctuations that occur during and immediately after childbirth. Postpartum blues or “the baby blues” are very common, occurring in up to 80 percent of new mothers. The onset of postpartum blues usually occurs three to five days after delivery, and it subsides as hormone levels begin to stabilize. Symptoms generally do not last for more than a few weeks. If a woman continues to experience moods swings or feelings of depression for more than two weeks after childbirth, the problem may be more serious than just “the baby blues.”

Q. What is postpartum depression (PPD)?

A. Postpartum depression (PPD) is a major form of depression and is less common than postpartum blues. PPD includes all the symptoms of depression but occurs only following childbirth. It can begin any time after delivery and is estimated to occur in approximately 10 to 20 percent of new mothers.

Q. What are the symptoms of PPD?

A. Symptoms of PPD are the same as those for clinical depression, and may include specific fears such as excessive preoccupation with the child’s health or intrusive thoughts of harming the baby. Given the stressful circumstances of caring for a new baby, it is understandable that new mothers may be more tired, irritable and anxious. But when a new mother is experiencing drastic changes in motivation, appetite or mood she should seek the help of a mental health professional. For a clinical diagnosis of postpartum depression to be made, symptoms of PPD generally must be present for more than two weeks following childbirth, to distinguish them from postpartum blues.

Q. What causes PPD?

A.The causes of PPD are not entirely clear, but research suggests that three factors may contribute to its onset. First, intense hormonal fluctuations after giving birth, such as decreased serotonin levels, may play a role. There are also situational risks associated with PPD. Childbirth itself is a major life change and transition, and big changes can cause a great deal of stress, resulting in depression. If some other major life event also coincides with childbirth, a mother may be more susceptible than average to PPD. Finally, life stresses may play a role. Ongoing stressful circumstances can compound the pressures of having a new baby and may trigger PPD. For example, excessive stress at the office, added to the responsibilities of being a new mother, can cause emotional strain. The nature of the mother’s relationship with the baby’s father and any unresolved feelings about the pregnancy might also affect a woman’s risk of experiencing PPD.

Q. How is PPD treated?

A. Postpartum depression is treatable. For many women the most effective approach is a combination of antidepressant medication and psychotherapy (also known as “talk therapy”) with a professional counselor or therapist trained in issues surrounding childbirth. A treatment plan should be individualized with a health care provider. Social interaction through support groups and with friends and family can also play a critical role in recovery from PPD. Exercise and good nutrition may also help to improve a new mother’s mood and also aid in her recovery. However, women who are having difficulty carrying out a normal, everyday routine might find it difficult to do these kinds of things. That’s why professional treatment is so important.

Q. How does PPD affect babies?

A.When a new mother has severe depression, she is less able to respond to her child’s needs. PPD makes it profoundly difficult for a woman to connect with her baby in the way she would like to. She may be physically and/or emotionally distant from her child, and may have difficulty doing the routine tasks of baby care, such as responding to the baby’s cries, promptly changing diapers, bathing, and feeding. Several studies have shown that the more depressed a new mother is, the greater the delay in the infant’s development. A new mother’s attention to her newborn is particularly important immediately following birth, because the first year of life is a critical time in cognitive development. Left untreated, PPD may contribute to delays in motor development and increased anxiety in a young infant. Over extended periods the mother’s inability to relate to her infant may lead to attachment problems in the child.

Q. Is PPD preventable?

A. In most cases PPD is preventable, to the extent that early identification can lead to early treatment. A major part of prevention is being informed about the risk factors, and the medical community can play a key role in identifying and treating PPD. Women should be screened by their health care provider to determine their risk for acquiring PPD, and other health care providers who come into contact with postpartum women – such as nurses, midwives, and pediatricians – should also be vigilant for signs of PPD, referring women for treatment when postpartum depression is suspected. Because social support is also a vital factor in prevention, partners, family members, co-workers, and friends can play an important part in prevention, by identifying the risk of PPD and helping a woman to seek professional help.

Q. How is PPD different from postpartum psychosis (PPP)?

A. In rare cases, women may experience postpartum psychosis (PPP), a condition that affects about one-tenth of one percent of new mothers. Onset is quick and severe, and usually occurs within the first two to three weeks following childbirth. Symptoms are similar to those of general psychotic reactions such as delusions (false beliefs) and hallucinations (false perceptions), and often include physical symptoms (such as refusal to eat or frantic energy), mental symptoms (such as extreme confusion or incoherence) and behavioral symptoms (such as paranoia or irrational statements). A woman who is diagnosed with PPP may require hospitalization until she is in stable condition. Because psychosis can result in behaviors that are unpredictable and potentially dangerous to a young child, the level of risk should be carefully monitored by a mental health professional and the family. It is important to have plans to support the mother and care for the child during a crisis. Doctors may prescribe a mood stabilizer, antipsychotic or antidepressant medications to treat postpartum psychosis.

Q. What can HMHB and its partners in maternal-child health do?

A. PPD is preventable and treatable, yet women are simply not getting help. Health care providers can familiarize themselves with the available screening tools and put them into practice. Childbirth educators and doulas can educate pregnant women about the importance of stress management and help women plan ahead for things that are likely to be difficult in the postpartum period and which may make PPD more likely or more severe. It’s important to recognize that this is a child and family health issue as much as it is a women’s health issue. New dads, other family members and friends who are in close contact with moms need to be able to recognize PPD and know where to turn for help. Many women are not able to take the initiative to get help on their own when they are profoundly depressed. We all have a role in educating policymakers about the need to mandate education and screening for PPD as part of standard, perinatal health care. New Jersey has set a great standard for other states. Increasing awareness of this issue is absolutely essential to the health of mothers, babies and families.

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