Postpartum Depression Underdiagnosed

For most new mothers, the first days after giving birth can be like an emotional see-saw.

The lack of sleep, new responsibilities and general anxiety about whether you'll measure up to the daunting parenting task that lies ahead can take a psychic toll.

So most women can feel elated one minute and down in the dumps -- the "baby blues" -- the next.

For some, however, that "down" feeling -- postpartum depression -- is longer and deeper. And it needs prompt medical attention.

"Ten to 17 percent of women have postpartum depression," said Dr. Diana Dell, an assistant professor of obstetrics and gynecology and psychiatry at Duke University Medical Center. But the problem is often overlooked, even by physicians, she said.

Dell partly faults society for not giving new mothers enough support. "We think you are supposed to birth your baby, pick up your grain sack and go on," she said.

But postpartum depression "is the most underdiagnosed obstetrical complication in America," added Dell, who is an obstetrician as well as a psychiatrist.

And that's troubling, she said, because talk therapy and medication can help treat the condition and get women back on track, making them healthier people and happier parents.

Another expert says adding complementary therapies to the mix, such as massage therapy, can also pay big dividends.

Postpartum depression, like other clinical depression diagnoses, involves a host of symptoms, and can surface a few days or even months after childbirth, according to the National Women's Health Information Center. But unlike the "baby blues," which are fleeting but very common following childbirth, postpartum depression persists not for days but for weeks -- even months.

Among the symptoms: Feelings of restlessness or irritability; frequent bouts of crying; lethargy; inability to eat; overeating; trouble focusing; feelings of worthless and guilt; fear of hurting oneself or the baby.

What can make postpartum depression different is that women experience more than the usual amount of anxiety that is seen in depressed patients. "All depression can have an element of anxiety but this is very striking in the postpartum period," Dell said.

The exact causes of the disorder aren't known, but hormonal changes in the body may trigger the symptoms. In the first days after childbirth, levels of the hormones estrogen and progesterone -- which escalate during pregnancy -- plummet. Sometimes, thyroid levels also drop after giving birth, and that may contribute to the mood swings, anxiety and fatigue, the National Women's Health Information Center says.

But at the root, Dell believes, is the lack of support for new mothers. "Women feel all alone," she said. Risks of postpartum depression are higher, she added, if the woman has suffered a depression during the pregnancy or if her husband or partner isn't supportive.

To make matters worse, women with postpartum depression are often the ones striving to be the best mothers possible, Dell said.

For that reason, they may not even mention their depressed feelings, she said. "Even if someone asks [if they are feeling depressed], they may deny it," she said.

Luckily, if treatment is sought the outlook is good, said Margaret Beal, an associate professor at the Yale School of Nursing, who has researched the role of complementary therapy for postpartum depression.

Antidepressant medication and talk therapy are often an ideal combination, according to Beal. "I recommend women see some kind of mental health professional for a psychiatric assessment," she said.

In research published recently in the Journal of Midwifery and Women's Health, Beal also found that certain complementary or alternative therapies, used in concert with medication and talk therapy, can help. Those therapies include massage, aromatherapy and acupuncture, she said.

The most serious form of postpartum depression, called postpartum psychosis, is rare, Dell said. This is a very worrisome mental illness that can strike suddenly after childbirth, often within the first three months. Women can lose so much touch with reality that they have auditory hallucinations and delusions, leading them sometimes to harm or even kill their babies.

Depression following childbirth can be measured as a continuum, Dell and other experts said. At one end, the "baby blues" are fleeting and usually minor. True depression is more serious and needs to be treated. And psychosis needs immediate medical attention.

Dell has reassuring words for women who think they may have postpartum depression: "It is common, it is treatable and it doesn't mean you don't love your baby."

Getting professional help quickly is the best thing a depressed new mom can do for herself -- and her baby.

More information

To learn more about postpartum depression, visit the National Women's Health Information Center.

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