Postpartum depression: the importance of getting help

Postpartum depression (PPD) is characterized by a full-blown episode of depression that occurs within four weeks of delivery.  It is more serious and severe than the "baby blues," the weepiness that lasts just three to seven days post-delivery.  A recent study in the April issue of JAMA Psychiatry now shows that as many as one in every seven women suffers postpartum depression.

Postpartum depression is associated with adverse outcomes for both mother and child, beyond the misery and guilt women afflicted with this disorder typically experience. For instance, postpartum depression predicts maternal suicide. Although postpartum women are less at risk for suicide than the general population of women, suicide is the second leading cause of death among them and accounts for 20 percent of deaths.  Moreover, postpartum depression can adversely affect attachment between mother and child, and maternal mental illness is highly predictive of later child psychological problems.

The research examined 10,000 women four to six weeks after they had given birth at Margee-Womens Hospital at the University of Pittsburgh. Women were first screened for symptoms of postpartum depression using the Edinburgh Postnatal Depression Scale (EDPS), a well-researched and common measure of the disorder.  What made this study unique is that women who were identified as "at-risk" via a cut-off score of 10 or above on the EDPS were then visited in their homes for a full face-to-face diagnostic interview.  During the two to three hour interview, an experienced clinician could determine with more sensitivity if the mother met criteria for actual postpartum depression, as well as any other psychological disorders.

Results showed that 14 percent of the 10,000 women screened were at risk for PPD and 3.2 percent reported thoughts of self-harm.  Of those at-risk women who consented to in-depth psychological interviews, 68.5 percent met criteria for major depressive disorder. The majority identified the onset of their depression as postpartum (40 percent), followed by during their pregnancy (33.4 percent), and prior to pregnancy (26.5 percent).

A striking finding was that 22.6 percent of interviewed women met criteria for bipolar disorder. This was a higher prevalence than expected, even though prior research has shown that women are most likely to experience first and recurrent bipolar episodes during the postpartum period.  Of those women who met criteria for depression, more than half (66 percent) also met criteria for another psychological disorder, overwhelmingly (82.9 percent) an anxiety disorder such as generalized anxiety disorder, panic disorder, social phobia, and post-traumatic stress disorder.  Based on the results, researchers called for more thorough screening of women during the postpartum period, with increased attention to bipolar and anxiety disorders.

Women (and their partners) who are concerned about the possibility of PPD can ask their doctors for screening and referrals during routine post-natal care.  Results of well-controlled studies have indicated that common antidepressants such as Prozac and Paxil are effective in treating PPD and that Interpersonal Therapy (IPT) and Cognitive Behavioral Therapy (CBT) are effective therapies.

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