Four days into new motherhood, Lindsey was thrilled to be a mom and still awestruck by her baby. She felt fortunate to have only minor physical discomfort from her delivery and, because her husband was so helpful with the baby, she was less exhausted than one would expect a new mom to be. But she did notice some uncharacteristic feelings and reactions. Usually a no-nonsense, take charge type, she now cried at the littlest things — such as when a sappy love song played on the radio. And she was becoming snappy. When her husband came home one evening and made a noncritical remark about the house looking unkempt, she nearly bit his head off.
Caryn had wanted a baby very badly, and was happy and optimistic throughout her pregnancy. However, six weeks after delivering a healthy baby by Cesarean section, she began feeling that her body “got it wrong” and did not perform as it should have. She was wracked with guilt about whether she could have breathed or pushed differently to allow for a vaginal delivery. She felt sad nearly all the time, and was unable to enjoy her baby. She thought she would be an inept mother because she felt inept at giving birth. She lost interest in food, and couldn’t sleep even when the baby slept. Caryn sometimes wondered if her baby and husband would be better off without her.
Lindsey was experiencing baby blues, a normal reaction to postpartum hormonal changes that happens to about half of new mothers. Caryn had a much more serious problem – postpartum clinical depression.
Baby Blues is a misleading name for normal postpartum mood changes. That’s because women with baby blues don’t feel sad most of the time. What they do experience is intense emotional responsiveness. They react more strongly — and feel emotions more deeply — than usual. Their moods change more often. Most women with baby blues cry often, but they are just as likely to cry from happiness as they are from sadness.
Postpartum emotional reactivity usually peaks at about three to five days after the baby is born, just when the breast milk is coming in. This is probably not a coincidence. Oxytocin, the hormone that causes milk letdown, peaks at this time. Oxytocin affects a new mother’s brain, priming her to bond with her child. It influences the parts of the brain that determine moods, deepening emotions.
Women with baby blues don’t need medical treatment, but do need understanding, support and enough sleep. Under those circumstances, normal postpartum mood changes fade away after a few days or weeks. However, if a new mom is stressed and does not get enough support or sleep, the blues can turn into depression.
Postpartum depression is a serious illness requiring professional treatment. Women with postpartum depression feel sad, tearful or empty nearly all the time, and may have difficulty enjoying anything, including their new babies. They also have some or all of the following symptoms:
• Changes in appetite: a loss of interest in food, or taking extra comfort in eating
• Unable to sleep
• Excessive, unwarranted guilt and/or self-doubt
• Feelings of hopelessness
• Difficulty concentrating or making everyday decisions
• Low energy
• Thoughts of death or suicide
Untreated postpartum depression can become chronic and recurrent. It can interfere with mother-infant bonding and parenting, and can increase the risk that the baby will grow up to suffer from depression or have behavioral or learning problems. Fortunately, help is available.
Postpartum depression can be treated with psychotherapy, medication or both. If you have any symptoms, talk to your doctor or midwife. When determining which treatment, including medication, is best for you, your doctors will take whether you are breastfeeding or not into account. In addition, they will speak to your family about how best they can help you during your recovery.
Caryn reported her symptoms to her ob/gyn at her six-week postpartum checkup, and was referred to a psychologist for cognitive-behavioral therapy. This short-term psychotherapy helped her reduce self-blaming thoughts and gain confidence in her new role as a mother. Her obstetrician also prescribed sertraline, an antidepressant medication recommended for women who are breastfeeding. After two months of treatment, Caryn felt much better. She and her husband are now enjoying their new family!
Laura J. Miller, M.D., is director of the Women’s Mental Health Program, Department of Psychiatry, University of Illinois at Chicago.
For more information, go to www.cdc.gov or www.womenshealth.gov