Postpartum Depression

Postpartum Depression: Etiology and Symptoms

The presentation of major depression during the postpartum period demands focused attention. Maternal depression has a debilitating effect on a woman's ability to interact with her newborn and on the infant's cognitive and social-emotional development. Although 10% to 20% of women are affected by depression during the childbearing years, the opportunity for diagnosis and treatment during the perinatal period is often missed. Disparities between a standardized operational definition and clinical practice as well as a lack of clarity in diagnostic symptomatology confounds challenges to detection and treatment.

Diagnostic Challenges

Although postpartum depression is a widely used term and an accepted part of the psychiatric nomenclature, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) does not recognize postpartum depression as a distinct and valid disorder. Instead, “postpartum onset specifier” is listed within the category of mood disorders. This specifier applies to the presentation of a major depressive, manic, or mixed episode, Bipolar I, Bipolar II, and brief psychotic disorder within the 4-week period following childbirth. A presentation during the postpartum period is considered to be the current or most recent episode of an already existing mood disorder (American Psychiatric Association, 1994). The stressors associated with the perinatal period perhaps trigger the episode of depressive symptoms presenting during this period.

Others, however, favor a biologically based explanation for the existence of a specific and distinct condition of postpartum depression. Researchers in Europe and Japan recognize a cluster of symptoms associated with a condition thought to be a true postpartum depression, which is unrelated to any preexisting condition of mood disorder. Symptoms include physical weakness, anemia, pallor, menstrual irregularities, and gastrointestinal disturbances. Biological causal explanations suggest that the dynamic drop in estrogen levels immediately following delivery affects pituitary function. These changes, in turn, act on glands that produce substances affecting mental states (Ziporyn, 1992).

Conditions that Mirror Postpartum Depression

There are other physical conditions that mirror symptoms of depression. Anemia and thyroid dysfunction are common conditions that present during the postpartum period. Fluctuations in weight, motivation, sleep cycling, and anxiety levels are shared symptoms of both thyroid dysfunction and depression (Epperson, 1999). Confusion surrounding symptomatology is further exacerbated by the occurrence of two other conditions associated with the postpartum period.

“Postpartum blues,” estimated to affect 26% to 85% of all new mothers, mirrors depression. Symptoms of postpartum blues usually present within 2 weeks following birth, peak between Days 3 and 7, and resolve spontaneously. Patients most commonly describe anxiety, tearfulness, irritability, feeling overwhelmed, and changes in appetite and sleep patterns. Postpartum psychosis, or rather a psychotic episode during the postpartum period, is rare and affects 0.2%, or 1.7 out of every 1,000, childbearing women. Symptoms include delusions, hallucinations, and suicidal/homicidal ideations (Bright, 1994). This rare disorder places mother and infant in immediate danger, yet the terms postpartum depression, post-partum blues, and postpartum psychosis are often used interchangeably.

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