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Postpartum Depression: When having a baby
gives you more than the blues
by Karen Kleiman, MSW

Part Two

When a baby is born, everyone expects that this will be the best time in their life. No one expects this time to be complicated by tears, frustrations, feelings of inadequacy, anxiety attacks and/or depression. It doesn’t always make sense and it certainly isn’t fair.

What causes PPD?
Theories about what causes PPD are very controversial. Most experts agree, however, that it involves a combination of hormonal, biochemical, psychosocial, and environmental influences. It is understood that no single factor is ever totally responsible for the emergence of PPD. For instance, although it is suspected that hormones play a large part in the development of PPD, we also know that fathers and adoptive mothers have suffered with PPD, which tells us that it is not strictly hormonal.

Many things can put a woman at risk for PPD. Some of these risk factors are:

• previous PPD
• 
  
• family history of anxiety/depression (genetic predisposition)
• 
  
• unplanned pregnancy
• 
  
• unsupportive spouse
• 
  
• recent separation or divorce
• 
  
• major loss in past two years (death of loved one, move, job)
• 
  
• obstetric complications
• 
  
• environmental stressors

These risk factors do not cause PPD. Many women can have a number of these risk factors and never get depressed. We don’t always know why. Other women can have one or even no risk factors and end up with a full blown major depression. What we do know is that these risk factors make a woman more vulnerable and if she knows she is at risk, she can begin to take preventative measures, such as mobilizing a support network.

The impact of PPD and the factors that play the largest part in any particular case is quite variable and is best determined by a complete diagnostic assessment. Researchers have concluded that women are most vulnerable to emotional illness following the birth of a child. This, coupled with the fact that the postpartum period is perhaps the most demanding time in any woman’s life, combine to set the stage for emotional fatigue and stress.

How do you know if what you are feeling is “normal”or if it is PPD? Because of the reasons noted previously, it has been difficult for women to get the help they need. It is important for women to know when what they are feeling is okay, and when they may need to seek further support. Frequently, it is not just what you are feeling that tells us that something may be amiss, but it is the frequency, intensity and duration of the feeling. In other words, it is common for a new mother to feel sad and anxious intermittently throughout the early months. It may be a concern, however, if she is crying all day long and experiencing panic attacks keeping her up at night.

This is what makes the diagnosis of PPD so complicated. There is no standardized, scientific test to determine the degree of adjustment difficulty. Confirmation of PPD is made by clinical description, that is, what mom reports, how she looks, how she sounds. If you have recently had a baby are are not feeling quite yourself, it is important to take this seriously. If you have been feeling bad for more than two weeks, it may be time to consider talking to a professional about how you are feeling.

Many people confuse PPD with the more common phenomenon of baby blues. The “blues” refer to a hormonally triggered state that is characterized by tearfulness, depression, fatigue, irritability, and anxiety. Research shows that the incidence of baby blues is as high as 80 percent of all new mothers. Onset is usually soon after delivery and remits spontaneously within two weeks. No treatment is required other than understanding of the situation and support. If symptoms of what appears to be baby blues persist beyond two weeks, the possibility of PPD should be considered.

Since many PPD symptoms are heightened states of what any new mother (without PPD) may feel, they are often casually dismissed as temporary and expected responses to the postpartum adjustment period. In other words, if a new mother tells her doctor she is feeling weepy and tired, he/she may remind mom that this is “normal” and she will feel better soon. This may or may not be true. Medical professionals need to be more responsive to the statements of the mother who is concerned about the way she feels. Unfortunately, most women are not eager to share their emotional anguish and unless the right questions are asked, her level of acute distress may continue to go unnoticed.

Next Part
Part One	Part Two
Part Three	Part Four

About the Author: Karen Kleiman, MSW, is a clinical social worker and mother of two who writes and lectures on the subject of postpartum depression. She is the author of This isn’t What I Expected: Overcoming Postpartum Depression (Bantam Books, 1994). Ms. Kleiman is founder and director of The Postpartum Stress Center which provides educational consultation, diagnostic assessment, and group & individual therapy for women and their families who experience difficulties related to pregnancy, pregnancy loss and the postpartum period.