POSTPARTUM DEPRESSION

Postpartum Depression



Postpartum Depression

Postpartum depression is depression in mothers that occurs following the birth of their child. Women often feel pressure from others to experience joy and delight after giving birth; however, in reality, normal postpartum adjustment often involves a difficult transition to a new role, decreased freedom, and increased financial constraints. Contrary to media depictions of women with severe postpartum depression who harm their children, most women with postpartum depression experience symptoms of mild to moderate severity that readily respond to treatment. It is well established that depression generally results from a combination of vulnerability factors (e.g., genetics, pessimistic cognitive style) and stressful life events; examination of depression in the postpartum period provides an opportunity to consider the manner in which vulnerability factors put women at risk for experiencing depression in the context of a discrete, clearly defined stressor.

DIAGNOSIS

Although postpartum depression is readily identified in the research literature and in the media, there is no official diagnosis of postpartum depression per se. Instead, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) indicates that women are assigned a diagnosis of major depressive disorder with postpartum onset if they meet criteria for a major depressive episode within the first 4 weeks following childbirth. A diagnosis of major depressive disorder requires that individuals endorse at least five of the following symptoms: depressed mood, lack of interest or enjoyment in activities, appetite disturbance, sleep disturbance, fatigue, worthlessness or inappropriate guilt, concentration difficulties or indecisiveness, and suicidal ideation. These symptoms must occur more days than not over at least a 2-week period and cause life interference or significant personal distress. Although this is the definition that mental health practitioners use for diagnosing postpartum depression in their clinical practice, some researchers have defined postpartum depression as being either a major or minor depressive episode (i.e., consisting of fewer than five of these symptoms) following childbirth. It also is important for clinicians who diagnose postpartum depression to realize that many features of normal adjustment (e.g., sleep deprivation) overlap with symptoms of depression. Thus, such symptoms should be regarded as indicative of postpartum depression only if they are in excess of what is considered normal adjustment for postpartum women. A useful tool to screen for depression specific to the postpartum period is the Edinburgh Postnatal Depression Rating Scale.

Some researchers have documented that postpartum depression lasts, on average, between 6 and 8 weeks; however, there are many instances in which postpartum depression extends beyond the first year following childbirth. Although the DSM-IV postpartum onset specifier indicates that the major depressive episode begins within 4 weeks after childbirth, many women with postpartum depression also report major depression during pregnancy, and there are many instances in which women develop depression several months after childbirth. Recently, researchers have raised the possibility that there might be two types of postpartum depression—discrete episodes that begin following childbirth, and recurrences of non-postpartum depression.

Postpartum depression is often contrasted with two other instances of postpartum emotional ...