Cindy-Lee Dennis, PhD, is associate professor of nursing and psychiatry at the University of Toronto and holds a Canada Research Chair in Perinatal Community Health.
Q: I have never suffered from depression. What are the odds I might develop PPD?
Q: Are there any warning signs during my pregnancy that I am at increased risk for PPD?
A: Yes, and they are easy to spot: If a mom is feeling at all depressed or anxious for two weeks or more during her pregnancy, chances are good it may continue into the postpartum period. This is why it's important that you get treatment for that original depression.
Q: How do I know whether I am experiencing the "baby blues" or PPD?
A: "Baby blues" occur in the first couple of weeks after delivery in approximately 50% to 80% of mothers; for most of them the tearful episodes go away on their own. However, if you start not enjoying once pleasurable things, sleeping too little or too much, or having changes in appetite and sudden mood swings, then you might be developing postpartum depression. Often women begin to believe that they are not very good mothers. If these symptoms and feelings come every day and last more than two weeks, then you should seek help from a health professional such as a family physician or a public health nurse. These professionals can refer you to a mental health specialist such as a psychiatrist or psychologist if necessary.
Q: I am a 30-year-old woman who suffered PPD with my first child. I want to have another but fear it could happen again. Is there anything I can do?
A: Above all, you need to have a support system in place, usually made up of family and close friends. This support will help you develop coping skills that will be of great benefit both in warding off postpartum depression or dealing with it if it returns. Having a supportive marital situation is very important. It is also important to develop realistic expectations with your partner about the challenges and stresses that you will both face in the postpartum period and how you will deal with these stresses. You will also want to meet other women in the community who have young children. These women can provide excellent support and validate the challenges of motherhood. Furthermore you should plan events to get out of the house on a regular basis so you do not become isolated. And think about what type of help you can arrange in relation to child care and household responsibilities so that you can get sufficient rest and take a break. Remember that your fears are genuine, and you have to be prepared.
Q: If I develop PPD, should I consult a doctor for medication and a therapist, or first see how it goes with the drugs?
A: If your symptoms are mild, you might first contact a health professional like your family physician. Sometimes talking with close friends or family members can help, and you can always participate in a mothers support group or various activities that get you out of the house.
If the symptoms are moderate to severe, this is where antidepressants come into play. It's hard to go to therapy or supportive activities without first getting some relief. I am referring to severe symptoms which can decrease your ability to function in regular day-to-day activities. But keep in mind that antidepressants only control the symptoms of postpartum depression. They will not make your marriage better if that is the cause of your depression. Combining antidepressant medication and couples counseling may be the best treatment option in this case.
Q: Are women who have multiple births more likely get postpartum depression?
A: The stress involved in caring for two or more children at the same time can be a factor. You may get less sleep, not be able to get out of the house as much as before, and not have the chance to take part in outside activities that offer a break from the responsibilities. This potential isolation and increase in child-care stress may place you at risk of developing postpartum depression.
Q: If I have periodic "bad thoughts," even about suicide, though with no intention of carrying it out, should I seek help?
A: I would talk with a health professional such as your ob-gyn or family physician. Explore why these bad thoughts come up. This kind of thinking, even if it might not seem serious to you, can progress into something truly serious.
Q: Which antidepressants accumulate in breast milk?
A: All do—but at different levels. Some are more "breast friendly" than others. Ask your family doctor or a specialist. And there is a lot of information online at sites like Motherisk.org.
Q: If it is not yet certain that antidepressants in breast milk are harmless, shouldn't I just these avoid medications altogether?
A: It depends on the severity of the symptoms. You have to weigh the pros and cons. If a mom is severely depressed and cannot function, the antidepressants will likely be very helpful, with little effect on the baby. There are some very good drugs available that are safe for breast-feeding. Even so, surveys show that less than 50% of prenatal and postnatal women are receptive to taking medications, especially those who are breast-feeding. Most antidepressants cross the placenta and are present in breast milk, and while they can be very safe these mothers do not want their fetuses exposed to any level of medication.
Q: Might it be helpful to undergo talk therapy before or during pregnancy to deal with any emotional issues that could put me at risk for postpartum depression?
A: If a woman is not symptomatic during pregnancy, then I would not recommend going into any preventive psychotherapy. I would, however, recommend that she have some supportive people in place just in case. And it is very important that she talks with her husband or partner about the challenges of having a new baby. Does he agree to help out around the house without being asked? Those sorts of issues. And Mom needs to eat well and get sufficient sleep; mothers who get less than six hours sleep in a 24-hour period are put at increased risk to develop postpartum depression.
Q: Women with postpartum depression are sometimes advised to hire household help and babysitters so they can focus on getting well. Might that serve to further shelter her from the world, thus increasing the feelings of isolation?
A: It's perfectly OK to take on help around the house to give her some space to care for herself and try to get better. This is all part of building a support network.
Q: If I have a child at a time when my home life is unhappy, do I have a greater chance of getting postpartum depression?
A: We know that conflict in life increases the risk of postpartum depression. The role of the partner is especially important. It has been shown that women with no history of depression but with poor marital relationships are at increased risk. As such, it is important to develop other support networks, such as other women with children, and get counseling to address the unhappy home life.
Q: I feel terrible that because of my postpartum depression, I may not be giving my baby the emotional nurturing she needs. Is this reason for concern?
A: One single episode of postpartum depression rarely affects a young child long-term. You might not be as responsive to a child's needs, and you may not be as positive as a nondepressed mom, but you have no reason to feel guilty. However, if your depression continues for several months or keeps recurring you should, of course, get treatment.
I am sometimes asked if there is research on this topic, like long-term outcome studies. There is, but it does no good to highlight rare negative outcomes to women who are already feeling anxious and guilty about their mothering ability. It's better to highlight that she can still be a good mother and needs treatment so she can respond to her child in a way that makes her feel good.
Q: What about these people who end up harming themselves or their children?
A: Most mothers with postpartum depression do not harm themselves or their children. However, mothers with a different condition called postpartum psychosis are at higher risk to harm themselves due to severe symptoms such as hallucinations. Mothers with this very rare condition less than 1% require immediate attention.
Q: Considering that sleep deprivation is a major symptom of PPD, can I take sleeping pills while on medication?
A: Sleep deprivation can be a risk factor for postpartum depression. However, do not take any sleep aids before consulting a doctor, especially if you are on other medications or are breast-feeding. You want to make sure that the sleeping aid will not interact with another medication and possibly harm your baby.
Q: How do I go about finding a doctor who understands PPD?
A: You could ask your family physician or ob-gyn for a referral. Sometimes in person or online postpartum depression support groups are helpful. Keep in mind, however, that not every psychologist or psychiatrist is trained to treat postpartum depression. Ideally you would find someone with clinical expertise who can provide the specialized treatment required.
Q: Where do I find information about PPD support groups?
A: There is a lot of information on health-related websites. One good one is Postpartum Support International. Sites like this can help you find organizations in your community.