Postpartum depression can last years if left untreated

Postpartum (post-par-tem) adj. Of or occurring in the period shortly after childbirth.

Psychiatrist Madelaine Wohlreich was talking about the weeks after childbirth, postpartum, which "can be among the most exciting in a lifetime.

"But this is also a time of high stress, requiring many adjustments. Lack of sleep, changes in patterns of daily life and concerns about the baby's care are common experiences. Most mothers feel emotionally upset or overwhelmed at times during the adjustment period.

"Sometimes mothers experience emotional difficulties in the weeks after a baby is born. The causes are many, and include hormonal and chemical changes in a woman's body after childbirth, as well as changes the new baby brings to her life. Depression is the emotional illness most commonly experienced by mothers after childbirth."

Wohlreich, herself the mother of a six-year-old boy, heads the Postpartum Disorders Project at Pennsylvania Hospital in Philadelphia -- a project that aims at public education toward a whole range of disorders, not only depression but also everyday baby blues, common anxiety and debilitating psychosis, which strikes two out of 1,000 new mothers and separates them from reality.

In an interview, Wohlreich said that up to one in 10 new mothers is affected by moderate-to-severe depression that, without adequate treatment, can last for months or even years. With good treatment, depression can be put to rest in a few weeks, she said, but it's amazing -- and downright discouraging -- how many women get no help or the wrong kind of help.

"One woman was told that she needed intensive long-term psychotherapy. . . . Medication was withheld from another woman because she was judged by her doctor to be `too high functioning' to require medication. . . . Another woman was told by her physician that there is no such thing as postpartum depression" and that she just needed to pull herself together and get going.

The so-called "baby blues" strike almost every mother, usually two to 10 days after childbirth, and consist mainly of periods of weepiness that are not necessarily related to feelings of sadness. This is not a psychiatric illness, and it usually subsides within a day or two -- without treatment.

On the other hand, depression usually begins two to six weeks after childbirth, with major symptoms such as fatigue, sleep disturbances, loss of pleasure and interest in things, and loss of appetite. Often neither husband nor wife is immediately aware that anything is wrong, said Wohlreich. "If they haven't had a baby before, they may think that this is how she's supposed to feel. They don't recognize it as an illness," and frequently the new mother is left to fend for herself.

"During the pregnancy, I see the husband come in with the wife for her visits, but on the postpartum visit she's almost always by herself. The expectation is that after the baby arrives the mother knows what to do and doesn't need support."

Here are some other points made by Wohlreich:

* Women are at higher risk of developing postpartum depression if they have a personal history of depression and especially bipolar illness. A family history of depression also increases the risk. A woman who has had postpartum depression is at increased risk for another depression in her next pregnancy, but the good news is that "she can recognize it quickly" and she knows what to do about it.

* Treatment often involves both short-term psychotherapy -- "to shore up things so she can resume her role as mother" -- and anti-depressant medication. But medication -- especially for breast-feeding mothers -- "can be tricky. I don't like to give medication to the baby through the mother, and it's hard to tell a woman who feels that she's a failure as a mother that she must give up nursing so she can take medication."

* The depression most likely stems from biochemical and hormonal changes and environmental stress created by the baby's arrival. Studying postpartum depression can "be a model for understanding how these factors interact."

* The "vast majority" of depressed mothers do not harm their children, but those who do attract wide media exposure that perhaps makes the problem appear to be worse -- in terms of abused children -- than it really is.

* The effect of postpartum depression on marriage "is not good. The wife may be irritable, unhappy, not interested in sex. . . . The husband may get angry at her. When he tries to cheer her up and it doesn't work, he may withdraw -- at the time when she most needs his support." Some marriages crack.

* Postpartum depression has been reported in women who adopt babies, but this doesn't mean necessarily that environmental stress plays a dominant role in development of the illness. It's possible that hearing a baby cry can stimulate hormone production in a woman.

* Women who go back to work shortly after childbirth don't seem to fare better or worse than women who stay at home with the baby.