Postpartum depression, as it has traditionally been known, is now called major depressive disorder with postpartum onset. The postpartum onset specifier may also be applied to bipolar disorder (I or II) or brief psychotic disorder. Thus postpartum symptoms may appear as depression, mania, or psychosis.
The common feature is onset within four weeks of the birth of a child in women who do not have either cyclothymia or dysthymia. Postpartum mood episodes with delusions or hallucinations may be more common with a first birth, and 30% to 50% of women who have had one such episode have another with subsequent deliveries.
The symptoms of postpartum onset mood disorders and nonpostpartum mood disorders are the same. However, the course of the symptoms may vary more in postpartum depression, and the moods are frequently less stable. For a diagnosis of postpartum onset depression, a depressed mood or loss of pleasure or interest in nearly all activities must last for at least two weeks, accompanied by at least four other symptoms affecting appetite, sleep, activity level, self-concept, or thinking.
Mothers with a postpartum onset mood disorder may contemplate suicide and may be obsessed with thoughts of the new child being injured or killed. They may find it difficult to concentrate, and they may be physically agitated.
If delusions are present, as they are in as many as 1 in 500 births, they are usually about the baby. As the delusions may be that the baby is possessed by a demon or has special powers, a pastor or Christian therapist may be especially helpful. Christian counselors may be well prepared to assist women with postpartum depression who feel guilty about being depressed at a time when others are telling them that they should be happy.
New mothers who do not have a postpartum onset mood disorder may experience some of the same symptoms, but these so-called baby blues typically last for less than one week after the birth. Clinicians should consider a diagnosis of a postpartum onset mood disorder only if the symptoms (especially those of severe anxiety, repeated weeping, and lack of interest in the new baby) persist for more than one week. Lack of interest must be distinguished from lack of attention or awareness, which may indicate delirium during the postpartum period rather than depression.
Postpartum mood episodes may be severe. Especially if they are accompanied by delusions or hallucinations, they may interfere with developing a bonding relationship with the baby and may even lead the mother to attempt to kill her infant.
Many factors contribute to postpartum onset mood disorders. Physical exhaustion from the pregnancy and labor probably plays a role, as does the accompanying dehydration. Within a few days after delivery, the mother's hormone levels drop abruptly, and estrogen levels in particular have been linked to mood.
Psychological pressures on new mothers and fathers are significant. Both must cope with the physical demands of parenting, with sleep disruption increasing the difficulty. They must learn to communicate with the baby and in a new way with each other. They may be ambivalent about their new family status and roles, and the baby may bring financial and emotional pressures.
The most effective treatment appears to be postpartum counseling within a few days of the birth. Women who know that they should expect their emotions and attitudes to fluctuate for awhile can anticipate recovery in two to three weeks. Those who do not may need clinical treatment for a mood disorder.