If you’re a mother, chances are you remember those first days with your infant as a mixture of joy, exhaustion and physical recovery. And if you’re like almost 80 percent of new mothers, you also can relate to the ‘baby blues,’ a short-term episode of irritability, anxiety and moodiness that strikes in the first couple of weeks after childbirth.
Most mothers’ hormones, schedules and emotional states stabilize within a month of giving birth, and they are able to enjoy the wonders of parenthood. However, between five and 15 percent of new mothers experience a far more debilitating condition in the aftermath of childbirth: postpartum depression.
A true medical condition, postpartum depression is more common in women who have a history of depressive illness. “A personal history of depression is the biggest risk factor for postpartum depression,” confirms Dr. Leslie McCloskey, a SLUCare gynecologist. “Twenty-five percent of women with a history of depression will develop postpartum depression.”
Symptoms may appear anytime from a month to a year after giving birth, she says, noting that the condition typically presents within the first few weeks postpartum. “It can be difficult to tell some of the usual postpartum changes from symptoms of depression,” McCloskey adds. Symptoms may include insomnia even when the baby is sleeping, rapid changes in weight, lethargy, panic attacks, irritability or anger, a sense of being so overwhelmed that it’s difficult to care for the baby, lack of mother-infant bonding, and loss of appetite.
The good news is that postpartum depression generally responds very well to treatment, she says. Mild to moderate cases may require only psychotherapy, but more severe cases have been shown to respond to antidepressants, particularly the class known as selective serotonin re-uptake inhibitors (SSRIs), which includes Prozac and Zoloft.
There is no evidence that SSRIs are contraindicated for nursing mothers, although some women refuse the medication because they fear it will affect their infants or because they experience unpleasant side-effects. Yet hope remains in the form of another potential treatment option: transcranial magnetic stimulation (TMS).
TMS was developed in the 1980s, and the procedure uses a special electromagnet that delivers short bursts of energy to stimulate nerve cells in the brain, correcting brain chemistry and alleviating depression symptoms. TMS gained Food and Drug Administration Approval last year for the treatment of major depression. Now, researchers at Washington University are exploring its use for women with postpartum depression.
There are no known side effects of TMS, says Dr. Keith Garcia, a psychiatrist with Washington University Physicians who was involved in the TMS study. “It is well established as a treatment for major depression, and it’s another option women can consider for treating postpartum depression,” Garcia says.
Patty Flynn, R.N., BSN, a clinical research nurse coordinator with the Washington University School of Medicine Department of Psychiatry, describes the pilot study that she and other researchers recently completed: Nine women who had postpartum depression were treated with TMS for one hour, five days a week for four weeks. Following the treatment course, the women reported that their symptoms had disappeared, and they remained asymptomatic at six months postpartum. The study has been submitted for publication, and the researchers are working to obtain a National Institutes of Health grant for a larger study, hoping to confirm their initial results.
“Avoiding treatment for postpartum depression is debilitating and can be dangerous,” Flynn says. “Women may have intrusive thoughts of harming their child, for instance. Unfortunately, some women refuse to seek treatment because they are afraid of being branded a ‘bad mother.’“
“But this is something that’s very treatable, and women shouldn’t be embarrassed by it,” she says. “Talk to your doctor about how you feel. This is a time to enjoy your newborn, so don’t hesitate to get help.”