Postpartum Depression Study at Magee-Women's Hospital
By Christopher S. Famy, M.D.

The postpartum period should be the happiest time in a new mother's life. Sadly, this is also the time when women are at greatest risk for developing symptoms of depression. From our screening study at Magee-Womens Hospital in Pittsburgh, PA, we know that 14.6%, or one out of every 7 women who deliver will have symptoms of postpartum depression at 4-6 weeks after birth. 'Vanessa' represents one such mother who returned home from the hospital with her newborn. She experienced many of the following symptoms of depression:

• Feeling sad most of the day nearly every day
• Crying
• Losing interest or pleasure in activities you used to enjoy
• Having low energy or motivation
• Feeling restless or overwhelmed and not able to calm down
• Eating too little or too much
• Sleeping too little (even when baby sleeps) or too much
• Having trouble focusing or making decisions
• Feeling worthless and guilty
• Withdrawing from friends and family
• Feeling that life is not worth living

On her routine postpartum follow up visit, Vanessa was lucky to see a medical professional who was experienced with the diagnosis and treatment of postpartum depression. Left untreated, these symptoms can interfere with a woman's ability to care for her newborn and can continue on average for 7 months. Vanessa's provider ordered blood tests to screen for medical contributions to her mood symptoms, such as hypothyroidism and anemia, and reviewed the following treatment options.

Psychotherapy or 'talk therapy' involves meeting with a skilled clinician who will problem solve around life stressors and offer supportive counseling. Cognitive exercises, insights, and homework assignments could help Vanessa cope with negative thoughts and improve her depressive symptoms.

Antidepressant medication is recommended for women with postpartum depression but, unfortunately, treatment is often delayed due to concern of medication effects on the breastfed newborn. Recently, the American College of Obstetrics and Gynecology (ACOG) reiterated that breastfeeding has clear short and long-term benefits for mother and infant, and most psychotropic medications are transferred through breast milk at very low levels and are unlikely to affect the baby. Because women who have recently given birth are often sensitive to side effects of medications, the doctor should begin the medication at half the normal recommended dose and increase it to the effective dose. At least six months of treatment is recommended in order to avoid relapse into depression.

Regardless of the treatment approach, we recommend close follow-up of women with postpartum depression. Vanessa also needed a crisis plan for her mood symptoms. Just like her doctor might have given emergency instructions if she had increasing abdominal pain or fever after delivery, she should also know what to do if her mood symptoms worsened. This plan included calling her treatment team, available crisis clinic hotlines, going to the closest emergency department, or calling 911. Thanks to early diagnosis and treatment, Vanessa recovered and is enjoying her family life.

For information about depression during pregnancy, postpartum depression or our research studies, you may contact us at 1-800-436-2461. You may visit our website at: www.womensbehavioralhealth.org.

By Christopher S. Famy, M.D., and staff at the Women's Behavioral HealthCARE of the University of Pittsburgh

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