What is postpartum depression? A local expert explains

4:02 PM, Oct 4, 2013   |    comments
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WASHINGTON (WUSA9) -- On Thursday, Miriam Carey led police on a chase though downtown Washington with her young child in the car.  She wound up being shot to death by police, as she resisted arrest, rammed police vehicles, and attempted to break through a barricade.

Carey's family and friends say she suffered from postpartum depression. While this is not confirmed, many wonder if postpartum depression can lead to this violent outcome.

We asked Dr. Julia Frank of George Washington Medical Faculty Associates help us clarify the condition known as postpartum depression.

Q: What are the different levels of postpartum depression?

Dr. Frank: Post partum depression ranges from mild to severe. A few days of tearfulness ("baby blues") within the first two weeks are very common, and not necessarily a sign of depression. However, any depression with hallucinations or compelling suicidal thoughts is considered severe. Inability to sleep when the baby is sleeping, panic attacks, overwhelming feelings of helplessness or inadequacy are all also markers of severity. The feeling that the baby would be better off without the mother is much more common than any actual wish to harm the baby. Although the time it takes to feel a deep sense of love for the baby ("attachment") may vary from a few hours after delivery to several weeks, if such attachment does not develop by the time the baby is settled and smiling, the mother may be suffering significant depression.

Q: What are warning signs?

Dr. Frank: Women who were depressed during pregnancy and women who have had depressive episodes in the past are at special risk for postpartum depression. The condition can begin for the first time within the first few weeks of delivery. Overall, 10-15% of new mothers may be depressed. The warning signs of depression are sometimes hard to separate from the normal sleep problems, anxiety and difficulty concentrating that most new mothers have for a time. Loss of the ability to enjoy things, loss of one's sense of humor, not looking forward to things, guilty feelings, tearfulness that persists for more than 2 weeks, profound sadness and intense anxiety are recognized symptoms. The Edinburgh Postnatal Depression Scale is a paper and pencil test that women can take to judge whether they are experiencing more than the normal level of difficulty in the first few months post partum.

Q: If those warning signs are displayed, what is the next course of action?

Dr. Frank: Women who are contemplating suicide or who can't function at a minimal level should seek emergency psychiatric evaluation in an emergency room. Otherwise, calling the office of the delivering obstetrician and coming in for a visit or asking for a mental health referral is a good step. The MFA has a special clinic for pregnancy related psychiatric disorder (The Five Trimesters Clinic) and people may refer themselves by calling 202-741-2888 and asking for the clinic. If a woman cannot get an appointment in a reasonable period of time (usually two weeks or less) someone from the clinic may call and help her find mental health care from another source. Women covered by public insurance in DC can also call the DC ACCESS help line, 1-888-7WE-HELP (1-888-793-4357) for referral to one of the mental health clinics in the city's network.

Q: How long does it take for this condition to set in?

Dr. Frank: Postpartum depression may develop quite rapidly, over the course of the first few days or weeks after delivery. In some women, it comes on more gradually. Usually, depression that begins more than three months after delivery is not considered post partum depression, exactly, but many times women don't come in until they have been having problems for months.

Q: How dangerous is postpartum depression with psychotic features?

Dr. Frank:  This is a very dangerous condition indeed. It is, however, remarkably treatment responsive. Women who experience this may look hopelessly ill and are at risk for behaviors that endanger themselves and their children, but they also usually recover completely with only a few weeks of appropriate treatment.


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