Postpartum Depression
Postpartum Deression (PPD): The incidence of PPD is thought to be 5% to 9% of women in the first few months after childbirth, but can also occur after a miscarriage. The symptoms may be very similar to the symptoms of a major depression, and is probably caused by changes in brain chemistry that accompany the hormonal and other physiologic changes of pregnancy (i.e., levels of placental corticotropin-releasing hormone (CRH) during the 25th week of pregnancy may help predict a woman's chances of developing PPD). Mothers who have had several children without PPD can then experience PPD, and while most women experience significant lifestyle changes with their first pregnancy, most do not develop PPD.
Baby blues or Maternity Blues: This is a more common affecting up to 80% of women, and is usually a mild and transitory mood state lasting up to a few days that does not require specific care. Maternity blues do not portend a PPD nor are they a risk factor for PPD. The major risk factors for PPD are poor-social supports, a history of premenstrual dysphoric disorder, depression and/or anxiety before or during previous pregnancies (this does not mean the prenatal depression causes postnatal depression as they could be initiated by a separate causes). The development of PPD is also a risk factor for PPD in future pregnancies.
PPD may or may not go away without care, but considering the responsibility and tasks a new mother has to care for the newborn it makes sense to consult with a mental health care provider as soon as symptoms are seen. Hormonal therapy, vitamins, or dietary supplements are usually not effective alone, and counseling, psychotherapy and anti-depressant medication is usually necessary for improvement. A good social support network may be necessary backdrop for these therapies to work. If a mother with PPD is considering drug therapy, she should consult with her physician on taking medications while breastfeeding.
Postpartum Exhaustion: Also called postpartum fatigue, postpartum exhaustion is another condition that can be seen after a birth. It is thought to be related to hormone changes and the physical stress of pregnancy (especially anemia, infections/inflammation, and thyroid problems).
Women with postpartum exhaustion may be at increased risk of developing PPD and should be followed closely. Postpartum exhaustion and PPD both cause significant distress and impairment of social function so that prevention for those who have risk factors, and education for expectant mothers on the symptoms of these conditions, is of high importance.
Postpartum Psychosis (PPP): PPP is a relatively rare mental illness involving a rapid onset of psychotic symptoms in a woman in the few weeks following childbirth and likely caused by hormonal and neurotransmitter abnormalities. Psychotic symptoms include delusions (false beliefs, often paranoia), hearing or seeing things (auditory or visual hallucinations), and disturbances in logical thought. PPP is thought to be seen in 1 to 2 women per 1,000 births.
In some women, a PPP is the only psychotic episode they will ever experience, but, for others, it may be the first sign of, or recurrence, of a major psychiatric disorder (such as bipolar disorder or schizophrenia). PPP is generally thought to be a separate disorder from PPD, however, this delineation may not always be clear as many clinicians including the Meguro Counseling Center have seen a number of persons with PPD who may begin to experience psychotic symptoms and these cases would be considered a type of PPP called "postpartum depression with psychotic features" (i.e., a severe form of PPD).
PPP will usually respond well to the initiation of anti-psychotic medication, and rapid care is necessary to prevent behavior in the mother that is potentially dangerous to herself or her children (these behaviors may be seen in 4-5% of mothers).
Psychiatric Medication Use During Pregnancy and Breastfeeding
Medication Use in Pregnancy: Although psychiatric drugs as a group are relatively safe to take during pregnancy, a risk-benefit analysis needs to be considered for each individual case. Any pregnancy where the mother has a history of a serious psychiatric disorder should be considered high risk and the mother and fetus must be carefully monitored. Please see the Pregnancy section on the medication page.
Medication Use In Breastfeeding: Most drugs will pass into human milk to some degree. However, compared to the amount of drug that can pass thru the placenta during pregnancy, the amount of medication that passes into breast-milk is relatively low. For SSRI anti-depressants (e.g., Prozac or Zoloft), the amount of medication that passes into breast-milk is typically less than 5% of the dose given to the mother. Some studies suggest that amounts of less than 10% are safe for the newborn, although extensive data does not exist for all medications.
Of special note are sedatives (benzodiazepines) and the mood stabilizer lithium. Sedatives that enter into the breast milk, and especially those with long half-lives, can cause infants to become drowsy. The amount of lithium that passes into breast-milk varies widely in lactating mothers, and monitoring of the blood levels of the mother and infant should be performed.
A risk-benefit analysis on the decision to breast-feed and continue to take psychiatric medications, to breast-feed and discontinue medications, or not to breast-feed and continue taking psychiatric medications needs to be done on an individual basis upon consultation between the mother and her physician.
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The Meguro Counseling Center consists of Western-trained therapists able to provide face-to-face mental-health care for the international community in Tokyo. With extensive experience in Japan, these therapists have a deep understanding of the stresses of living in Japan.