Postpartum depression (PPD) is a condition that describes a range of physical and emotional changes that many mothers can have after having a baby. PPD can be treated with medication and counseling. Talk with your health-care professional right away if you think you have PPD.
There are three types of PPD women can have after giving birth:
- The so-called "baby blues" happen in many women in the days right after childbirth. A new mother can have sudden mood swings, such as feeling very happy and then feeling very sad or angry. She may cry for no reason and can feel impatient, irritable, restless, anxious, lonely, and sad. The baby blues may last only a few hours or as long as one to two weeks after delivery. The baby blues do not always require treatment from a health-care professional. Often, sharing child-care duties, joining a support group of new moms, or talking with other moms helps.
- Postpartum depression (PPD) can happen a few days or even months after childbirth. PPD can happen after the birth of any child, not just the first child. A woman can have feelings similar to the baby blues -- sadness, despair, anxiety, irritability -- but she feels them much more strongly than she would with the baby blues. PPD often keeps a woman from doing the things she needs to do every day. When a woman's ability to function is affected, this is a sure sign that she needs to see her health-care professional right away. If a woman does not get treatment for PPD, symptoms can get worse and last for as long as one year. While PPD is a serious condition, it can be treated with medication and counseling.
- Postpartum psychosis is a very serious mental illness that can affect new mothers. This illness can happen quickly, often within the first three months after childbirth. Women can experience psychotic depression, in that the depression causes them to lose touch with reality, have auditory hallucinations (hearing things that aren't actually happening, like a person talking), and delusions (interpreting things differently from what they are in reality). Visual hallucinations (seeing things that aren't there) are less common. Other symptoms include insomnia (not being able to sleep), feeling agitated (unsettled) and angry, strange feelings and behaviors, as well as less commonly having suicidal or homicidal thoughts. Women who have postpartum psychosis need treatment right away and almost always need medication. Sometimes women are put into the hospital because they are at risk for hurting themselves or someone else, including their baby.
What specialists treat depression?
A variety of health-care specialists evaluate and treat people with this condition, including the following:
- Primary-care providers like family doctors, internal-medicine practitioners, or geriatricians (physicians who specialize in treating the elderly)
- Mental-health specialists, such as psychiatrists, clinical psychologists, social workers, pastoral or mental-health nurses, or other counselors
- Primary care or mental-health prescribers, like physician assistants or nurse practitioners
- Health-maintenance organizations
- Community mental-health centers
- Hospital psychiatry departments and outpatient clinics
- Community support groups, often hospital affiliated
- University or medical school-affiliated programs
- State hospital outpatient clinics
- Family service/social agencies
- Private clinics and facilities
- Employee assistance programs
- Local medical and/or psychiatric societies
What tests do health-care professionals use to diagnose depression?
People who wonder if they should talk to their health professional about whether or not they have depression might consider taking a depression quiz or self-test, which asks questions about depressive symptoms. In thinking about when to seek medical advice about depression, the sufferer can benefit from considering if the sadness lasts more than two weeks or so or if the way they are feeling significantly interferes with their ability to function at home, school, or work and in their relationships with others. The first step to getting appropriate treatment is accurate diagnosis, which requires a complete physical and psychological evaluation to determine whether the person may have a depressive illness, and if so, what type. As previously mentioned, the side effects of certain medications, as well as some medical conditions and exposure to certain drugs of abuse, can include symptoms of depression. Therefore, the examining physician should rule out (exclude) these possibilities through a clinical interview, physical examination, and laboratory tests. Many primary-care doctors use screening tools, symptom tests, for depression, which are usually questionnaires that help identify people who have symptoms of depression and may need to receive a full mental-health evaluation.
A thorough diagnostic evaluation includes a complete history of the patient's symptoms:
- When did the symptoms start and under what circumstances/stressors?
- How long have symptoms lasted?
- How severe are the symptoms?
- Have the symptoms occurred before, and if so, were they treated, what treatment was received, and was it effective?
The doctor usually asks about alcohol and drug use and whether the patient has had thoughts about death or suicide. Further, the history often includes questions about whether other family members have had a depressive illness, and if treated, what treatments they received and which were effective. Professionals are becoming increasingly aware of the importance of exploring potential cultural differences in how people with depression experience, understand, and express depression in order to appropriately assess and treat this condition.
A diagnostic evaluation also includes a mental-status examination to determine if the patient's speech, thought pattern, or memory has been affected, as often happens in the case of a depressive or manic-depressive illness. As of today, there is no laboratory test, blood test, or X-ray that can diagnose a mental disorder. Even the powerful CT, MRI, SPECT, and PET scans, which can help diagnose other neurological disorders such as stroke or brain tumors, cannot detect the subtle and complex brain changes in psychiatric illness. However, these techniques are currently useful ruling out the presence of a number of physical disorders and in research on mental health and perhaps in the future they will be useful for the diagnosis of depression, as well.