Depression: Birth and the Blues

For too many American women, the birth of a baby is less the arrival of a bundle of joy than a passage to depression.

Childbirth is an emotionally intense event; mood changes in the days following delivery are particularly common. Up to 85% of new mothers may experience mild postpartum "baby blues" beginning three days after birth. However, they usually resolve on their own within 14 days.

Postpartum depression is a more severe condition that typically begins two to three weeks after delivery and lasts for at least two weeks, sometimes over a year. Approximately 10% to15% of women in the U.S. suffer from the sometimes debilitating disorder.

Most of them, however, do so in silence. They may be persistently sad or experience mood shifts, crying, feelings of anxiety or of being overwhelmed, inability to sleep, irritability or agitation, and poor appetite. A woman may lose interest in caring for her child.

Despite the prevalence of postpartum depression, it carries risks to the mother, to the child's development and even safety-and to every family member. Nevertheless, it remains a largely hidden disorder.

More than half of women with the disorder do not seek professional help. And for those who visit family doctors the condition is missed up to 50% of the time.

Those most at risk have had a prior depressive episode before pregnancy or a family history of depression. In addition, women who have an unwanted pregnancy, have experienced complicated labor or delivery, who lack social support, or who have experienced some form of major stress such as the death of a loved one are also at increased risk. A woman who suffers depression after the birth of a child is three times more likely to develop depression following a subsequent birth.

Depression at any time reflects the interplay of many factors, and experts believe that postpartum depression similarly results from the complex conjunction of biological and psychosocial factors. Childbirth is a time of hormonal upheaval-and of major psychological adjustment.

Labor and childbirth are accompanied by dramatic changes in estrogen, progesterone, and even the stress hormone cortisol, among others. All of these hormones are known to influence functioning of the nervous system. Yet studies have not demonstrated that normal postpartum shifts in hormones are responsible for pathologic mood changes in women.

At least not by themselves. Experts point to the fact that the postpartum period is vary fragile time of psychological and social reorganization for all women. What's more, it's particularly challenging in U.S. culture, where new mothers are relatively isolated despite a heightened need for social support. Studies show that feelings of isolation and lack of support - from partners, family members, physicians, or friends - are particularly acute among those women who develop postpartum depression.