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Post-Partum Changes:
 "The Baby Blues, or Something Else?"

    Women who experience significant changes in their more normal thinking and mood after pregnancy may carry some of the genetic material that is related to a type of mood disorder more popularly known as Bipolar Disorder.  Women who have previously never had any symptoms of diagnosable mood disorder may find that right after giving birth their thinking and moods are changed.  These changes are also more common with those women who have significant mood changes during their pre-menstrual periods.

     Those that are most vulnerable may have very significant changes, feel suicidal, and have thoughts that are unusual and bizarre.  A woman who has never felt this way or had this type of thinking before may feel ashamed and not divulge this to her physician. There is a mindset in our culture that pregnant woman have to endure whatever comes along and that to voice concern is a show of weakness.  If the woman has a family history of diagnosable mood disorder, she is at elevated risk for pregnancy-related mood and thought changes.  Post- partum (e.g. post-birth) mood changes should be treated with great care.  Too often we have read of women treated with the typical antidepressants, such as Prozac, Zoloft, and Paxil, who have done horrible things to their children due to what I feel is incompetence on the part of their caregivers.  Women should be given antidepressants only with great care, especially if they have a known history of Bipolar Disorder.  We know that these drugs tend to cause what is known as an "activation phenomenon".  What this means is that if a person carries the genes for Bipolar Disorder even if s/he has never had active symptoms, these drugs can "kindle" or bring to the surface symptoms that can be so extreme that once begun it may be too late to know that the person has been misdiagnosed or mistreated. 

     Recently, women in the news such as Brooke Shields and Marie Osmond have disclosed the depression, mood swings, and delusional and terrifying thinking they had after giving birth.  Brooke Shields recalls that this was "the most devastating challenge I have ever faced".  Marie Osmond in her book, "Behind the Smile", describes in detail what it is like to have to "fake it" for the benefit of others.  What many doctors do not tell women is that by the second trimester of their pregnancy the woman's body is producing 50 times the amount of Progesterone that it did before pregnancy.  Progesterone acts on the brain much like an antidepressant does.  The big letdown comes after the woman gives birth when her Progesterone level drops to 0.  Marie found out that her own mother also had this "post-partum depression" but never discussed it due to the image she wanted to project.  That image is the one of being able to handle it all, to be strong.  She did not really want Marie to tell her story, but then changed her mind.  In her book, Marie describes some of the symptoms and lists some risk factors she feels are part of the "Baby Blues".

     Some risk factors as detailed in the book," Behind the Smile, My Journey out of Post Partum Depression" by Marie Osmond:

  • Your mother had PPD (Post Partum Depression)
  • You had a difficult time getting pregnant
  • You have stressful events in life (Marie had every one of these), such as:
    • Loss of a job
    • Moving
    • Death in the family
    • Marriage and relationship problems
    • Sexual or emotional abuse as a child
    • You suffer from PMS or thyroid problems
    • Your pregnancy or birth experience was complicated
    • You have a family history of depression

    Marie also wrote: "Another factor that is interesting is that there is evidence now that the depression you may have may not even be your depression. It may be literally carried through DNA from an ancestor. I have seen photos of my ancestors and there were a few branches of my family tree that I think should have been broken off. So thanks a lot, grandma!"

    More specifically, the symptoms of true Post Partum Depression are listed below.

Symptoms of Postpartum Depression

    About 70 percent of new mothers get the "baby blues" -- feelings of anxiety and irritability that can hit three or four days after delivery, but disappear quickly. Postpartum depression, which can appear even a year after giving birth, is more severe and can last for months, if not treated. About 1 in 10 new mothers experience the disorder. Symptoms include:

  • Severe sadness or emptiness; emotional numbness or apathy.
  • Withdrawal from family, friends, or pleasurable activities.
  • Constant fatigue, trouble sleeping, overeating, or loss of appetite.
  • A strong sense of failure or inadequacy.
  • Intense worry about the baby or a lack of interest in the baby.

  • Thoughts about suicide; fears of harming the baby.

How Can This Happen?

    This occurs when caregivers of woman fail to take a comprehensive history.  If a physician treats to the tip of the iceberg, that is, treating to the symptoms the woman presents in the office, they can cause a tragic error by not recognizing underlying genetic vulnerability that can cause trauma for her and her family.  If the woman has a family history of alcoholism, Bipolar Disorder, schizophrenia, or even rage and anger management problems or other known diagnosable mental problems the physician should proceed with extreme caution and monitor very, very closely for any of the symptoms of building mood problems.  These include, but are not limited to feeling anxious, depressed, nervous, jittery, high, manic-y, mood swings, and great energy, to name but just a few.  This is especially true for those women who have a history of significant premenstrual moodiness. There is also research that indicates those who have a rapid response to antidepressants, such as feeling better in just a few days rather than the more usual 2-3 weeks, are at greater risk for these significant problems.

 How To Prevent This

     While not routinely done, obstetricians should have a good working relationship with a specialist in treating mood disorders, and that would be a psychiatrist or other well-qualified specialist.  Now, not even all psychiatrists or other mental health care providers are well versed in the genetics of mood disorders, or fully understand the relationship of hormonal and genetic vulnerabilities.  Only a specialty service that routinely deals with and understands these relationships can offer the type of cutting edge interventions that can prevent and assist women who find themselves in the turmoil of moods and hormones interacting together to cause emotional uproar.  A woman who has recently given birth needs more that just a brief 15 minute visit to be able to discuss her ongoing mood and thinking changes that are also a normal part of post-birth, or post-partum as it is known.  There is a tendency of the woman to want to be the "good patient", and not disclose to her obstetrician how she feels.  This is the patient taking care of the caregiver. 

    She may want to gratify her doctor by being strong and not disclosing some of the real concerns she has.  By educating woman to take greater charge of their health, both physically and emotionally, we can prevent what all too often make the nightly news, and that is another woman who has done something totally out of character and harmed herself or her children.  Society more often than not will then blame the woman instead of her caregivers, who in reality caused this by not understanding the interaction of hormones, moods, and thought.

     I would urge all hospitals and departments of social services to spend some time with these women before they return home.  In the age of "mangled care" there is often not the time to check on them to see if they have the type of history that puts them at risk or if they had a mother who also had post-partum blues or other mood or thought changes related to her pregnancies. 

Author

William Shryer, DCSW, LCSW                          
Clinical Director                                                           
Diablo Behavioral Healthcare
Danville, CA

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