The issue that is most often associated with the diagnosis of PPD is the time frame, however Records notes that there are major discrepancies between the maternity and psychiatric literature making a 2-12-month diagnosis difficult (Records pp). The subjects in Records's study described how their past abuse experiences affected their thoughts and view of their labor, delivery, and postpartum experiences (Records pp). Records revealed that "all of the subjects felt that the combined recall of trauma events and the labor and delivery experience provided the foundation for the PPD...perceived negative labor and delivery experience as the basis for their PPD" (Records pp).
In the May 01, 2002 issue of OB GYN News, Erik L. Goldman cites Dr. Diana Dell's press briefing sponsored by the American College of Obstetricians and Gynecologists. According to Dell, women are under tremendous pressure to "make perfect babies and to be perfect mothers and perfect wives...and she's got huge expectations about what it will be like," and reality is less like a Gerber baby food commercial and more like Marine boot camp than most new mothers expect (Goldman pp). Being a new mother means that there is an incessant demand, the woman must obey every order, and there is "no rest, no mercy and no concern" for her feelings (Goldman pp). Yet this does not mean that false expectations cause postpartum depression, however in a woman with a history of depression or other risk factors, the "discord between longstanding expectations and the realities of early parenthood can trigger episodes of depression which can sometimes tailspin very quickly" (Goldman pp). Dell estimates that up to 70% of all pregnant women experience some symptoms of depression during their pregnancy or in the postpartum periods, but only 10-16% of them meet the criteria for major depression (Goldman pp). Up to 20% will have an episode of major depression before the end of the first year, and the numbers are even higher, up to 25%, for first time adolescent mothers (Goldman pp). Dell advised being especially concerned about women with bipolar disorder or schizophrenia, and although psychosis is very rare among the general female population, it has a prevalence of 25-35% among women with these conditions (Goldman pp).
In the April 15, 1999 issue of American Family Physician, C. Neill Epperson reports that postpartum major depression, PMD, occurs in approximately 10% of childbearing women, and may begin anywhere from 24 hours to several months after delivery. Epperson cautions that before a definitive diagnosis of PMD is made, it is important to rule out any medical condition such as thyroid dysfunction or anemia (Epperson pp). Women who lose an excessive amount of blood during delivery may complain of fatigue as a result of anemia, and a number of depressive symptoms such as "a low mood, a lack of motivation, weight gain, anxiety and fatigue can be symptoms of thyroid dysfunction" (Epperson pp). Epperson reports that roughly "5% of postpartum women have transient hypothyroidism, sometimes preceded by hyperthyroidism, during the first year postpartum, and in others, permanent thyroid dysfunction develops" (Epperson pp).
Lee Cohen reports in the February 01, 2002 issue of OB GYN News, that antidepressants for postpartum depression should be considered the treatment of choice, and that nonpharmacologic therapies, such as interpersonal psychotherapy may also help. Although all antidepressants are secreted into breast milk, the amount of infant exposure is extremely low thus nursing mothers should not be concerned (Cohen pp).
David R. Offord reports in the January 01, 2002 issue of Journal of the American Academy of Child and Adolescent Psychiatry that there is substantial empirical data to support that postpartum depression is an important risk factor in poor child outcomes.
Cohen, Lee. "Treating postpartum depression." OB GYN News. February 02, 2002.
Retrieved October 29, 2005 from HighBeam Research Library Web site.
Epperson, C. Neill. "Postpartum Major Depression: Detection and Treatment."
American Family Physician. April 15, 1999. Retrieved October 29, 2005 from HighBeam Research Library Web site.
Goldman, Erik L. "Prenatal reality check may cut risk of postpartum depression."
OB GYN News. May 01, 2002. Retrieved October 29, 2005 from HighBeam Research Library Web site.
Offord, David R. "Should postpartum depression be targeted to improve child mental health?" Journal of the American Academy of Child and Adolescent Psychiatry. January 02, 2002. Retrieved October 29, 2005 from HighBeam Research Library Web site.
Records, Kathie. "The lived experience of postpartum depression in a…