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Frequently Asked Questions

The questions were compiled by Ricardo J. Fernandez, MD, ABPN, DFAPA who is a member of the NJ Working Group on postpartum depression and is also the Medical Director at Princeton Family Care Associates in Princeton, N.J., and an Associate Clinical Professor, Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Piscataway, NJ.


What Patients Should Know

As a licensed healthcare provider, you are in a position to help new mothers understand their condition and feelings. Here are some questions frequently asked by patients, along with responses that can help you to guide new mothers and their family towards recovery from postpartum depression.

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Is it normal for me to feel so tired?

Although fatigue and tiredness can be expected after giving birth to a child, excessive tiredness can be a symptom of perinatal mood disorders (PMD). Find out what help the mother has available to her. Answering the following questions will help you help your patient:

  • How difficult is the infant?
  • Is she taking the opportunity to rest when rest is available?

If it appears that the new mother is more tired than would be reasonable for her situation, inquire about other symptoms of depression.

  • Does she feel sad?
  • Is she detached from the infant?
  • Is she crying a great deal?
  • Can she sleep when the baby is sleeping?
  • Has she found that she is not enjoying the baby or
    other things in her life as much as she had previously?

Affirmative answers suggest a possible diagnosis of PMD.

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Isn't this just the "baby blues"?

The "baby blues" (or maternity blues) occur in a significant number of women. The baby blues manifest within the first few days, but rarely more than a week postpartum. A mother with the blues is moody, sensitive and overly reactive to her baby and environment. With time, these symptoms abate without further intervention. When symptoms persist longer than one week, the clinician should inquire about symptoms of depression. Finally, it is important to note that any woman who experiences the baby blues is at twice the risk for developing PPD over the subsequent weeks to months.

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The baby is 18 months old and I am still depressed. Is this still postpartum depression?

Postpartum depression usually occurs within one year of birth. However, undiagnosed, untreated, or improperly treated, PPD can continue for up to two years before it will spontaneously resolve. Even then, a smaller percentage of women will not recover without treatment. Late onset symptoms are seen in women who develop PPD after weaning the infant late in the postpartum course. Another possible reason for chronic symptoms can be hypothyroidism and should be looked for in women who do not respond to standard treatment.

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How long do perinatal mood disorders last? Will they go away on their own?

Left untreated, PMD can persist for up to two years. Even at two years, some depressed women will not recover and continue with chronic symptoms. When adequately treated, most women can achieve positive response to treatment in two to four weeks and complete remission in six to eight weeks from starting treatment.

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How long do I have to be on medications?

Generally, treatment must be continued for nine to twelve months after the woman has had a complete remission of her symptoms.

Stopping antidepressants earlier can lead to a relapse or recurrence of depression symptoms. When medications are to be discontinued, they should be decreased gradually over weeks to months.

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Is PMD biological, psychological, or hormonal?

It's all three. PMD is referred to as a biopsychosocial problem. Biologically, hormones seem to play a part in the onset and presentation of the illness. Sometimes women can develop a thyroid problem postpartum, or may have a genetic predisposition to depression. Neurochemically, it appears that women with PPD suffer from a neurochemical imbalance, most often involving the neurotransmitter serotonin. Psychosocial issues are also important. These include the new infant-mother relationship, changes in the marriage, impact on other family members and career and work issues.

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If I have PMD, can I go on birth control pills?

It is not uncommon for postpartum moms to ask about birth control pills. Understandably, they are fearful of becoming pregnant after suffering from PPD. Adverse effects known for birth control pills include symptoms of depression. As such, mothers recovering from PPD who are prescribed birth control pills can develop worsening of their depressive feelings. In women recovering from PPD, other means of contraception may be better choices while they are being treated. If birth control pills are prescribed, women with PPD should be monitored closely for worsening of symptoms.

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Why do I start feeling worse symptoms when I get my period?

It is not uncommon for women to have sudden worsening of their symptoms with the return of their menstrual cycles. Since menstruation returns so unpredictably, women who are recovering will suddenly begin to feel much worse, alarming themselves and the clinician. Often when the menstrual flow begins, the symptoms will again abate. Unfortunately, premenstrual worsening can occur up to two weeks before every period and can be significantly disruptive in the recovery process. Depending on the severity, the psychiatric medications may have to be adjusted to accommodate the cyclic worsening.

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How can my husband and my family help?

PMD is a family illness. It affects all members of the immediate family. Family members can help by first recognizing and accepting the illness. Denial in the family system can be quite destructive in the recovery from PMD. Providing as much childcare support as possible while the mother is ill is important for a good and prompt recovery. Grandparents, other relatives or friends can provide time for childcare allowing the recovering mother time for herself, and time alone with her husband.

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Does being depressed mean that I can't be a good mother?

It is not uncommon for depressed mothers to feel guilt and shame about their depression. This guilt and shame will often manifest as insecurities about the ability to mother. Depressed mothers need to know that PMD is a medical illness like any other medical condition. It is not their "fault" and is not a reflection of being a "bad" mother. Mothers with PMD who are responding to treatment are perfectly capable of taking care of their child and can be as "good" a mother as any other woman.

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Can I take medications if I am breastfeeding?

Although we cannot say that any medication is safe in breastfeeding, we can say that there is a significant body of published data that suggests that certain medications seem safer to use. These antidepressants seem to cross over minimally, if at all, into the breast milk. In addition, mothers can be taught to alter their breastfeeding schedule and add some bottle feeding to minimize exposure to the infant. By a combination of proper medication selection and other accommodations in breastfeeding, it is possible for most mothers with PPD who wish to breastfeed to do so.

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Is breast milk essential for the baby's health? Will the baby suffer if I have to give up breastfeeding?

Although it is recommended that women breastfeed their infants whenever possible, infants can develop perfectly well with bottle-feeding. It is actually more important for the infant's health and well-being that the mother not be depressed. Many studies have shown that infants with chemically depressed mothers manifest abnormalities in developmental, psychological and behavioral testing versus infants of non-depressed mothers. From the infant's perspective, it is better to be bottle-fed by a non-depressed mother than be breastfed by a depressed mother. Lastly, with proper medication selection many women taking medication for PMD can continue to breastfeed.

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Is postpartum depression common after pregnancy?

About 10 percent to 20 percent of women who deliver an infant will develop PPD. This percentage is fairly constant in different countries that have been studied.

There seems to be a connection between maternity blues and PPD although they are clearly different conditions. Women who experience maternity blues have a 20 percent chance of having PPD, while women who do not have maternity blues run about a 10 percent chance.

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If I have had PMD before, will I get it again with another pregnancy? How about at other times in my life?

If a woman experiences PMD she has about a 50 percent to 60 percent chance of having PMD in a subsequent pregnancy. What happens to a woman who has had PPD at other times in her life is not currently clear. A significant number may develop recurrent depression unrelated to pregnancy. Times of hormonal change, such as postpartum and the perimenopause periods, may be times of increased risk for depression for these women. A smaller percentage may go on to develop bipolar disorder, where a person has "high" and "depressive" phases in their life, unrelated to the postpartum state. There are some women, however, who experience depression only in the postpartum period.

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If I have PMD, can I request paid or unpaid disability leave from my work?

PMD is a medical illness. As such, a woman suffering from PPD can be advised to explore with her employer the options available to her for a leave from the workplace.

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Will my depression affect my children?

If a mother is adequately treated, there will be no difference in her mothering ability when compared to woman who is not ill. Conversely, there are many studies showing that women who suffer from chronic untreated depression are significantly impaired in their ability to mother. The children of these mothers will show developmental, psychological, and behavioral problems. This is one of the reasons why an early diagnosis followed by effective and aggressive treatment is very important.

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Will my depression affect my marriage?

PMD is highly stressful to the family unit, particularly when it occurs, as it often does, following a first pregnancy. For first time parents, changing the relationship from dyad (husband and wife) to a triad (husband-wife-infant) is difficult enough without the added stress of an impaired mother. Studies consistently show that a poor marriage increases the risk of postpartum depression and we can also extrapolate that poor marriages are much less capable of tolerating the stress brought on by PPD. That being said, a healthy marriage before the illness is usually able to endure the added stress and often comes out stronger when the mother recovers. When a woman suffers from PPD, it is very important to have the husband join the therapy as soon as possible. Couples who work together, in conjunction with other treatment approaches, often deal successfully with this stressful and trying event.

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Is it common to worry a lot about the baby?

It is common for women to become focused on their infant after birth. This is part of the maternal instinct and is probably mediated by the hormone oxytocin.

All mothers become more observational of the infant, have an increased desire for safety and cleanliness and are somewhat hyper-aroused. Women who develop PPD often will develop an exaggerated sense of these instincts which can be quite distressing to the mother and require treatment. The depressed mother may become excessively worried about the baby's health and safety, causing her to feel anxiety in otherwise normal situations. Sometimes these fears about the baby's safety become so great that the mother herself begins to think she could be dangerous to her child either though negligence or by a direct act. These preoccupations may enter her mind intrusively and repetitively causing the mother much discomfort. These symptoms are highly responsive to antidepressants that affect serotonin.

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Is it normal to have trouble sleeping after giving birth?

Of course it's normal. Young infants are on their own schedule and require attention 24 hours a day. They sleep for only short periods of time, which is when the mother can rest. Mothers with PPD have intrinsic problems with sleep as a symptom of their illness. While a mother who is not depressed can sleep whenever her baby sleeps, the postpartum depressed mother is unable to sleep, even when the baby is sleeping, and even when someone else is caring for the child. This specific inability to sleep is a good indication that a mother may be suffering from PMD.

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Will I be able to have other children and how long should I wait?

PMD can be seen as a complication of pregnancy. There are many other medical complications that can accompany pregnancy, such as gestational diabetes or preeclampsia. Having a medical complication is not a contraindication for further pregnancies. After suffering from PMD, a detailed discussion should ensue to look at all the factors implicated by a future pregnancy.

Most women will go on to have other children, understanding that they now have a higher risk of depression not only in the postpartum period but also during pregnancy. Some women decide that they do not want to take that risk again. Once a woman is identified as being at risk for PMD with a subsequent pregnancy, many clinical interventions can be considered to minimize the risk of recurrence and symptoms can be treated early before they become severe. /p>

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Perinatal mood disorders are treatable. But first you have to ask for help.

call the helpline 24/7 at

1-800-328-3838


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Last Modified: Thursday, 12-Jul-12 11:44:41