A California Doctor Delivers Good News to New Moms with Postpartum Blues: It's Curable
Having a baby is supposed to be a woman's greatest joy. So why then are many new mothers sad, weepy and sleepless? One possible reason: postpartum depression (PPD), an illness known since Hippocrates' day but one that still defies full medical understanding. In 18th-century England women showing its symptoms were bled, tied to their beds or given doses of opium. Even today many doctors will tell a PPD victim that her problems are all in her head.
San Francisco psychiatrist James Hamilton, 79, believes there's much more to PPD than that. Hamilton, who has a Ph.D. in psychology from Berkeley and an M.D. from Stanford, was an associate clinical professor of psychiatry at Stanford until 1978. He is the author of a definitive text on PPD, Postpartum Psychiatric Problems.
Currently a consulting psychiatrist, he discussed with San Francisco bureau chief Nancy Faber the appropriate care for this debilitating and still puzzling illness.
Exactly what is postpartum depression?
It is a catchall term that applies to two kinds of serious mental illness, as well as to a great many lesser syndromes, that affect mothers soon after childbirth.
What are the symptoms of the more severe forms of PPD?
The first kind usually begins between the third and 14th day after birth and is characterized by insomnia, extreme agitation, anxiety, confusion and rapid mood swings. The second type begins slowly and insidiously in the third or fourth week and may develop into deep depression.
What about the less severe types?
One is known as the third-day blues and brings on anxiety, confusion, tearfulness and sleeplessness. It may last from 24 to 72 hours and then go away without treatment. Another type comes on more slowly, bringing anxiety, crying and depression, plus such physical symptoms as headaches, constipation, tremors, episodes of palpitations, sweating and diminished sexual response. Although not regarded as a life-threatening illness, it may go on for months or even years.
How many women are victims of PPD?
The frequency of severe cases has been constant the world over and has been so for the last century and a half: one in every 1,000 births. This means more than 3,000 cases in the U.S. yearly. As for lesser PPD, I'd say 50 percent of mothers suffer from some form of it.
What are the causes?
Physical changes incidental to child-bearing. During the last trimester of pregnancy, hormone activity is accelerated, dominated by a very active pituitary gland. Within 24 hours after birth the pituitary becomes sluggish. The other endocrine glands and their particular hormones follow suit. In effect, the system is thrown into low gear after childbirth.
How does PPD differ from other forms of depression?
The physical symptoms—headaches, severe insomnia, confusion, constipation—are not present in the usual forms of depression. Other signs include skin changes, loss of hair, a slowing down. To a startling degree PPD women are up one day and down the next. Regular depression doesn't have such striking changes.
Which mothers are most at risk?
Those who have had postpartum reactions previously. The chances of a severe reaction are one in 1,000, but if there has been an earlier reaction, the chances jump to one in four.
Are career women more at risk than those who stay at home?
No, but I think people driven to do a great many things, whether it is to be a perfect housewife or go back to a law career, have a harder time with PPD.
How do you treat these illnesses?
With severe cases, we hospitalize the mother—for her own protection and that of the baby—in a safe environment with trained personnel who understand PPD. Tranquilizers and other medication may be used to quiet the mother's agitation. It is most important to let her know that she has a disease with important physical symptoms and that, while it is a serious disease, it is one from which she will recover.
What else can you tell the patient?
You assure her that this is a phenomenon that happens occasionally, that hits like lightning without any prior cause. What she is suffering from is not a character defect related to something that happened 20 years before.
Why would PPD mothers feel guilty?
During most pregnancies, the mother-to-be goes through a certain amount of distress, but she anticipates that she will have a pleasurable experience raising her child. If after a week or so she begins to have PPD symptoms, she sees herself as being less than competent. And when she finds herself not full of love 24 hours a day and occasionally angry at the child, she decides that she is not a good mother. Women who suffer from lesser PPD often carry this unfair image of themselves for years. They believe they are failed mothers—unless somebody comes along and says, "Yes, this happens to a lot of women."
Are many mothers afraid to talk about their problems?
Yes. If they complain to their obstetrician, the doctor takes their temperature, checks their blood pressure and pulse and sometimes even does a complete physical; then he says, "You are perfectly fine." It's not very therapeutic if you're having real symptoms.
Suppose a baby cries continually. Could not that in itself cause depression and anxiety?
There's no question but that the pressure of waking in the middle of the night to nurse a baby or taking care of a sick child can only worsen symptoms, just as in any illness. While I stress the physical causes of PPD, I don't mean to deprecate how stress, lack of sleep and fatigue can add to the illness.
Can drugs be used to treat PPD?
This is controversial. I have had some success treating the PPD that comes after three weeks, both severe and the lesser syndrome, using small doses of the hormone thyroxine. Another physician has administered small amounts of prednisone, a cortisonelike substance, for two or three weeks to mothers suffering from the severe early agitation and seems to have had excellent results. But much more research is needed.
What can be done to prevent PPD?
An English expert on the disease, Katharina Dalton, believes that progesterone administered to the mother at birth can be effective in heading off symptoms of psychosis in those who have had PPD after previous pregnancies. Other physicians have tried a variety of vitamins with favorable results. I did some work years ago which suggests that long-acting estrogen, given on the delivery table and orally thereafter for a few days, seems to prevent a recurrence of PPD. The catch with estrogen is that it is the same treatment used to suppress lactation.
Is PPD always curable?
With proper treatment I would say the percentage rate for recovery would be in the high 90s.
What if PPD goes untreated?
The two risks in severe cases are that the mother might try to harm her-self or the baby. With more moderate cases, the woman can adapt to her disability but loses her verve, enthusiasm and energy. She acclimatizes herself to chronic illness and complaints. It can change her whole personality.
In milder forms is PPD self-treatable?
Yes, but the woman needs to know she's not alone. There's an excellent popular book, published last year, called The New Mother Syndrome: Coping with Postpartum Stress and Depression by Carol Dix, who suffered from PPD. I wrote the introduction, because I thought it was a very important tool for mothers with this condition.
How can family and friends help?
By listening and taking the mother's complaints seriously. Be sure someone is around at all times to watch whether she is getting better or worse. If things don't improve, make sure someone keeps in touch with the physician in charge. The most common complaint of women suffering from postpartum ailments is that no one listens and no one believes them. That makes PPD a lot harder to overcome.
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