Postpartum Depression Can Begin During Pregnancy

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Symptoms of postpartum depression come in three distinct subtypes and may actually first appear while a woman is still pregnant, a team of American researchers report in a new study.

Postpartum depression (PPD) is a form of moderate-to-severe depression normally thought to occur in the days, weeks or months after a woman gives birth. In a study published in January 2015 in the journal The Lancet Psychiatry, researchers from the University of North Carolina School of Medicine used information from a large-scale, multinational project to identify common clusters of symptoms that appear in women affected by this condition. These researchers concluded that, depending on the amount and severity of the symptoms present, postpartum depression falls into any one of three subtypes and in some cases may first arise during pregnancy.

Postpartum Depression

Postpartum depression produces symptoms that strongly resemble the symptoms typically associated with major depression, as well as symptoms that specifically relate to new motherhood. Examples of symptoms that overlap with major depression include the onset of negative emotional states such as guilt or helplessness, a complete or partial inability to feel pleasure, loss of mental focus, irritability, declining energy levels, mental agitation, disrupted sleeping patterns, disrupted eating patterns, anxiety, a loss of personal and/or social connections and a preoccupation with death-related matters and/or suicidal thinking. Examples of symptoms uniquely associated with new motherhood include the onset of negative or violent thinking regarding one’s newborn child, exaggerated or absent concern regarding one’s newborn child, fear of being in one-on-one situations with a newborn child and loss of the ability to adequately care for a newborn child.

Postpartum depression is generally viewed as a more severe version of a common post-childbirth condition known as the postpartum blues. Slightly more than one out of 10 new mothers in the U.S. will develop PPD as an extension of the postpartum blues or at some later point in time. Known risks for the disorder include having an unplanned pregnancy, giving birth before reaching age 20, having a current history of alcohol abuse or drug use, being socioeconomically disadvantaged, experiencing unusual personal pressures during pregnancy and having a prior history of any type of anxiety disorder or mood disorder.

Diagnosing PPD

In the U.S., the guidelines for diagnosing postpartum depression (and all other forms of depressive illness) come from an organization called the American Psychiatric Association. Before making such a diagnosis, doctors can use a number of screening tools to identify women likely affected by the condition. Examples of these tools include tests called the Edinburgh Postnatal Depression Scale, the Postpartum Depression Screening Scale and the Patient Health Questionnaire. Not all doctors use the same screening procedures, although they must use the same basic criteria to make a diagnosis.

Different Types of PPD

In the study published in The Lancet Psychiatry, the researchers used information drawn from a large-scale project called Postpartum Depression: Action Toward Causes and Treatment to help determine if postpartum depression manifests in distinct ways in different affected women. This multinational project includes institutions from seven countries and gathers data from thousands of individuals. The researchers conducted their study in two tiers or phases. In the first phase, 6,556 women were assessed for postpartum depression with the Edinburgh Postnatal Depression Scale. In the second phase, the researchers separately examined the case histories of 4,245 women known to be affected by postpartum depression.

The researchers concluded that there are three identifiable subtypes or classes of postpartum depression. Four main factors help determine if women fall into one of these three classes: the severity of PPD symptoms, when PPD symptoms first appear, whether or not an individual has thoughts of suicide and whether or not an individual has potentially diagnosable anxiety symptoms. The three identified classes of postpartum depression—termed class 1, class 2 and class 3—are distinguished by specific combinations of the potential factors and represent increasing levels of PPD severity. The researchers concluded that the most severely affected women (class 3) first develop their symptoms while pregnant, experience prominently “down” or negative moods, have elevated anxiety levels, think about committing suicide and develop significant pregnancy complications. However, they also concluded that pregnancy complications actually happen most often in women with generally less severe class 2 postpartum depression, a condition that most frequently arises within the first month following childbirth.

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