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Postpartum Depression: Factors Women
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Selective serotonin reuptake inhibitors (SSRIs) are the first-choice medication for treating postpartum depression. They usually take 4 to 8 weeks to improve depression, though some women improve sooner. SSRIs are considered relatively safe for use while breast-feeding because in general they pass into the breast milk at low levels (with the exception of fluoxetine [Prozac, Sarafem], which has been found in higher amounts in breast milk). 9
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Sue, Julie, and Susie have all had experiences with postpartum depression (PPD), to various degrees. The term PPD (or PND, Postnatal Depression, in some countries) itself is controversial, as are many other aspects of the condition. There is no official psychiatric diagnosis, and there is widespread disagreement about causes and risk factors. Research is often contradictory and inconclusive. The question of whether postpartum depression is unique to the childbearing experience, or is an expression of an already existing depression or a tendency toward depression, is debated in professional circles.
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Most experts feel that the sudden drop in estrogen and progesterone is the reason behind postpartum depression. In women who are not pregnant, the rise and sudden fall of the hormones every month is the cause of many women feeling grouchy and overly sensitive just before their periods.
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In addition to hormonal changes and disrupted sleep, certain cultural expectations appear to place women from those cultures at increased risk of postpartum depression. For example, women who bear daughters in societies with a strong preference for sons are at increased risk of postpartum depression. In other cultures, a strained relationship with the husband's family is a risk factor. In Western countries, domestic violence is associated with a higher rate of PPD.
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Selective serotonin reuptake inhibitors (SSRIs) are first-line agents and are effective in women with postpartum depression. Use standard antidepressant dosages, eg, fluoxetine (Prozac) 10-60 mg/d, sertraline (Zoloft) 50-200 mg/d, paroxetine (Paxil) 20-60 mg/d, citalopram (Celexa) 20-60 mg/d, or escitalopram (Lexapro) 10-20 mg/d. Adverse effects of this drug category include insomnia, jitteriness, nausea, appetite suppression, headache, and sexual dysfunction.
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Epperson (1999) indicates that complications of labor are not a consistent factor for predicting Postpartum Depression. In research conducted by Hannah, Adams, Lee, Glover, & Sandler (1992) and a separate study by Campbell & Cohn (1991) found that obstetric factors increased the risk of Postpartum Depression while studies by Paykel, Emms, Fletcher, & Rassaby (1980) and O’Hara, Rehm, & Campbell (1982) found the opposites. Studies conducted by Cox, Connor, & Kendell (1982) and Playfair & Gowers (1981) demonstrated no association at all.
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