ASK DR.MOORE July 15, 2005

Dr. Mark Moore, author of the gender selection book Baby Girl or Baby Boy--Choose the Sex of Your Child, answers readers' questions on pregnancy and pediatrics.

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Post-Partum Depression

Brooke Shields' new book "Down Came The Rain--My Journey Through Post-Partum Depression" and all the commotion with Tom Cruise's commentary on the subject, highlights the broad scope and sensitivity of this serious, yet poorly understood illness.

2500 years ago, Hippocrates recognized a "puerperal fever" after delivery, which he attributed to 'congestion of menstrual discharge that backed up to the brain causing delirium'. Not quite on the mark. Since that time, many have attempted to classify and define postpartum depression, but controversy continues over its cause, and whether it really is a separate disease from non-pregnancy associated depression.

Depression is a common malady affecting upward of 1 in 4 persons. It affects more women than men and its incidence overlaps with the fertile years aged 25-45. postpartum mood changes are common affecting up to 50% of deliveries. There spectrum of presentation is wide from the "baby blues" all the way to full blown psychosis (thankfully rare). True post partum depression is less frequent occurring in 10% of mothers.

Risk factors for post-partum depression include but are not limited to: 1. A history of severe PMS 2.concurrent serious stressors and major life events (financial, family, social) 3.lack of social support structure 4. poor/malnutrition 5. High weight gain during pregnancy 6. Traumatic birth such as preterm infant or unexpected cesarean section. 7.women over age 30 delivering first baby 8.relationship problems with spouse or partner 9. Undesired pregnancy.

Symptoms include: depressed mood, changes in appetite and sleep pattern(increased or decreased), frequent thoughts of dying or wanting to harm oneself, difficulty concentrating, agitation, anhedonia (loss of interest in pleasurable activity) and fatigue.

The treatment of postpartum depression involves similar medications used to treat other types of depression--tricyclic antidepressants (TCA's), seratonin reuptake inhibitors (SSRI's), plus psychotherapy in more severe cases.

Often, the doctors that cared for you during your pregnancy, an OB/GYN or Family Physician will also be the one to recognize the onset of post-partum depression. If you think you have a problem with depression after delivery, they will listen and help. Other resources for those with post partum depression can be obtained from their office or through online support websites.

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Readers may send questions to our email address. This column is for informational purposes only and is not a substitute for professional or medical advice.

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