Postpartum depression threat remains

Drop in hormone levels after pregnancy can be tough to take

Dr. Daniel Rapport is a psychiatrist at the University of Toledo Medical Center.

Jack Meade/University of Toledo

For members of many families, the birth of a baby is one of the most happy moments of their lives, but for some mothers the experience can be filled with a jumble of unexplained emotions and can result in something much more unexpected: Depression.

The Oct. 3 death of Miriam Carey, who was shot by police after she tried to ram the gates of the White House and led police on a 16-block car chase, has thrown postpartum depression into the spotlight. Ms. Carey had her 1-year-old daughter in the car at the time and family members say her mental health had been deteriorating before the incident. She had recently been diagnosed with postpartum depression and psychosis, a more severe form of depression characterized by hallucinations and paranoia.

A study published in the journal JAMA Psychiatry in March shows that as many as one in every seven new mothers suffers postpartum depression. The study also found that among women followed for a year after delivery, some 22 percent had been depressed. Postpartum psychosis affects about one out of every 1,000 women according to the Center for Disease Control and Prevention.

Postpartum depression is described by medical professionals as moderate to severe depression in a woman after she has given birth. The depression may occur soon after delivery or up to a year later. Most of the time it occurs within the first three months after delivery. Signs of the disease include mood swings, lack of joy, decreased appetite, and insomnia.

The exact causes are unknown, but experts say changes in hormone levels during and after pregnancy may be a contributing factor.

Dr. Daniel Rapport is a psychiatrist at the University of Toledo Medical Center.

“When a woman is pregnant her body changes dramatically. Those changes have an effect on her [hormone levels],” said Daniel Rapport, a psychiatrist at the University of Toledo Medical Center who specializes in mood disorders. “These shifts in hormone levels could lead to changes in serotonin and dopamine, which is likely to cause depression or even psychosis,” Mr. Rapport said.

Dopamine plays a role in the regulation of voluntary movement, motivation, and the sensation of pleasure. Serotonin primarily affects mood, memory, impulsiveness, and social behaviors.

Any severe stressor, including sleep deprivation, could worsen the illness, Dr. Rapport said.

“That’s when people become delusional. They panic, they get depressed, and their behavior becomes disturbed,” he said. “You’re no longer dealing with someone that’s rational.”

In some cases the depression begins before pregnancy, Dr. Rapport said. In women predisposed to mood disorders the depression can be latent and is only discovered after the change in hormones during and after pregnancy.

The severity of depression varies by person and ranges from mild to severe.

The mildest form, known as the baby blues, lasts a few weeks and involves crying, sadness, and irritability.

Psychosis is the most severe form and usually requires medication and counseling for treatment.

Family members are often the first to notice the changes, but often misjudge the emotions.

Dr. Jenny Zamor is an obstetrician and gynecologist at Mercy Women’s Health Center.

Area doctors say the changes are not to be waved off, and as a result they’re paying closer attention to new moms.

At Mercy Women’s Health Center, nurses and doctors screen women during prenatal checkups and later to see how well the mothers are bonding with the babies.

“We do testing and try to rule out anemia, thyroid disorder, and any other organic reasons for postpartum-like symptoms,” said Dr. Jenny Zamor, an obstetrician and gynecologist at the center.

“We see all new moms two weeks and six weeks after birth. We see them more frequently if we’re worried.”

During checkups, Dr. Zamor encourages both patients and family members to ask questions and be open and honest about their concerns.

“A lot of times patients are embarrassed or too shy to speak up. It’s OK to feel overwhelmed, but if you need help, reach out and ask for it,” Dr. Zamor said.

“Families have to pay attention too. If it’s getting out of hand and her coping mechanisms are gone, it may be time to get her some help.”

Contact RoNeisha Mullen at: rmullen@theblade.com or 419-724-6133.