Since I see a fair number of patients who are of the age where they expect and want to have babies, the issue of managing depression during and after the pregnancy often arises. Today I thought I would focus on a small segment of this large issue–that of the spector of postpartum depression. This issues splashes across the front pages of newspapers periodically when some tortured soul ends up harming her own kids while in the midst of a serious postpartum depression. While bringing the issue out onto the table (good), it also can provide more stigma to the condition. Some people start to think that postpartum depression is synonymous with “gonna murder my kids”. This is obviously not the case. All the same, it MUST be looked for and, once diagnosed, carefully managed, so that the risk of tragic outcome is minimized.
To that end, I wanted to summarize the results of an article I ran across in the American Journal of Psychiatry (September, 2006). The article entitled “Familiality of Postpartum Depression in Unipolar Disorder: Results of a Family Study” took a look at how we might predict the risk for a woman developing postpartum depression after delivery of a first baby. Our diagnostic criteria (DSM-IV) uses a fairly broad time frame for the diagnosis of this syndrome–Major Depression criteria must be met within the first six months after delivery. What the study found was that when you use more restrictive criteria for the family history you get greater predictive value of the family history. Specifically, women with a family history of developing depression within 6 months of delivery (the standard DSM criteria), had a 15 % risk of developing postpartum depression themselves. In comparison, women with a family history of developing Major Depression within 2 months of delivery (more restrictive time criteria than DSM currenly uses), had a 42 % risk of developing postpartum depression. This increased predictive value is certainly important, but we must remember how difficult it can be to get this sort of information from our relatives. It is going to be difficult for many families to get this information accurately. People will likely remember being “blue” or “sad” following delivery, but will be hard pressed to remember how soon after delivery the symptoms worsened. The clear message from this study is the need to ask the questions and to have my patients ask their family the questions. Your risk is never zero, even without a family history. Knowing that there is a strong family history of early onset postpartum depression provides us with time to develop a plan of monitoring and quick action should a new mom start to experience symptoms of depression.
–Dan Hartman, MD
