Factors Linked to Postpartum Depression

Most women get the blues after giving birth, but the difference between that mild feeling of “being down” and depression is like the difference between a gentle spring rain and a flood.

Experts divide postpartum disorders into three classifications: postpartum blues, postpartum depression and the more rare postpartum psychosis.

The “baby blues” are usually marked by fatigue and, frequently, tears, said Dr. Lori Altshuler, a psychiatrist who teaches at UCLA Medical Center and has a private practice in Manhattan Beach.

The blues typically start from three to seven days after birth and last a few weeks, Altshuler said. New mothers often are told that such a feeling is normal because “it helps them not feel anxious.”

But a woman struck by postpartum depression often has insomnia, is agitated and has trouble concentrating, Altshuler said. Other symptoms may include a feeling of worthlessness, decreased appetite and a loss of interest in her surroundings, including the baby.

The blues cure themselves; a clinical depression requires medication and counseling.

The psychiatrist said one problem with postpartum depression is that it may not show itself until a week or more--sometimes months--after the baby is born. By that time, the mother is home and without professional help. As a result, the first professional to realize what the mother is experiencing may be a pediatrician, when the mother brings in the baby for a checkup.

Altshuler said about one in 10 new mothers develops postpartum depression. About one in 1,000 develops postpartum psychosis, which she defined as losing touch with reality. The psychotic mother may think her baby is deformed when it’s fine, may hear voices or see apparitions, she said.

Even among the minority of women who become psychotic, the risk of a mother killing her child is only about 3%, Altshuler said. “It’s not a huge number, but it is more than insignificant,” she said.

Yet the psychiatrists’ bible, the “Diagnostic and Statistical Manual,” does not have a separate entry for postpartum psychosis. The manual lists definite symptoms for most known diseases and disorders, but in postpartum disorders, “Symptoms are so variable that (the disorder) doesn’t fit into one category,” Altshuler said. As a result, the index listing for the illness refers doctors to other forms of mental illness, such as major depression.

Although some doctors say the trauma of giving birth triggers previous mental disorders, others contend postpartum depression is a separate illness that stems from hormonal changes caused by the birth process.

Research has been unable to link the onset of postpartum depression with levels of stress, a difficult childbirth, or one’s income level or marital status. But according to a recent issue of the Harvard Medical School Mental Health Letter, women who have been depressed before pregnancy are more likely to have depression afterward.

Postpartum depression also appears to be more common in women who have a family history of mood disorders. Other factors that might contribute to the onset of the disorder are an unhappy marriage, conflict with parents, and isolation from friends and family.

The change in hormones also is suspected of playing a significant role because, after delivery, a woman has lower levels of the hormones estrogen and progesterone, which are produced by the ovaries and the placenta. The level of the hormone prolactin, which stimulates the secretion of breast milk, increases at childbirth.

Altshuler, who trained at the National Institute of Mental Health, said many women suffering from postpartum depression refuse to enter a hospital, fearing it will interrupt their bonding with their children.

But she said one study found there was not much difference between children not separated from their mothers and those separated for a short period “as long as there are some other loving surrogates attending to the child.”

Psychiatrists say some women suffering from postpartum depression kill themselves because they fear they will harm their babies.

In April, 1987, on her 23rd birthday, Sheryl Massip of Anaheim tried to throw her 6-week-old son, Michael, into oncoming traffic, but a car swerved and avoided the baby. Then Massip positioned the infant under the wheel of her Volvo, drove over him and put the body in a trash can.

After a jury convicted her of second-degree murder, Orange County Superior Court Judge Robert R. Fitzgerald stunned the legal community by reducing the verdict to voluntary manslaughter and acquitting Massip because of insanity.

The state Supreme Court agreed last month to consider the prosecution’s appeal of Fitzgerald’s ruling.

Times staff writer Shari Roan contributed to this story.