Postpartum depression so severe that it could prompt a new mother to methodically drown all five of her young children, as a mother is accused of doing in Houston last month, is extraordinarily unusual. But milder forms of the mental disorder are common and easy to explain in terms of estrogen plunges, exhaustion and a demanding newborn, doctors say.
When you add misplaced expectations, an immediate loss of purpose (no longer carrying a child within) and a sense of guilt about your unhappiness, postpartum blues, a mild form of postpartum depression, becomes a natural reaction that afflicts up to 80 percent of new mothers.
Postpartum depression is neither mysterious nor difficult to explain, says Dr. Linda Norton, a forensic pathologist formerly with the Dallas County Medical Examiner's office, who has investigated hundreds of cases of child abuse, including dozens that resulted in the death of a child.
"First, you've been through a pretty horrific experience giving birth. Just because women have been doing it for thousands of years doesn't mean it's a piece of cake," Norton says.
Then, "This new infant offers you nothing -- doesn't do anything but eat, excrete, cry and sleep for about six weeks. If it were not for very strong maternal bonding, human infants would not survive. Mom would wake up and walk off," Norton continues.
Take a normal human who hasn't recently been through the stress of giving birth and deprive her of sleep for a couple of weeks. Then make a lot of demands and see how long it takes to get her depressed, the doctor suggests.
Norton says it takes six weeks for a woman to get back to her pre-pregnancy biochemical state.
"Any normal woman who doesn't get a little depressed is a little abnormal, or a really good actress," she says.
The tragedy occurs in not recognizing the less-common cases of serious postpartum depression that require medical care and the even rarer postpartum psychosis that demands emergency treatment.
Major depression that is manifested in lack of interest in the baby, suicidal or violent thoughts, hallucinations or bizarre behavior is abnormal, and immediate treatment is needed, says Dr. Maduhukar Trivedi, a depression expert at the University of Texas Southwestern Medical School in Dallas.
"Serious depression is more likely to occur in women who had a mental illness before pregnancy," Trivedi says. It may be recurrent depression triggered by the trauma of giving birth, or it may be mild depression that comes back more severely and lasts more than a couple of weeks.
