While many new mothers experience brief periods of sadness following birth, these feelings are often mild and fade on their own. However, if these feelings do not dissipate, they could be symptoms of postpartum depression (PPD), a serious and debilitating illness. Recent studies in England have found PPD to be the leading cause of suicide among new mothers.

Though some women who experience PPD may have suffered from previous episodes of depression, this is not always the case; it is possible for such a depression to develop without warning. PPD is often marked by intense feelings of sadness, anxiety, exhaustion without the ability to sleep, perceived feelings of failure, preoccupation with the baby’s well-being or even thoughts of harming the child.

Dr. Peter Schmidt of NIMH’s Behavioral Endocrinology Branch is investigating new treatments for postpartum depression.

The symptoms of PPD usually do not subside on their own and may require active treatment with medications or therapy and emotional support from friends and family. Current treatments for PPD, though potentially effective, cannot rapidly relieve the debilitating symptoms of the illness. For example, traditional antidepressants such as selective serotonin reuptake inhibitors (SSRIs) can take from 4 to 6 weeks to be effective. In the meantime, the woman continues to cope with feelings of overwhelming sadness, anxiety and fear.

However, Dr. Peter Schmidt and his colleagues in NIMH’s Behavioral Endocrinology Branch hope to offer a fast-acting and effective alternative to these treatments. The new method involves the use of estrogen, a naturally occurring hormone, to lift the symptoms of depression in women with PPD. Schmidt notes that estrogen therapy has been found to reduce depression in 2 to 3 weeks in the majority of women. An added benefit is that most women can discontinue therapy after about 6 to 8 weeks, without a re-emergence of depressive symptoms. Also, use of an estrogen patch does not pass hormones into breast milk, unlike SSRIs, which can be passed on to the nursing infant. In fact, the level of hormones in the patch is significantly lower than what a woman would receive from a typical birth-control pill.

A Patient’s Story

A 27-year-old mother called and scheduled an appointment at NIMH. Despite planning and looking forward to her pregnancy, within a month after delivering a healthy baby girl she had become persistently sad and unable to enjoy any aspect of her daily life. She felt detached from her new baby and worried about her ability to be a good mother. Concerns about her child’s well-being constantly entered her mind and had begun to affect her relationship with her husband. Though both parents had been excited in the months leading up to the child’s birth, they now argued excessively and contemplated separation. The mother had no history of depression and could not recall any depressive symptoms during the pregnancy, but was now at a loss as to what to do. She felt hopeless and out of control. After qualifying for an NIMH trial, she began treatment with estrogen therapy and within 3 weeks her symptoms began to subside. Her mood and her relationship with her husband both improved dramatically over the course of treatment. After 8 weeks the estrogen was discontinued and her mood remained stable.

Schmidt’s group conducted a landmark study in which researchers modeled the effects of pregnancy and the postpartum in non-pregnant women with a history of PPD and compared their progress with healthy volunteers. The study found that the risk for depression was greatly elevated for women who had had a previous episode of PPD. This pointed toward a hormonal trigger for PPD. In addition, several studies suggest that estrogen therapy can help to rapidly alleviate depression.

Schmidt is currently looking for volunteers to participate in two postpartum research studies. The first will explore the benefits of treating PPD with estrogen. Women who think they might currently be depressed and have given birth within the last 6 months are encouraged to participate. Women participating in this study may help to advance a treatment that could alleviate their own symptoms and may someday lead to a new standard of care for postpartum depression.

The second study is for women with a history of PPD. Healthy individuals without a history of postpartum depression are also needed to serve as controls. Participants in this study will go through a “simulated” pregnancy by taking a course of hormones that mimic the experience of pregnancy in an abbreviated time frame. Participants will be evaluated and monitored for signs of depression. This will help researchers determine how and to what extent fluctuating levels of hormones during pregnancy can influence mood and behavior.

The women in this study will learn whether they may experience PPD following a future pregnancy. Women who are interested in participating in the trial or who would like more information should contact NIMH at (301) 496-9576.