"It's horrible to say," said Christina*, reflecting on her depression following the birth of her first child, "but here I had this beautiful new baby, and I just didn't care about her. The feelings of love just weren't there. All I could think about was how meaningless everything seemed. I managed to feed her and change her, but that was about it."
Stories like Christina's, unfortunately, are all too common -- a situation that has prompted the U.S. House of Representatives this week to authorize spending $3 million to pursue studies of postpartum depression and to carry out a national campaign to increase awareness of the issue.
Postpartum literally means "after birth," and this period is a time when women, who suffer from depression at twice the rate that men do, are especially vulnerable.
A study in this month's American Journal of Psychiatry of more than 4,000 pregnant women showed that more than 10 percent of them suffered from major depression after giving birth. This study, from the Centers for Disease Control and Prevention, also found substantial, though lower, rates of depression in women just before and during pregnancy.
How does a time of such beauty and hope become so dark and desperate?
Can we blame it all on hormones? The female hormones estrogen and progesterone are obvious suspects, as they rise to several hundred times their normal levels in pregnancy and then drop suddenly after delivery. However, no consistent differences in hormone levels or functioning have been found between postpartum women with and without depression.
One study, however, did suggest that the change in hormone levels plays a critical role for some women. A group at the National Institute of Mental Health showed that a subset of women with a history of postpartum depression had a recurrence of depressive symptoms when high levels of estrogen and progesterone induced by medication in an experimental setting were precipitously dropped.
Several studies have shown that postpartum depression runs in families. A group from the United Kingdom found that among women with a family history of depression -- those whose sisters had experienced depression -- had a 42 percent chance of experiencing postpartum depression in their first deliveries.
Another group, led by Dr. Douglas Levinson of Stanford University, found that women with a family history of postpartum depression were more than three times more likely to experience it themselves compared with women without this history.
And a third study, conducted by Dr. Jennifer Payne of Johns Hopkins University and others, similarly found an increase in risk for postpartum mood symptoms in women with bipolar disorder who had a family history of these symptoms.
These results suggest a genetic contribution to postpartum depression risk. One study of twins reported that 38 percent of the risk is in the genes. Scientists are busy tracking down potential genes that might be culprits. Risk genes could be those that are turned on or off by changing levels of estrogen or progesterone.
But other factors may also play a role. Stress hormones, which could be activated by the stress of caring for a newborn, might play a role in triggering depression. And the sleep deprivation that new mothers experience might further fan the flames of smoldering depression.