Sadness  and  Support:  
A  Short  History  of  Postpartum  Depression  
 
 
 
 
 
 
 
 
 
 
 
 
 
Robert  Sparks  Essay  Contest  
May  3,  2013  
 
 
 
   
  

A  famous  case:  
 
“Once  upon  a  time,  there  was  a  little  girl  who  dreamed  of  being  a  mommy.    She  
wanted,  more  than  anything,  to  have  a  child  and  knew  her  dream  would  come  
true  one  day.    She  would  sit  for  hours  thinking  up  names  to  call  her  baby….And  
then  one  day,  finally,  she  became  pregnant.    She  was  thrilled  beyond  belief.    She  
had  a  wonderful  pregnancy  and  a  perfect  baby  girl.    At  long  last,  her  dream  of  
being  a  mommy  had  come  true.    But  instead  of  being  relieved  and  happy,  all  she  
could  do  was  cry.”  
 
Brooke  Shields  famously  compared  her  tears  following  the  birth  of  her  daughter  to  

the  rain  taking  down  the  itsy-­‐bitsy  spider  in  the  well-­‐known  children’s  song.    The  above  

quote  is  from  the  opening  page  to  Shields’  widely  read  memoir,  Down  Came  the  Rain,  

published  in  2005.      

Shields’  book  gave  a  public  and  famous  face  to  a  disease  that  women  had  suffered  

silently  throughout  all  of  history.    In  it,  Shields  shares  in  intimate  detail  her  struggles  

following  the  birth  of  her  daughter.    She  was  helpless,  sad,  and  scared.    She  lost  all  

motivation  to  parent.    She  did  not  acknowledge  her  depression.    For  some  time,  she  

resisted  professional  help  and  medication  and  even  contemplated  suicide.    And  when  she  

came  out  whole  on  the  other  side,  after  successful  treatment  with  antidepressant  

medications  and  psychotherapy,  she  wanted  to  prevent  others  from  suffering  in  silence.1    

Now,  nearly  a  decade  later,  thanks  to  Shields  and  a  host  of  other  celebrities,  

bloggers,  researchers  and  political  advocates,  postpartum  depression  (PPD)  has  become  a  

household  term.    Today,  when  women  go  to  a  physician  for  prenatal  care,  they  see  posters  

in  the  doctor’s  office  explaining  what  PPD  is  and  what  they  should  do  if  they  develop  

depressive  symptoms  after  childbirth.  As  part  of  routine  childbirth  classes  and  when  

leaving  the  hospital  after  childbirth,  women  are  given  pamphlets  about  PPD  and  business  

cards  for  counselors  and  psychiatrists,  should  they  need  them.    And  pregnant  women  are  

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routinely  screened  for  PPD  at  postpartum  obstetrics  follow-­‐ups—and  even  by  pediatricians  

during  infant  checkups.    Such  widespread  awareness  and  acceptance  of  PPD  did  not  always  

abound,  however.  

Recent  research  indicates  that  nearly  70-­‐80%  of  women  suffer  from  some  

depressive  symptoms  within  the  first  two  weeks  following  delivery.    These  depressive  

symptoms  are  now  widely  recognized  as  manifesting  in  various  ways  with  varying  degrees  

of  severity.  Tearfulness  and  mood  lability  seen  soon  after  birth  in  many  women  has  become  

known  as  the  postpartum  or  “baby  blues.”  The  postpartum  blues  are  considered  a  “normal”  

reaction  to  giving  birth.  However,  some  women  experience  true  major  depressive  episodes  

in  the  weeks  and  months  following  birth  that  are  more  persistent,  manifesting  as  loss  of  

pleasure,  interest,  sleep,  and  self-­‐worth.  It  is  these  episodes  that  are  referred  to  as  PPD,  

estimated  to  affect  10-­‐13%  of  women  during  the  postpartum  period.  Finally,  beyond  the  

postpartum  blues  and  major  depressive  episodes,  about  1  or  2  in  1000  women  develop  

cognitive  disturbances,  bizarre  behavior  or  hallucinations,  and  a  severe  condition  known  as  

postpartum  psychosis.  2    

Depression  following  childbirth  has  long  carried  a  social  stigma.  Many  people  think  

that  a  woman  should  be  happy  following  the  birth  of  a  child—and  when  she  is  not,  she  is  

often  looked  upon  unkindly.      

Women  have  long  tried  to  hide  signs  of  depression,  sometimes  with  dire  

consequences  when  their  depressive  symptoms  turn  into  thoughts  of  harming  themselves  

or  their  babies.  A  well-­‐publicized  example  is  that  of  Melanie  Stokes,  who  killed  herself  in  

Chicago  in  2001  after  suffering  postpartum  mental  illness.3    Recent  legislation  to  support  

PPD  research  and  advocacy  now  bears  her  name.    

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Moreover,  medical  professionals  have  not  long  been  supportive  of  treatment  for  

depression  following  childbirth.    The  psychiatric  community  did  not  officially  recognize  

depression  in  the  postpartum  period  until  the  fourth  edition  of  its  Diagnostic  and  Statistical  

Manual,  published  in  1994.    Even  now,  the  DSM  IV  identifies  depression  with  a  postpartum  

onset  as  being  only  depression  that  appears  within  four  weeks  after  delivery  of  a  baby.    

However,  many  experts  argue  that  PPD  may  develop  anytime  within  the  first  year  

following  delivery,  and  clinicians  are  encouraged  to  screen  women  for  periods  longer  than  

just  those  four  weeks  following  the  birth  of  their  children.4  

Controversies  and  speculation  about  depressive  symptoms  following  childbirth  

have  existed  since  the  earliest  medical  literature.  Hippocrates  made  the  first  known  

reference  to  PPD  in  the  fourth  century  B.C.  and  his  hypotheses  became  dogma  that  survived  

for  over  a  thousand  years.  He  proposed  that  lochial  discharge—the  fluid  that  comes  from  

the  uterus  after  birth—if  suppressed,  could  flow  to  the  head  and  result  in  agitation,  

delirium  and  attacks  of  mania.    He  also  thought  that  blood  collecting  at  the  breasts  of  a  

woman  could  indicate  onset  of  madness.5    Another  early  reference  to  postpartum  mental  

symptoms  comes  from  Trotula,  a  13th  century  female  physician,  who  believed  that  

postpartum  mental  disturbances  were  due  to  increased  moisture  in  the  body  following  

childbirth.    She  wrote  “If  the  womb  is  too  moist,  the  brain  is  filled  with  water,  and  the  

moisture  running  over  the  eyes,  compels  them  to  involuntarily  shed  tears.”6  

Even  then,  down  came  the  rain.  

Observations  of  postpartum  mental  disturbances  continued  throughout  history.    

During  the  Middle  Ages,  women  who  exhibited  melancholy  during  or  after  childbirth  were  

thought  to  be  witches  or  victims  of  witchcraft,  as  any  other  stigmatized  individual  might  

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have  been.    By  the  16th  century,  descriptions  existed  of  a  “disturbance  of  the  maternal  

instinct”  following  childbirth,  and  most  reports  were  focused  on  mothers  who  killed  their  

children.    Known  as  “melancholic  filicide,”  these  deaths  led  physicians  to  increase  study  of  

postpartum  mental  disorders.    One  well-­‐known  16th  century  physician,  Castello  Branco,  

described  a  case  of  postpartum  melancholy  as  such:    “The  beautiful  wife  of  Carcinator  who  

always  enjoyed  the  best  of  health,  was  attacked  after  childbirth  by  melancholy,  and  

remained  insane  for  a  month,  but  recovered  with  treatment.”  Though  Branco  does  not  

describe  what  type  of  treatment  he  used  for  the  wealthy  woman,  reports  of  experimental  

treatments  began  to  surface  over  the  following  centuries.7  

An  early  case:  
 
A  25-­‐year-­‐old  woman  gives  birth  to  a  child  at  home.    She  is  accompanied  in  the  
birth  by  a  local  midwife,  and  the  midwife  comes  back  to  check  on  her  
periodically  following  the  birth  of  her  child.    The  woman  begins  to  feel  very  sad  
and  overwhelmed  in  the  weeks  following  the  birth  of  her  child.    She  ceases  to  
cook  and  barely  feeds  her  baby.    Her  neighbors  become  worried  that  the  baby  
may  die  and  call  for  the  local  physician  to  come  see  this  woman  in  her  home.    
The  physician  is  unsure  of  why  the  woman  is  unhappy,  even  in  light  of  having  a  
new  healthy  baby,  but  he  has  seen  other  women  act  like  this  in  past.    He  tells  
the  woman  to  take  lukewarm  baths  and  he  gives  her  a  medication  that  he  says  
will  calm  her  mind.  
 
In  the  mid-­‐19th  century,  Jean-­‐Etienne  Esquirol  became  one  of  the  first  physicians  to  

provide  detailed  case  reports  of  postpartum  psychiatric  illnesses.    He  reported  92  cases  of  

postpartum  delirium  and  melancholy  and  suggested  that  the  numbers  of  women  suffering  

from  postpartum  mental  disturbances  was  likely  higher  than  the  number  of  cases  he  

observed  in  mental  hospitals.    He  thought  that  mild  cases  were  likely  cared  for  at  home  and  

never  reached  his  hospital.    Esquirol  suggested  treatment  that  included  careful  nursing,  

tepid  baths  and  purgatives—a  common  treatment  for  many  medical  ailments  at  the  time.8    

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Esquirol,  like  most  doctors  of  the  19th  century,  believed  that  two  categories  of  postpartum  

illness  could  be  defined:  puerperal,  which  was  said  to  occur  within  6  weeks  of  childbirth,  

and  lactational,  meaning  that  it  occurred  greater  than  6  weeks  following  delivery.    These  

categories  survived  for  decades  despite  the  lack  of  any  true  scientific  evidence  for  the  

division.  

Around  the  same  time,  an  American  psychiatrist,  MacDonald,  objected  to  the  rigid  

classification  of  puerperal  mental  illness  based  on  time  of  onset  and  proposed  classifying  

diagnoses  based  on  acuteness  of  onset  of  symptoms.    Symptoms  observed  included  

decreased  strength  and  spirit,  restlessness,  sleeplessness,  and  irritability.    His  treatments  

also  included  tepid  baths—specifically  given  between  94  and  98°F—as  well  as  “large  doses  

of  opium”  to  calm  the  mind  9    The  use  of  opium  should  not  be  too  surprising—as  with  

Esquirol’s  purgatives,  opium  was  given  for  all  variety  of  ailments  at  the  time.  

In  1858,  Louis-­‐Victor  Marcé  published  the  first  formal  paper  devoted  entirely  to  

puerperal  mental  illness,  his  Treatise  On  Insanity  In  Pregnant,  Postpartum,  And  Lactating  

Women.    He  wrote  of  310  cases  of  pregnant  and  postpartum  women  that  he  had  personally  

observed  and  became  the  first  to  systematically  address  categorization  of  their  disorders.    

In  his  results,  he  reported  that  9%  of  women  developed  depression  during  pregnancy,  58%  

in  the  puerperal  period,  and  33%  in  the  lactational  period.    Marcé  noted  no  major  features  

distinguishing  the  psychoses  of  pregnancy  from  those  in  women  in  the  non-­‐pregnant  state.    

However,  he  believed  that  postpartum  cases  of  depression  had  many  features  that  

distinguished  them  from  other  mental  illnesses  and  proposed  that  this  should  indeed  be  

classified  as  a  separate  diagnosis.  His  main  observation  was  that  while  most  PPD  symptoms  

could  be  found  in  other  types  of  mental  disturbances,  the  syndromes—that  is,  the  

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particular  combinations  of  symptoms—were  distinct.  In  line  with  Hippocrates  and  Trotula  

before  him,  Marcé  hypothesized  that  postpartum  psychological  symptoms  occurred  in  

relationship  with  the  profound  organic  and  functional  changes  occurring  in  the  female  

reproductive  system  following  childbirth.10  

Marcé  is  still  remembered  today  through  the  Marcé  Society,  a  group  of  physicians  

and  researchers  who  unite  to  study  PPD  throughout  the  world.    His  work  has  had  a  

significant  impact  on  history  of  PPD—however,  not  always  as  might  be  imagined.  

Historically,  Marcé’s  research  was  often  used  as  early  evidence  that  PPD  was  not  a  separate  

entity  from  other  forms  of  depression,  based  on  a  misinterpretation  of  his  statements  that  

depression  in  pregnancy  was  not  a  separate  entity.  

During  the  19th  century,  treatments  for  PPD  changed  in  line  with  the  medical  ideas  

of  the  era.  Many  at  the  time  suggested  bleeding  as  a  way  to  reduce  inflammation  and  

eliminate  excess  fluid  in  the  body.  Similarly,  many  recommended  opium  to  calm  the  mind.  

Restraints  and  separation  from  the  woman’s  infant  were  also  popular.  These  were  

immortalized  in  Charlotte  Perkins  Gillman’s  story  The  Yellow  Wallpaper.    Gillman  tells  a  

story  about  a  young  woman  suffering  from  strange  thoughts  following  the  birth  of  her  

child.    The  woman’s  husband  places  the  woman  in  a  room  at  a  summer  home,  away  from  

her  child,  to  help  her  improve,  but  rather  than  get  better,  she  proceeds  to  become  even  

more  delusional.11  

In  the  early  20th  century,  three  main  lines  of  thought  emerged  regarding  the  

description  of  mental  disturbance  and  depression  following  childbirth.  These  three  

theories  were  eloquently  summarized  and  discussed  by  Dr.  James  Hamilton,  a  preeminent  

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psychiatrist  and  founder  of  the  Marcé  Society,  in  his  1962  book,  Postpartum  Psychiatric  

Problems.      

The  first  theory,  proposed  by  Strecker  and  Ebaugh  in  1926,  suggested  that  

depression  following  childbirth  had  no  actual  relationship  to  the  pregnancy,  delivery,  or  

postpartum  changes  and  was  indistinct  from  other  psychiatric  illness.    Strecker  and  Ebaugh  

believed  that  all  cases  of  postpartum  mental  illness  could  be  fit  into  other  standard  

categories  of  psychiatric  illness—dementia  praecox,  manic-­‐depression,  and  delirium.    They  

called  on  physician  groups  to  eliminate  “postpartum  psychosis”  from  the  psychiatric  

terminology,  and  the  American  Psychiatric  Association  and  American  Medical  Association  

did  indeed  remove  it  from  their  diagnostic  manuals  based  on  these  and  other  

recommendations.      

In  his  book,  written  several  decades  later,  Hamilton  pointed  out  perceived  flaws  in  

their  research.    For  example,  he  noted  that  a  large  majority  of  cases  categorized  as  manic-­‐

depressive  had  noticeable  clouding  of  the  sensorium  –  a  symptom  usually  not  seen  in  

affective  disease.  Despite  perceived  flaws,  however,  the  Strecker  and  Ebaugh  study  stood  

up  for  decades  and  even  still  contributes  to  controversy  in  perinatal  psychiatric  literature  

to  this  day.  

A  second  theory,  proposed  by  Zilboorg  in  1928,  used  the  psychogenic  etiologies  

popularized  by  Freud  and  others  at  the  turn  of  that  century,  to  explain  PPD.    Zilboorg  

attributed  PPD  to  pre-­‐pregnancy  frigid  personalities.    He  and  others  suggested  that  there  

might  be  a  potential  relationship  to  suppressed  homosexuality,  unresolved  Oedipal  

longings,  or  anal-­‐regressive  resultant-­‐father  identification.    This  theory  was  further  

developed  by  Franks  in  1934,  proposed  that  strong,  unresolved  incestuous  drives,  frigidity,  

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attachment  to  the  father,  and  schizoid  characteristics  (among  other  hypotheses)  might  be  

the  root  of  PPD.    While  such  beliefs  have  not  survived  into  modern  day  understandings  of  

PPD,  these  psychologists  did  publish  the  first  observations  of  personal  history  or  family  

history  of  depression  in  women  with  postpartum  symptoms—a  legacy  that  may  be  found  

in  current  research  supporting  that  women  who  have  previously  experienced  depression,  

or  who  have  a  family  history  of  mental  illness,  are  more  likely  to  develop  PPD  than  women  

with  no  historical  factors.12  

Finally,  the  third  theory  of  the  time  harkened  back  to  the  work  of  Marcé,  as  well  as  

Hippocrates  and  Trotula  before  him,  suggesting  that  physiologic  changes  in  women’s  

bodies  surrounding  the  birth  of  the  child  may  uniquely  lead  to  postpartum  psychiatric  

changes  distinct  from  other  illnesses.    Kilpatrick  and  Tiebout  in  1926  suggested  that  PPD  

might  be  due  to  “an  unknown  toxic  process.”    They  cited  cases  in  which  women  had  

concurrent  thyroid  enlargement,  menstrual  difficulties,  and  excessive  hair  growth  with  

PPD,  and  hypothesized  that  the  processes  were  likely  linked.    Additionally,  Kanosh  and  

Hope  in  1937  reported  on  asymptomatic  periods  following  birth,  and  believed  that  

psychiatric  symptoms  must  be  related  to  some  chemical  or  hormonal  change  that  occurred  

after  a  few  days.    They  also  suggested  that  PPD  might  possibly  be  related  to  lactation  as  

they  noted  some  cases  of  women  who  developed  depressive  symptoms  only  after  weaning  

of  their  infant.13  

Following  the  Second  World  War  in  the  mid-­‐20th  century,  many  psychiatrists  began  

studying  milder  forms  of  postpartum  psychiatric  diseases.  It  was  noted  that  women  often  

did  not  seek  care  for  postpartum  illness  due  to  fears  of  being  placed  in  a  psychiatric  

hospital  and  separated  from  their  husbands  and  children.    As  described  in  the  example  of  

  8  
  

Gillman’s  story  The  Yellow  Wallpaper,  it  had  once  been  common  to  separate  women  

suffering  from  depressive  symptoms  from  their  infants.  In  the  late  1940s,  however,  

psychiatric  wards  in  Britain  and  Australia  began  successfully  incorporating  mother-­‐and-­‐

baby  units  where  mothers  suffering  from  PPD  could  receive  care,  while  remaining  close  to  

their  infants.14  

A  modern  case:  
 
A  29-­‐year-­‐old  female  presents  for  her  six-­‐week  postpartum  check-­‐up.  She  is  
accompanied  by  her  healthy  six-­‐week  old  son.  When  asked  how  she  is  today,  she  
tears  up  and  responds,  “Ok  …  I  guess.”  She  has  filled  out  a  mood-­‐screening  
questionnaire  that  shows  that  she  feels  exhausted,  has  decreased  interest  in  
things,  and  has  not  been  finding  enjoyment  in  her  normal  activities.    When  
questioned  further,  she  reports  feeling  very  down  and  teary  during  the  last  few  
weeks.  She  has  lost  interest  in  reading  and  knitting  and  finds  it  hard  to  even  
feed  her  child.  She  has  had  decreased  appetite,  increased  anxiety,  and  cannot  
sleep  even  when  her  baby  is  sleeping.  She’s  been  feeling  like  this  for  several  
weeks  and  thinks  it  may  be  getting  worse.    Her  physician  discusses  treatment  
with  anti-­‐depressant  medications,  though  she  acknowledges  risks  of  such  drugs  
while  breastfeeding.    She  suggests  the  woman  might  see  a  psychiatrist  and  a  
counselor  for  help  with  her  current  symptoms.  
 
 In  the  later  20th  century,  many  of  the  ideas  and  treatments  that  are  still  prevalent  

today  began  to  develop,  often  building  on  the  ideas  of  earlier  physicians  while  

incorporating  new  scientific  research  techniques  to  refine  our  understanding  of  PPD.    In  

1968,  Brice  Pitt  described  “atypical”  depression  in  the  postpartum.    His  was  one  of  the  first  

modern  studies  to  draw  attention  to  “less  severe”  depressions  than  postpartum  psychosis.    

His  study  was  designed  in  response  to  the  work  of  community  health  visitors  who  went  to  

check  on  new  mothers  in  their  homes  after  discharge  from  the  hospital  following  

childbirth.    These  nurses  reported  to  him  that  many  women  dealt  with  varying  degrees  of  

depression  following  birth,  but  most  did  not  seek  treatment.    Pitt’s  large  cohort  study  was  

  9  
  

the  first  community-­‐based  study  of  depression  in  the  postpartum  and  he  found  that  

approximately  10.8%  of  women  in  the  cohort  suffered  PPD.    He  called  the  depression  

“atypical”  because  the  symptom  profile  was  somewhat  different  than  non-­‐postpartum  

depression.15  

In  addition  to  the  Western  observations  of  PPD,  many  studies  have  shown  that  

postpartum  blues  and  postpartum  psychosis  occurs  in  fairly  uniform  ways  across  cultures.  

PPD  varies  depending  on  cultural  demands  placed  on  women  postpartum,  but  most  

cultures  have  forms  of  PPD  and  various  beliefs  about  its  causes.  In  Uganda,  for  example,  

there  is  a  recognized  puerperal  mental  illness  called  “Amakiro,”  which  is  believed  to  be  

caused  by  promiscuity  of  the  mother  during  pregnancy.  Symptoms  of  Amakiro  include  

restlessness,  pallor,  and  mental  confusion,  as  well  as  the  notion  that  the  mother  wants  to  

eat  her  baby.    In  Nigeria,  there  is  a  postpartum  mental  illness  known  as  “Abisiwin,”  which  is  

believed  to  be  caused  by  too  much  heat  in  the  body.  16  

 Cross-­‐cultural  research  has  also  pointed  out  that  Western  cultures  often  place  high  

demands  on  women  to  re-­‐integrate  quickly  into  society  following  childbirth,  while  other  

cultures  may  keep  woman  at  rest  or  in  seclusion  while  elder  women  care  for  the  new  baby.    

Some  have  hypothesized  that  this  social  requirement  for  women  to  return  to  work  and  

other  stressful  environments  quickly  following  the  birth  of  a  child  may  contribute  to  higher  

rates  of  PPD  in  Western  cultures.17  

Over  the  past  40  years,  there  has  continued  to  be  much  debate  in  psychiatry  

surrounding  PPD.    Questions  have  arisen  such  as  “Is  pregnancy  protective  against  

depression  or  a  risk  factor  for  depression?”  “Should  postpartum  blues,  depression  and  

psychosis  be  viewed  as  distinct  entities  or  a  continuum  of  symptoms?”  Literature  from  the  

  10  
  

1980s  and  90s  continued  to  examine  these  questions.    The  idea  first  proposed  many  years  

ago  by  Marcé,  preceded  well  before  him  by  Hippocrates  and  Trotula,  and  developed  by  

others  in  the  early  20th  century—that  PPD  is  likely  related  to  hormonal  changes  in  the  

perinatal  period—has  become  a  leading  theory  in  PPD  research  during  recent  years.    

Studies  have  shown  that  artificially  inducing  the  hormonal  changes  associated  with  the  

postpartum  period  significantly  increases  risk  of  developing  depression.    Other  studies  

have  identified  additional  important  risk  factors  for  PPD,  such  as  stressful  life  events,  

family  history  of  mood  disorders,  and  personal  history  of  depression.18  

Until  the  early  1990s,  most  psychiatric  organizations  still  espoused  the  idea  that  

there  were  not  enough  unique  features  of  PPD  to  warrant  a  separate  disease  categorization  

in  psychiatric  diagnostic  manuals.    The  DSM-­‐IV,  released  in  1994,  incorporated  

“postpartum  onset”  as  a  modifier  to  major  depression,  bipolar  illness,  and  other  psychiatric  

diagnoses;  this  specifier  is  used  when  such  disorders  appear  within  four  weeks  following  

the  birth  of  a  child.    However,  much  current  literature  challenges  the  “postpartum”  

definition  of  4  weeks  following  birth  and  suggests  that  PPD  may  still  appear  even  months  

after  giving  birth.19  

In  addition  to  at  least  some  formal  recognition  of  PPD  as  a  unique  entity,  treatment  

for  depression  in  general  also  greatly  improved  in  the  1990s,  and  the  medications  

developed  have  also  been  successful  in  improving  symptoms  of  PPD.    Antidepressant  

medications  came  into  widespread  use  for  PPD  in  the  late  1990s,  and  just  as  they  became  

the  first-­‐line  treatment  for  major  depressive  disorder,  SSRIs  are  also  now  the  first-­‐line  of  

medication  treatment  for  PPD.    Few  controlled  studies  exist  regarding  the  use  of  these  

  11  
  

medications  following  pregnancy,  but  what  does  exist  indicates  benefit  from  the  treatment.    

However,  concerns  regarding  infant  drug  exposure  through  breastmilk  still  abound.20  

Perhaps  the  greatest  change  in  thinking  surrounding  PPD  has  been  the  shift  to  

include  more  focus  on  screening,  as  well  as  the  surge  of  advocacy  surrounding  the  

diagnosis.    In  the  last  decade,  there  has  been  widely  increased  focus  on  prevention  of  PPD  

via  support  groups  and  therapy.    Screening  at  postpartum  obstetrics  visits  and  initial  

newborn  visits  to  a  pediatrician  are  now  increasingly  commonplace.    And  with  the  stories  

of  Brooke  Shields  and  other  famous  women  in  the  mainstream  media  and  less  formal  

outlets  on  the  Internet,  there  has  been  much  wider  acceptance  in  society  of  women  who  are  

not  perfectly  happy  following  the  birth  of  a  child.  Increased  discussion  of  the  condition  has  

led  to  more  support,  and  the  beginnings  of  a  reduction  in  stigma,  for  women  who  suffer  

from  PPD.    Recent  advances  in  this  area  include  the  Melanie  Blocker-­‐Stokes  Act,  which  

provides  government  funding  for  research  and  advocacy  for  PPD  in  the  United  States,  

legislation  in  New  Jersey  mandating  screening  for  PPD,  as  well  as  a  surge  in  popularity  of  

blogs  and  support  groups  related  to  PPD,  such  as  Katherine  Stone’s  “Postpartum  Progress,”  

and  the  Postpartum  Support  International  group.21  

PPD  is  a  common  and  treatable  condition.    However,  it  has  been  subject  to  

controversy  and  stigma  throughout  much  of  history,  leading  to  misclassification  and  lack  of  

access  to  treatment  for  many  patients.  While  many  barriers,  including  stigma,  still  exist  that  

limit  this  access  for  perinatal  women,22  further  research  and  advocacy  in  this  area  will  

continue  to  improve  treatment  and  access  to  care  for  women  suffering  from  depressive  

symptoms  following  childbirth.  

 
   

  12  
  

References  

                                                                                                               
1  Shields  B.    Down  Came  the  Rain:  My  Journey  Through  Postpartum  Depression.  New  York:  

Hyperion,  2006.    
 
2  Flynn  HA.    Epidemiology  and  Phenomenology  of  Postpartum  Mood  Disorders.    Psychiatric  

Annals  2005.  35(7):  544-­‐551.  

 
3  Elton  C.    Postpartum  Depression:  Do  All  Moms  Need  Screening?    Time.    20  Jul  2009.  

Available  via  <[Link]  

(Accessed  2  May  2013)  
 
4  Battle  CL.  Zlotnick  C.    Prevention  of  Postpartum  Depression.    Jul  2005.  Psychiatric  Annals.  

35(7):  590-­‐598.  
 
5  Hamilton  JA.  Chapter  12,  History.  In  Postpartum  Psychiatric  Problems.  St  Louis:  Mosby  

Harwin,  1962,  p126.  

 
6  Trotula  of  Salerno,  The  Diseases  of  Women.    A  translation  of  Passionibus  Mulierum  

Curandorum  by  Elizabeth  Mason-­‐Hohl,  MD.    Los  Angeles:  The  Ward  Ritchie  Press;1940.  
 
7  Brockinton  I.    A  Historical  Perspective  on  the  Psychiatry  of  Motherhood.  In    Perinatal  

Stress,  Mood  and  Anxiety  Disorders:  From  Bench  to  Bedside.    Basel,  Switzerland:  Karger  
Publishers,  2005.  
 
8  Hamilton,  1962,  p126-­‐7.  

 
9  Hamiton,  1962,  p  127.  

 
10  Hamilton,  1962,  p.  127-­‐30.  

 
11  Gillman  CP.  The  Yellow  Wallpaper,  first  published  1899  by  Small  &  Maynard,  Boston,  MA.  

 
12  O’Hara  MW.    Postpartum  Depression  Causes  and  Consequences.    New  York:  Springer-­‐

Verlag,  1995.  
13  Hamilton,  1962,  p.132-­‐136.  

 
14  Brockington,  2005.  

15  Pitt  B.  Atypical  Depression  Following  Childbirth.    Brit  J  Psychiatr  1968;  114:  1325-­‐1335.  

16  Cox  JL.    Postnatal  Depression.    Edinburgh:  Churchill  Livingstone  Publishers,  1986.  

 
17  Cox,  1986.  

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18  Wisner  KL,  Parry  BL,  Piontek  CM.    Postpartum  Depression.    N  Engl  J  Med  2002;  347(3):  

194-­‐199.  
 
19  Kendell  RE,  Chalmers  JC,  Platz  C.    Eipdemiology  of  puerperal  psychoses.    Br  J  Psychiatry  

1987;  150:662-­‐73.  
 
20  Miller  LJ,  ed.    Postpartum  Mood  Disorders.    Washington,  DC:  American  Psychiatric  Press  

Inc.,  1999.  
 
21  Information  about  these  initiatives  can  be  found  via:  

<[Link]  (NJ  Screening  law),  

<[Link]>  (Postpartum  Progress  Blog)  and  <[Link]>  
(Postpartum  Support  International)  
 
22  Kopelman  RC,  Moel  J,  Mertens  C,  Stuart  S,  Arndt  S,  O’Hara  M.  Barriers  to  Care  for  

Antenatal  Depression.    Psychiatric  Services.    Apr  2008.  59(4):  429-­‐432.    

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