Medical Edge Newspaper Column

New Mom Reports Diverse Symptoms

June 18, 2007
Dear Mayo Clinic:
I had a baby seven months ago and suffer from postpartum depression, so I'm on an antidepressant. I have other symptoms, as well. I breastfed my son for only three weeks, yet at the moment I have nipple pain. Also, my lymph nodes under my arms are sore and I have a pain in my uterus. Can you please give me an idea of what all this is about, or is it just my body going back to normal? — Australia

Answer:
It's quite common for new moms to experience "the baby blues," which result from a dramatic drop in hormone levels and other physical changes of childbirth. These symptoms generally fade within a few days or weeks as the body recovers.

Less often, though still commonly, a more intense form of depression develops within the first six months or so after giving birth. In these cases, the sadness, anxiety, restlessness, and other depressive symptoms derive from more than physical changes; emotional factors or lifestyle influences may also be involved. A woman might be feeling overwhelmed; and she may be struggling with identity issues, financial problems, or lack of support from her partner or other loved ones. And some individuals may simply be prone to depression, no less a medical condition than other diseases, which the stresses of caring for a new baby can exacerbate.

Postpartum depression is generally treated, like other forms of depression, with antidepressants, counseling, or both, as determined through consultation with your doctor. The drug component requires some persistence, as there are a great many medications to choose from and medication choice often must be individualized. Research into how individual genetic makeup affects response to these medications has led to the development of genetic testing which can help minimize the likelihood of side effects by avoiding medications that you may not tolerate well. Once the right drug is determined, relief can be substantial.

It is also very helpful to talk through your concerns with a psychiatrist, psychologist, or other mental-health professional. Through such counseling, you can find better ways to cope with your feelings, solve problems, and set realistic goals. Counseling and antidepressants are often pursued together for their complementary effect.

Self-care in four broad categories can also be helpful. First, it is important at this time to make sound lifestyle choices, such as getting adequate rest, exercising regularly, and eating a healthful diet, though admittedly this can be challenging with a new baby.

Second, set realistic expectations. Don't pressure yourself to do everything; do what you can and leave the rest, asking for help when you need it.

Third, find a reliable sitter so you can regularly make some time for yourself. Get dressed, leave the house, and visit a friend or run an errand. Schedule some time alone with your partner.

Fourth, avoid isolation. Be sure to have "support systems" in place with family, friends, and, possibly, local support groups for new moms or women with postpartum depression.

The other symptoms you report appear unrelated to depression and, at seven months out, unrelated to the childbirth. Nipple pain is common during lactation but at this point it is very unusual. Mastitis, an infection of the breast tissue, comes to mind, but it would be accompanied by fever. The lymph-node soreness you report could itself have an infectious cause; alternatively, what you're thinking is a swollen lymph node may actually be a cyst resulting from enlarged (post-childbirth) breast tissue in the armpit areas. And the pain you attribute to your uterus may be from several possible sources in the abdomen, making it quite difficult to address specifically.

The above symptoms do not appear to be manifestations of a single condition but instead are likely to be a combination of individual issues. They need to be diagnosed, one by one, and treated appropriately. For that to happen, it's essential that you see your doctor.

— Roger W. Harms, M.D., Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn.