Depression in New Mothers: Causes, Consequences, and Treatment Alternatives

An update of Dr. Kendall-Tackett's first book, Postpartum Depression (1993), Depression in New Mothers addresses recent advances in the understanding of postpartum depression and its treatment. In the foreword, Jane Honikman states that "denial and ignorance are two of the barriers in recognizing and treating women suffering from perinatal mood disorders." Thus the purpose of the book, as articulated by Kendall-Tackett is, "You have before you an opportunity to make a real difference in the lives of mothers and babies. My goal is to equip you to do just that."

Kendall-Tackett, a psychologist and a lactation consultant, divides this new book into several sections, each addressing myths surrounding postpartum depression: a review of the harmful effects of maternal depression, a discussion of causes and risks for development of postpartum depression, and assessment and treatment of the syndrome. The book seems directed toward nonphysician practitioners—such as nurses, social workers, midwives, and lactation consultants—who interact with perinatal women. The information about diagnosis of depression and somatic treatments, including medications, is fairly rudimentary and seems most useful in helping to determine when to refer a woman for more extensive mental health assessment and treatment. Bipolar disorder, psychosis, mood stabilizers or antipsychotics, and genetics are barely discussed, and electroconvulsive therapy is not mentioned at all. Given the severity of these syndromes, especially postpartum psychosis, it would seem prudent to give them more attention. However, two valuable lists address the assessment of suicide risk and the need for hospitalization.

Depression in New Mothers focuses throughout on issues of breast feeding and also on trauma and PTSD, sometimes in ways not directly associated with postpartum depression. These two areas are clearly of special interest to the author, and the emphasis causes the book to seem unbalanced. In a similar regard, there seemed to be a bias toward herbal remedies, "alternative" therapies, diet, and supplements in excess of the evidence supporting their efficacy in postpartum depression.

An especially interesting topic covered in the book, which may be often overlooked, is the psychological impact of "negative birth experiences." Factors such as losing a sense of control over the labor and delivery process, being traumatized physically by invasive procedures, feeling unsupported, and feeling like a failure can all lead to depression and may even lead to PTSD. All of these, obviously, can then impact parenting.

Overall, I found the book to be disorganized to read, sometimes jumping around to different topics, going off on tangents, describing studies in a confusing manner, and listing studies that do not directly apply to the topic at hand. Some of the interventions, such as "community-based care" and "preventive intervention," are not well described, but the book does a good job of describing cognitive-behavioral therapy and interpersonal psychotherapy.

Depression in New Mothers meets its goal of raising awareness of perinatal depressive syndromes and discusses relevant social factors, but, from my perspective, the book does not comprehensively cover assessment and treatment strategies.