No one says new mothers have it easy. Nights spent waking up every two hours and days spent trying to figure out just why the baby is crying so much leave about 80 percent of new mothers physically exhausted, emotionally drained and despondent over their seeming inability to do anything well. Call it the baby blues.
Most of these women feel better after two weeks, but 10 percent have a form of clinical depression that can last for many months. Mothers with so-called postpartum depression feel so sad, anxious and helpless that they have trouble taking care of the baby and themselves. In the most severe cases, they are suicidal.
Despite the prevalence of the condition, doctors disagree on the best way to treat it, and there is little research to guide them. But recently British doctors reported rapid improvement in postpartum depression in women who were treated with a skin patch that delivered estrogen into their bloodstreams.
The results of the six-month study, published in the Lancet, a medical journal published in Britain, involved 61 women with severe postpartum depression. Thirty-four of them used an estrogen patch for three months, and 27 used a patch with a dummy medication.
Although all the women improved over time, those receiving estrogen improved faster and to a greater extent than did those in the comparison group, the researchers found. They said that 80 percent of the women in the treatment group were no longer clinically depressed after three months, while most of those in the comparison group remained depressed for at least four months.
"This is a very important development and very logical treatment," said Dr. John W. W. Studd, an obstetrician and gynecologist at Chelsea and Westminster Hospital in London, who was one of the researchers.
His enthusiasm was shared by some experts on postpartum depression in this country. "This looks very hopeful," said Dr. Joan R. Youchah, an obstetrician and gynecologist and a psychiatrist at Albert Einstein Medical College in New York City. "This is a method of treatment that people have thought about but not studied. It's a good new direction to look in."
Dr. Michael W. O'Hara, chairman of psychology at the University of Iowa in Iowa City and a leading authority on postpartum depression, said, "This may be an alternative for women who don't respond to anti-depressants."
Doctors have long thought that postpartum depression is related at least in part to the sharp decline in estrogen that occurs immediately after childbirth. Estrogen levels normally fluctuate from 80 to 200 picograms per liter of blood in women of reproductive age who are not pregnant, Studd said.
During pregnancy, the levels shoot up to 5,000 picograms and immediately after childbirth they plummet to the range of 80 to 100 picograms, he said. The amount of estrogen used in the study elevated the women's estrogen to a normal prepregnancy level, he said.
Precisely how a drop in estrogen might set off depression is unknown, but studies show a relationship between the hormone and several neurotransmitters that influence mood, including serotonin.
Studd believes it is no coincidence that many women become depressed during the various times when their estrogen levels ebb. "Depression is twice as common in women as men and it tends to occur at times of hormonal change -- premenstrual, postnatal and menopausal," he said.
But he said it is too early to recommend estrogen as a treatment for postpartum depression until more studies are done. Perhaps the biggest unanswered question is whether estrogen is more effective than the standard treatments for postpartum depression, namely anti-depressants and psychotherapy. Despite their widespread use, even those treatments have not been well studied against postpartum depression.
A small study conducted by O'Hara found that two-thirds of women with mild to moderate postpartum depression were cured after three months of interpersonal psychotherapy, which focuses on people's relationships. But many women with severe postpartum depression need anti-depressants in addition to psychotherapy, he said. Doctors estimate that this combination helps about 90 percent of women with the problem.
But there are drawbacks to those treatments. "Psychotherapy is a lot more work than taking a drug," O'Hara said. "Many women find it easier to take a pill."
On the other hand, doctors say, many women must try several anti-depressants before they find one that works for them. Another disadvantage of anti-depressants is that they pass into breast milk, and their effect on infants is unknown. "As a result, we advise women to stop breast-feeding when they take anti-depressants," Youchah said.
The estrogen patch may also prove to be a problem for nursing mothers, since estrogen can interfere with milk production, said Dr. Joseph F. Mortola, an associate professor of obstetrics and gynecology and of psychiatry at Harvard Medical School.
But Studd, who has used the estrogen patch in his clinical practice for 10 years, said the patch did not suppress milk production once breast-feeding was established.
While it appears that estrogen comes closer than anti-depressants to treating the underlying cause of postpartum depression, experts say it is too early to call it the magic bullet.
Pub Date: 6/04/96