Postpartum depression: can exercise help?

by Karen Nordahl, MD

As printed in the Winter 2005-06 issue of Urbanbaby & Toddler magazine

You may have noticed that the subject of postpartum depression has made its way into the mainstream media.

Brooke Shields has written a book (which brought several of my own patients into the office), Oprah has discussed the issue, and although I do not agree with his comments, Tom Cruise did help publicize the condition.

But what does this all mean? How can you tell if you are depressed when you have little time for anything except for the care of your baby? You are not sleeping as well, not eating properly and at times overwhelmed by the new arrival. When does it get serious?

The 'baby blues' usually occur about the third day after delivery, and can last until the 10th day. The condition is characterized by tearfulness, anxiety, irritability, mood lability, increased sensitivity and fatigue. For most women the blues are short-lived, and usually resolve.

Some of the blues can be attributed to the isolation women experience during the early newborn period. It is important to ask for help when you need it, and do not try to be Supermom, at least not right away!

A group exercise program where you can be with other moms has been found to be effective in reducing some of the symptoms of the baby blues. If there are no group classes in your area, you can try to create one with family, friends or prenatal class participants who may be interested.

Postpartum depression is a different matter entirely. Part of the difficulty in making the diagnosis is that so many of the symptoms of postpartum depression can be confused with the normal emotions surrounding birth. The symptoms of fatigue, difficulty concentrating, sleep disturbance, and depressed mood often accompany the birth of a newborn. It is important as physicians to determine what is normal and what is not in the postpartum period. For example, a woman who worries excessively about her infant's weight gain two weeks after birth is normal. Worrying excessively about the same when your child is four months old and thriving is not.

If a diagnosis of postpartum depression has been confirmed, the standard treatment consists of medication and psychotherapy. Some early results from a study in Australia have suggested that a stroller walking program has helped alleviate the symptoms of postpartum depression when combined with medical and psychotherapy.

So what does this all mean? If you are feeling sad and depressed for a prolonged period after birth (after the first two weeks) talk to your doctor or midwife. You may not have postpartum depression at this stage, but you may be at risk for the condition. Your doctor will likely advise you to increase your support network (if possible), start some type of exercise program (this can be a simple walk outside with the stroller for ten minutes per day) and recheck with her in a few weeks.

If you or your family members are concerned about the possibility of postpartum depression, check with your doctor. Remember, is it sometimes very hard to sort out what is normal and what is not, so do not be afraid to task for help. Medication and/or psychotherapy are the mainstays of treatment, but an exercise program may help reduce the duration of your symptoms.

The workout below gives you an example of what may help.

Walking Program

Start walking 10 minutes per day with your baby in a stroller, watch your posture, and remember to do your Kegel and core exercises.

Increase by one minute per day until you reach 40 to 60 minutes.
Take one day off per week, and add some variety by pool walking or using a treadmill or exercise bike.
Dress yourself (and your baby) warmly for the elements.
Vary your walking route to avoid boredom, choose smooth, well-lit, open areas.
Wear comfortable walking shoes or running shoes with good shock absorption.

Web resource: www.wellmother.com: An excellent website developed by Vancouver's own postpartum depression expert, Dr. Shaila Misri.