Houston Chronicle

June 21, 2001

Postpartum depression's role doubted

Houston Chronicle Medical Writer

Two medical experts warned Wednesday against jumping to the conclusion that postpartum depression played any role in Andrea Yates' alleged killing of her five children.

Saying the case's initial facts more likely suggest an underlying psychological illness, specialists at the University of Texas Medical School at Houston and Baylor College of Medicine said more information is needed before postpartum depression is attributed any role in the deaths.

"Postpartum depression is very common and usually very mild and manageable," said Dr. Edward Yeomans, an OB-GYN and UT-Houston professor of maternal-fetal medicine. "It's extremely rare for it to result in something like this, where the person's history suggests she might have been depressed for other reasons."

Dr. Lauren Marangell, a Baylor professor of psychiatry and behavioral sciences, added that most people suffering from depression don't harm other people. But she said it can happen in severe cases, particularly if the patient has a degree of psychosis.

Yates had suffered from postpartum depression since the birth of their fourth child, 2-year-old Luke, her husband told police. He told officers she was on medication for the condition.

Postpartum depression affects roughly 8 to 15 percent of mothers. Starting about four weeks after birth and lasting for months, it can cause feelings of confusion, panic and hopelessness as well as changes in eating and sleeping patterns. It is usually treated by a class of anti-depressant drugs known as selective serotonin reuptake inhibitors. Prozac is the most commonly prescribed.

Postpartum depression is distinguished from postpartum blues, which usually appear a few days after birth and disappear within a couple of weeks. Marked by anxiety and oversensitivity, it is milder and shorter in duration than postpartum depression.

A third condition is postpartum psychosis, in which the sufferer loses touch with reality. Occurring in 1 to 4 of every 1,000 women who give birth, it can lead to hallucinations and thoughts of violence, particularly suicide. Yeomans said he was skeptical Yates had postpartum psychosis because she called police and her husband after the killings.

"That doesn't sound like the action of a psychotic," Yeomans said.

The cause of postpartum depression is not well understood. Hormonal changes are often cited, but Yeomans and Marangell said that though individual women might be sensitive to progesterone levels dropping soon after childbirth, there is no convincing evidence of hormonal changes a month later, when postpartum depression begins to occur. They added that no treatment involves hormones.

Nevertheless, because of the accepted wisdom that postpartum depression and psychosis involve chemical changes, it is a defense for infanticide in England until the child is 2. No such defense exists in any U.S. states, said J. Ray Hays, a UT-Houston Medical School professor of psychiatry, though attorneys often present such psychiatric evaluations.

Texas had a reputation for lacking leniency for such arguments, but in 1998 a Houston jury found not guilty by reason of insanity a mother who strangled her 4-month-old son with a rosary. Evonne Rodriguez's defense had included three doctors' psychiatric evaluations diagnosing her as psychotic or suffering from depressive disorder, partly brought on by postpartum depression.

Yates attempted suicide and was treated at a Houston-area psychiatric hospital two years ago, a fact that didn't surprise Yeomans or Marangell. They said that people who have bouts of depression often have recurrences and that Yates' depression only strengthens the supposition of a deeper-rooted mental imbalance.

"There's no way you can explain this kind of event from a rational perspective," Hays said. "It's just too bad a woman rational enough to call police and her husband after killing her children couldn't have called someone before who could have stopped her."

Copyright 2001 Houston Chronicle