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Postpartum Depression
Mood Disorders >> Postpartum Depression

POSTPARTUM DEPRESSION
Weepiness and mood swings are so common in new moms that this emotional rollercoaster has its own name - the baby blues. These feelings are perfectly normal and usually dissipate after a few weeks.

Postpartum depression, on the other hand, is a more serious condition that can interfere with your ability to take care of yourself and your newborn child. But with treatment, the support of your family, and attention to your own needs, you can get back on the road to healthy and happy motherhood. THE BABY BLUES
You’ve just had a baby. You expected to be basking in new mom bliss. You expected to be celebrating the arrival of your little one with your friends and family. But instead of celebrating, you feel like crying. You were prepared for joy and excitement—not exhaustion, anxiety, and weepiness. You may not have been expecting it, but mild depression and mood swings are common in new mothers. In fact, this post-delivery depression is so common that it has its own name: the baby blues. Up to 85% of new mothers experience the baby blues. In addition to moodiness and sadness, the baby blues can include difficulty sleeping, irritability, appetite changes, and concentration problems. Symptoms typically show up within a few days of giving birth and last from several days to a couple of weeks.

The baby blues are considered to be a normal part of new motherhood—probably caused by the hormonal changes that occur following birth. If you have them, there is no cause for undue worry. The baby blues usually don’t last very long and will go away on their own once your hormones level out. Aside from the support of your loved ones and plenty of rest, no treatment is necessary. However, if your symptoms don’t go away within two to three weeks, or they are severe (such as suicidal thoughts or an inability to care for your newborn), you may be suffering from a more serious condition known as postpartum depression.

According to the American College of Obstetricians and Gynecologists, approximately 10% of women who have just given birth experience postpartum depression.

SIGNS AND SYMPTOMS OF POSTPARTUM DEPRESSION
In the beginning, postpartum depression can look like the normal baby blues. In fact, they share many symptoms, including mood swings, crying jags, sadness, insomnia, and irritability. However, in postpartum depression, these symptoms are either longer lasting or more severe. Anxiety is also more prominent in postpartum depression. If you have postpartum depression, you may worry to excess over your baby’s health and well-being. In addition to obsessing over the safety of your newborn, you may be troubled by intrusive thoughts about harming your baby.
Signs and Symptoms of Postpartum Depression
  • Lack of interest in your baby
  • Negative feelings towards your baby
  • Worrying about hurting your baby
  • Lack of concern for yourself
  • Loss of pleasure
  • Lack of energy and motivation
  • Feelings of worthlessness and guilt
  • Changes in appetite or weight
  • Sleeping more or less than usual
  • Recurrent thoughts of death or suicide

Postpartum depression usually sets in soon after childbirth and develops gradually over a period of several months. But postpartum depression can also come on suddenly, and in some women, the first signs don’t appear until months after they’ve given birth. Because of the possibility of delayed onset, if you have a depressive episode within six months of having a baby, postpartum depression should be considered.

POSTPARTUM DEPRESSION CAUSES AND RISK FACTORS
The exact reasons why some new mothers develop postpartum depression and others don’t are unknown. But a number of interrelated causes and risk factors are believed to contribute to the problem.

CAUSES
The rapid hormonal changes that accompany pregnancy and delivery may trigger depression. After childbirth, women experience a big drop in estrogen and progesterone hormone levels. Thyroid levels can also drop, which leads to fatigue and depression. These hormone dips—along with the changes in blood pressure, immune system functioning, and metabolism that new mothers experience—can all play a part in postpartum depression. It has been theorized that women who are more sensitive to these hormone imbalances develop postpartum depression.

Women who have just given birth are also dealing with numerous changes, both physical and emotional. They may still be coping with physical pain from the pregnancy and delivery. They may also have difficulties losing the baby weight, leading to insecurities about their physical and sexual attractiveness. In addition to changes to their body, they are also dealing with lifestyle changes. The lifestyle adjustment can be particularly difficult for first time moms, who must get used to an entirely new identity. The stress of caring for a newborn can also take a toll. New mothers are often sleep deprived. In addition, they may feel overwhelmed and anxious about their ability to properly care for their baby. All of these factors can contribute to and trigger postpartum depression.

RISK FACTORS
Women with a previous history of depression are at an increased risk of experiencing postpartum depression. Your risk is also elevated if you have a history of severe PMS or premenstrual dysphoric disorder, if the pregnancy was unplanned, or if you had postpartum depression following a previous pregnancy. According to the National Institute of Mental Health, women with a prior history of postpartum depression have a 50% chance of recurrence.

Stressful events during pregnancy or birth also increase the odds of developing postpartum depression. Stressful events might include a difficult delivery, prenatal problems, premature birth, or illness during pregnancy. Finally, research has shown that women with marital difficulties or a general lack of social support have a greater chance of developing postpartum depression.

If you’ve recently given birth and have one or more of these risk factors, it is especially important to be on the lookout for any signs or symptoms of postpartum depression.

HOW POSTPARTUM DEPRESSION AFFECTS THE BABY
Postpartum depression can interfere with your ability to function, including your ability to take care of yourself and your child. If you have postpartum depression, it doesn’t mean that you’re a bad mother. However, when you’re consumed with symptoms of depression such as fatigue, irritability, apathy, and tearfulness, it is difficult—if not impossible—to properly look after your newborn’s needs. Your baby will be affected if the depression is left untreated.
The Impact of Postpartum Depression on Children
Behavioral problems Children of depressed mothers are more likely to develop behavioral problems down the line, including sleep problems, temper tantrums, aggression, and hyperactivity.
Delays in cognitive development Development is often delayed in babies and children who have depressed mothers. They may learn to walk and talk later than other children. They may also have many other learning difficulties, including problems with school.
Social problems Children of depressed mothers have difficulty establishing secure relationships. They may find it hard to make friends in school. They may be socially withdrawn, or they may act out in destructive ways.
Emotional problems Studies have shown that children of depressed mothers have lower self-esteem, are more anxious and fearful, are more passive, and are less independent.
Depression The risk of developing major depression early in life is particularly high for the children of mothers with postpartum depression.

If you’re suffering from postpartum depression, there is no reason to feel guilty or ashamed. The symptoms of postpartum depression are outside your control, and they don’t make you a bad person or a bad parent. However, the choice to get treatment is in your control. Considering the impact depression has on both you and your child, it’s important to seek help right away.

POSTPARTUM DEPRESSION AND ATTACHMENT
Research has shown that depressed mothers interact less with their babies. Women with postpartum depression are less likely to breastfeed, play with, and read to their children. They may also be inconsistent in the way they care for their newborns. Depressed mothers can be loving and attentive at times, but at other times they may react negatively or they may not respond at all. This inconsistency disrupts the bonding process between mother and child. This emotional bonding process, known as attachment, is the most important task of infancy. As the Canadian Paediatric Society states, “Attachment helps provide a solid base from which a baby can explore the world. It makes a baby feel safe and secure, and helps them learn to trust other people.”

A secure attachment is formed when the mother responds warmly and consistently to her baby’s physical and emotional needs. When the baby cries, the mother quickly soothes him or her. If the baby laughs or smiles, the mother responds in kind. In essence, the mother and child are in synch. They recognize and respond to each other’s signals. But a depressed mother is less likely to pick up on and respond to her baby’s cues. This sets the stage for an insecure attachment. A child who is insecurely attached is at risk for multiple developmental difficulties and delays, including behavioral, emotional, and social problems.

TREATMENT AND HELP FOR POSTPARTUM DEPRESSION
If you have postpartum depression, you should seek professional treatment. Left untreated, postpartum depression can last for a significant length of time—even up to a year or more. Postpartum depression responds to the same types of treatment as regular depression. Therapy, medication, and support groups can all be helpful.
  • Psychotherapy – Individual therapy or group therapy can be very effective in the treatment of postpartum depression. Psychotherapy is often the treatment of choice because of concerns over taking medication while breastfeeding. Interpersonal therapy (IPT), which focuses on interpersonal relationships and issues, is believed to be particularly effective for postpartum depression.
  • Hormone therapy – Estrogen replacement therapy sometimes helps with postpartum depression. Estrogen is often used in combination with an antidepressant. There are risks that go along with hormone therapy, so be sure to talk to your doctor about what is best—and safest—for you.
  • Marriage counseling – If you are experiencing martial difficulties or are feeling unsupported at home, marriage counseling could be very beneficial.
  • Antidepressants – For severe cases of postpartum depression where the mother is unable to care for herself or her baby, the use of antidepressants should be considered. Antidepressants commonly used for postpartum depression include tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) such as Prozac. Please consult your physician before beginning any medication.
COPING WITH POSTPARTUM DEPRESSION
The best thing you can do if you have postpartum depression is to take care of yourself. Be sure to get enough rest, get out in the sunshine each day, and eat a healthy diet. Set aside quality time for yourself to relax and take a break from your mom duties.

Self-help for postpartum depression
  • Find someone you can talk to about your feelings.
  • Find people who can help you with child care, housework, and errands so you can get some much needed rest.
  • Make time for yourself every day, even if it’s only for 15 minutes. Do something relaxing or that makes you feel good about yourself.
  • Keep a daily diary of your emotions and thoughts. This is a good way to let everything out and to keep track of your progress as you begin to feel better.
  • Give yourself credit for the things you’re able to accomplish, even if you only get one thing done in a day. If you aren’t able to get anything done, don’t be hard on yourself.
  • Give yourself permission to feel overwhelmed.
  • Remember that no one expects you to be supermom.
  • Be honest about how much you can do and ask others for help.
  • Join a support group.
Source: American Academy of Family Physicians

It’s also important to stay connected to family and friends. Don’t keep your feelings to yourself. Share them with your significant other or a close friend. Let your loved ones know what you need and how you’d like to be supported.

Helping a loved one with postpartum depression
If your loved one is experiencing postpartum depression, the best thing you can do is to offer support. Give her a break from her childcare duties, provide a listening ear, and be patient and understanding.

You also need to take care of yourself. Dealing with the needs of a new baby is hard for fathers as well as mothers. And if your significant other is depressed, you are dealing with two major stressors.

POSTPARTUM PSYCHOSIS
Postpartum psychosis is a rare, but extremely serious disorder that can develop after childbirth. It is characterized by loss of contact with reality. Postpartum psychosis should be considered a medical emergency. Because of the high risk for suicide or infanticide, hospitalization is usually required to keep the mother and the baby safe.

Postpartum psychosis develops suddenly, usually within the first two weeks after delivery, and sometimes within 48 hours.
Symptoms include:
  • Hallucinations (seeing things that aren’t real or hearing voices)
  • Delusions (paranoid and irrational beliefs)
  • Extreme agitation and anxiety
  • Confusion and disorientation
  • Rapid mood swings
  • Bizarre behavior
  • Inability or refusal to eat or sleep
  • Suicidal thoughts or actions
  • Thoughts of harming or killing the baby
Early warning signs of postpartum psychosis include an inability to sleep for several nights, agitation, euphoria or irritability, and avoidance of the baby. Women with a history of bipolar disorder are at an increased risk of developing postpartum psychosis. In fact, postpartum psychosis resembles a manic episode. Women who have previously had postpartum psychosis are also highly likely to develop it again if they have another child.

Melinda Smith and Jaelline Jaffe, Ph.D. contributed to this article. Reviewed by Jeanne Segal, Ph.D. Last modified on 11/15/07.

Reprinted with permission from http://www.helpguide.org/. C 2008 Helpguide.org. All rights reserved.

You can find the original article at
http://www.helpguide.org/mental/postpartum_depression.htm

SOURCE: www.helpguide.org

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