Postpartum depression: When moms feel out of control
By Elizabeth Landau, CNN
May 14, 2010 -- Updated 1443 GMT (2243 HKT)
This story started on CNN iReport
(CNN) -- Nine years ago, Chris Loo thought about putting her newborn daughter, Becky, in a basket on the steps of a church down the street from her home, and leaving her there.
"I don't think I really wanted to get rid of her, I just think I wasn't thinking at all," said Loo, 43, a social worker in Flushing, New York. "I started to really feel suicidal, like I just couldn't go on anymore." Watch her iReport
Becky, Loo's third child, is rarely ever in a bad mood, and people will ask Loo if they can spend time with her daughter when they're feeling down. But when the girl was born, Loo couldn't get up in the morning. She felt like she couldn't do anything.
About 10 percent of mothers, such as Loo, experience postpartum depression, severe emotional difficulties following the birth of a child, according to the Mayo Clinic.
Doctors do not know why some women have deep sadness and anxiety in the weeks or months following birth and others do not. They suspect a combination of environmental, genetic and biological factors contribute, but every woman is at risk, said Karen Kleiman, founder and director of the Postpartum Stress Center in Rosemont, Pennsylvania.
A recent study in the Archives of General Psychiatry suggests that postpartum depression is associated with higher levels of a brain protein called monoamine oxidase A (MAO-A), which removes chemicals that help stabilize mood. Researchers found that levels of this protein were greater in women four to six days after giving birth than in women who had not been recently pregnant.
The study, while small, provides a look at how postpartum depression may operate in the brain, and points to a possible remedy. Dietary supplements could be created to replace the nutrients removed by MAO-A which may lower the risk of postpartum depression, the authors said.
It's normal for new mothers to feel overwhelmed and tired, but sometimes those feelings can develop into something more serious. "Baby blues," which do not require medical attention, can include mood swings, sleep problems, irritability, crying, anxiety and sadness in the first couple of weeks after birth. Postpartum depression is more intense and intrusive: Women may lose interest in life, withdraw from family and friends, or think about harming themselves or their children.
Intensity and duration of these feelings distinguish a normal level of stress from a psychological condition, Kleiman said. After two to three weeks, clinicians usually consider the mother's experience as postpartum depression.
Lori Hansen, 43, of Garner, Iowa, suspected early on that her anxiety and insomnia may have been part of postpartum depression, and went to see her obstetrician-gynecologist four weeks after giving birth to her first son, Kyle.
"I was not in control of my emotions," she said. "I had no idea why I was crying."
Her OB-GYN prescribed an antidepressant, and wasn't helpful in answering Hansen's questions about the dosage, she said. Finally, she went to a psychiatrist at the University of Iowa, who helped her more with the treatment.
"Seek help early, and if you're not feeling better, continue to press the people who are treating you to seek ways to improve your treatment plan," she said.
Therapy and the support of friends and family helped Loo get through her depression. Two women from her church came to help when her husband couldn't be home, and an online support group also gave her comfort.
Cognitive behavioral therapy -- which focuses on changing thought patterns -- and antidepressant or anti-anxiety medications are all treatment options for women with postpartum depression, Kleiman said.
Having depression once puts mothers at risk for recurrence, Kleiman said. The upside is that they will be able to recognize it the second time, and perhaps already have a plan in place to treat it.
In retrospect, Loo believes she experienced postpartum depression with each of her three children, but the most intense feelings of losing control came with her youngest.
Hansen feared going through another round of depression, but still went on to have two more children. She had depression during pregnancy with both of them, but it went away quickly, and after their births she was fine.
But Kelly Bauer and her husband decided against having another child. She and her husband both had emotional difficulties after their daughter Wren was born nearly two years ago, with the mother crying all the time and thinking that having her daughter may have been a mistake. It's not depression that's keeping her from having more kids -- just that she thinks additional children would be a handful, she said.
"We know how we did with one, and it wasn't a smooth transition," said Bauer, 28, a glass artist in Troy, Ohio. "We're terrified to see what would happen with two."
Bauer, like Hansen, did find relief for her symptoms in antidepressant medication, but also credits her recovery to spending more time with her daughter and getting used to being a mother. She did not seek counseling, partly because she was afraid that if she told anyone what she was really thinking, her baby would be taken away.
"I talked to some of the other girls I knew who had had babies recently; everybody was like, 'Oh, I felt fine!' " she said. "After that, I didn't want to talk about it anymore, because I felt like a weirdo."
Bauer and Loo both had scary thoughts about not wanting their babies anymore. Unwanted thoughts are common. One 2006 study found that 91 percent of new mothers report having disturbing or intrusive thoughts.
Talking about these thoughts, such as throwing a baby out the window or burying her, can be an incredible intervention, Kleiman said. From the therapist's point of view, these thoughts do not mean that the child is in danger, as long as the mother expresses distress about them. Women who recall their scary thoughts without being upset about them may have psychosis, Kleiman said.
Loo has little memory of the first four months of Becky's life. When she began to recover, she wondered how her absence from her daughter's early months would affect her. But today, "Becky is the most joyous child I've ever known," she said.
Loo and Hansen both feel that they have become stronger people because they went through postpartum depression. For Loo, who has not had any depressive episodes since Becky was a newborn, the hard lesson was that it's OK to not be in control all the time.
"I used to get really stressed out when I couldn't succeed, and now I'm just like: I do my best," she said. "If it doesn't work the way it should work, try to work with it in a different way. I'm much more comfortable with failure than I've ever been."
Link http://edition.cnn.com/2010/HEALTH/05/14/postpartum.depression/index.html
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Postnatal Depression: More Common Than You Know
Postpartum Depression: More Common Than You Know
This article was found on this website http://www.webmd.com/depression/features/postpartum-depression-more-common-than-you-know
New mothers with postpartum depression can feel very alone. But at least 20% of new mothers experience it. Here's how to cope.
By Gina Shaw
WebMD the Magazine - Feature Reviewed by Brunilda Nazario, MD
Tina Merritt, now 39, of Virginia Beach, Va., had heard of postpartum depression when she was pregnant seven years ago. But when she gave birth to her son, Graham, she expected nothing but joy as she and her husband welcomed the baby boy who would be the first grandchild on both sides of their families."It took me a while to get pregnant, and it was a huge deal for everyone," Merritt says."I worked right up to the end of my pregnancy and felt great. I'd planned so long for this baby, I really thought everything would be wonderful."
Of course she did, says Michael Silverman, PhD, assistant professor of psychiatry at the Mount Sinai School of Medicine in New York City. "Most women have bought into the belief that when you give birth to a child, you immediately feel love like you've never experienced. [But] for many women, that's not reality. They feel that they're defective, that something's wrong, and they can't talk to anyone about it."
Instead of the picture-perfect motherhood she imagined, Merritt found herself terrified of taking care of her new son, worrying she would make a mistake. She describes the first year or more of his life as a big fog. "I don't remember much at all. I don't remember how old my son was when he crawled, don't remember him taking his first steps or eating solids for the first time."
It wasn't that she didn't want to care for her son, Merritt says -- she just didn't feel that she could. "I thought my husband or my mother-in-law could do it better, that I was supposed to be this perfect mother but I couldn't be," she recalls. Merritt's husband took on most of the child care, and she returned to work when Graham was 6 weeks old. "That was the one thing I could do right. I could work. Before that, my husband would come home from the office, and I'd be in the chair in my pajamas holding the baby -- exactly where I'd been when he left. I was so afraid to be alone with my son. He was 2 before I even took him to the grocery store by myself."
Perinatal Mood Disorders
To the 800,000 women who develop one of several types of perinatal mood disorders each year (that's about 20% of new mothers), Merritt's story is painfully familiar. Postpartum depression is often used as a catch-all description, but in fact, perinatal mood and anxiety disorders include a lot more than just classic depression -- and they can start before or well after delivery. New moms can develop:
Depression: This can include the typical signs, such as sadness and crying, as well as anger and irritability.
Anxiety and panic disorder: Like Merritt, mothers might feel anxious and fearful about their ability to take care of their baby and worry they will do something wrong. Some suffer debilitating panic attacks and feel unable to go out in public.
Obsessive-compulsive disorder: Women with postpartum depression can be plagued by constant worries about germs or intrusive thoughts about harming their baby. Others are obsessed with doing everything "perfectly."
Posttraumatic stress: If something went wrong during birth -- a medical complication or an emergency cesarean -- a mother might have anxiety attacks with flashbacks.
Postpartum Depression: a Hidden Epidemic
Although perinatal mood disorders are common, more than half of all cases are unrecognized and untreated. Some doctors attribute them to the "baby blues," a short-lived state of intense emotion that comes on and disappears quickly. In some cases, women don't confess their symptoms for fear of judgment or stigma. That's particularly tragic, experts say, because perinatal mood disorders -- such as postpartum depression -- respond well to counseling, medication, and other treatment.
"Even highly intelligent women don't recognize what they have, and when they do try to reach out, people just say, 'Yeah, that's motherhood. It's tough,'" says Birdie Gunyon Meyer, RN, MA, CLC, coordinator of the Perinatal Mood Disorders Program at Clarian Health in Indianapolis and president of Postpartum Support International. "Between 1% and 3% of women get gestational diabetes, and we check all women for it. About 20% of women get perinatal mood disorders, and we still don't routinely screen for that," she says. (That could change soon; see "The MOTHERS Act" below.)
Causes of perinatal mood disorders are still poorly understood, but researchers speculate that shifting chemicals in the brain during and after pregnancy -- such as oxytocin, a hormone related to mood -- play a role. It's more complicated than that, though, because new adoptive parents and fathers -- who are never pregnant -- can also develop depression and mood disorders.
Baby Blues vs. Postpartum Depression
When Merritt talked to her doctor at her six-week follow-up visit, she told him that she was crying a lot and that things didn't feel right. "He said 'Oh, that's just the baby blues. It's your hormones; it'll go away.'"
Her doctor was wrong. The baby blues and perinatal mood disorders are two very different things. Some 80% of women do have the baby blues after delivery, and it's true some symptoms are the same as for postpartum depression, such as mood swings, sleep disturbances, and loss of appetite. Sometimes the baby blues just involve an excess of emotion -- crying often, for no reason.
Baby Blues vs. Postpartum Depression continued...
But the baby blues come and go quickly. "Generally, these symptoms start within several days of delivery and usually go away within a couple of weeks," says Silverman. At six weeks after delivery, Merritt was well past the baby blues stage.
True postpartum depression, on the other hand, can begin any time in the first year after a baby is born. "The diagnostic criteria for postpartum depression say it's a depression that starts within the first four weeks after delivery, but it can start later than that -- or even before delivery," says Shoshana Bennett, PhD, a former president of Postpartum Support International and author of Postpartum Depression for Dummies and Pregnant on Prozac: The Essential Guide to Making the Best Decision for You and Your Baby.
That's why it's so important during the first few months to pay attention to any sense that things just aren't right. If you've had a psychiatric disorder in the past or a perinatal mood disorder with a previous child, keep an eye out for symptoms."Trust your instincts," says Karen Kleiman, MSW, LSW, executive director of the Postpartum Stress Center and author of several books on the disorder. "If you think something isn't right, it probably isn't. That doesn't mean something terrible is going on, but you should get help."
Start by calling your obstetrician -- more doctors are aware of postpartum depression issues now and can refer you for treatment. But if your doctor dismisses your concerns, as Merritt's did, contact a local or national support group.
Postpartum Depression vs. Postpartum Psychosis
What if you think you're going to hurt your baby? Christina Garman, 33, of Euclid, Ohio, says she still can't shake a memory from when her daughter Molly was a baby. She was sitting on her bed breastfeeding, but even as she nursed, Molly was still crying. A frustrated, exhausted Garman, who had struggled with post-delivery abdominal pain and difficulty nursing, had reached her limit.
"All I could see myself doing was throwing her across the room," she recalls, the horror of the moment still in her voice. "Or shake her. I would never do that, but for some reason those thoughts kept coming into my head. I thought, 'Who are you, and what have you done with your brain?'"
Garman's story might remind you of Andrea Yates, the Texas mother who drowned her five children in the bathtub. But Yates had postpartum psychosis, a very different and more rare condition that should not be confused with postpartum depression. It is not an extreme form of postpartum depression but a separate condition in which a new mother has a genuine psychotic breakdown and could harm her children. Garman was eventually diagnosed with postpartum depression obsessive-compulsive disorder.
Postpartum Depression vs. Postpartum Psychosis continued...
About one in every 1,000 new mothers develops postpartum psychosis, compared to the one in five who goes through other perinatal mood disorders. It comes on "very shortly after delivery, within the first 72 hours to the first couple of weeks," says Gunyon Meyer. "Often the first sign is that the mother is speeded up, not sleeping, and yet she feels great. Then she'll be having these unusual thoughts about harming the baby or 'protecting' the baby from evil by harming him or her. Sometimes these thoughts will wax and wane a little, so she thinks it's going away and doesn't tell anyone until she has a true psychotic break."
Both women with postpartum depression and women with postpartum psychosis have thoughts about hurting the baby, but the difference is that women with postpartum depression, like Garman, are horrified by these thoughts, while women with postpartum psychosis think they're normal. With postpartum depression, "acute depression and anxiety develop in ways that make women feel as if they're going mad," Kleiman says. "They don't realize that having these thoughts doesn't mean they're going to act on them. The thoughts are horrible and scary, but the good news is that they do scare you. Women with postpartum depression don't hurt their children. In fact, they'll go to extreme lengths to protect their children, even hurting themselves to avoid harming their child."
Treating Postpartum Depression
True postpartum psychosis requires intensive treatment and often hospitalization. But most women with postpartum depression and other perinatal mood disorders can find relief relatively quickly with treatments that usually include some combination of medication and counseling. In therapy, women learn specific techniques to quell persistent anxiety and rid themselves of intrusive thoughts about harm coming to their baby.
Women are also encouraged to find a way to take care of themselves, not just the baby. "You're a pitcher of water, and if you're always giving, you're going to be empty. How do you fill back up?" Gunyon Meyer asks. "Make sure you'll have time to go to the gym or even just the grocery store alone."
Antidepressants are another element of treatment for some women. Many worry about taking antidepressants, especially if they are nursing, because medication does get into breast milk. But most experts say those fears are generally exaggerated. "Though nothing is ever 100% risk-free, we do have studies that show no long-term adverse effects from taking antidepressants while breastfeeding," Gunyon Meyer says. On the other hand, she points out, numerous studies show how being severely depressed or anxious while pregnant or breastfeeding can have a negative effect on the baby.
Garman and Merritt, much like most of the women who come to the support group Gunyon Meyer runs, took medication in addition to counseling. Garman benefited from a program developed by her health insurance company, Medical Mutual. When a routine follow-up call the company makes to check on moms revealed signs of postpartum depression, the insurer alerted Garman's doctor, who called to intervene. She spent three months on a low dose of an antidepressant and had weekly calls with a social worker provided by her insurance company.
Healing From Postpartum Depression
It took Merritt much longer to find help. It was only after Graham, then 2½, broke his leg falling out of his crib that both Merritt and her husband felt so guilty they pursued counseling. That's where they learned that Merritt's strange detachment from Graham was due to postpartum depression and anxiety. She started taking antidepressants and continued with counseling, and within several months her anxiety began to wane. "They'd give me goals: 'You're going to go do this with your son by yourself this week,'" she recalls.
For Garman, in retrospect, there were warning signs that she might be at higher risk for postpartum depression. "I had dealt with anxiety on and off when I was younger, and took medication for it," she says. "I'd even seen one of my close friends go through postpartum depression. But in myself, I just couldn't see it." Even during treatment, Garman struggled with feelings of guilt. "I kept asking my social worker, 'Why do I feel like this?' And she'd say, 'Christina, it's not you.' I really had to learn to forgive myself for feeling that way."
Merritt says her son was about 3 before she really felt confident caring for him. She says the transition to parenthood is so rough that almost every new mom could benefit from therapy. "Becoming a parent is a life-changing experience," she says. "It changes your marriage, your career, everything. People don't get it. Even though I was fortunate and had a lot of people helping me, no one really understood what was going on."
"There's nothing that's not stressful about bringing a new baby into your home," Silverman says. "For many women, it helps just to know they're not alone. Remember those pictures of Brooke Shields when her first daughter was born? She looked like the glowing mother, but now we know, because she shared her story, that she was miserable. So if you're miserable, too, it doesn't mean you're defective. You're not crazy. It's OK that you feel crappy, and it's OK that you don't feel this instant bond. But it can get better, and it will -- if you get help."
Creating a Postpartum Wellness Plan
Even if you're not at risk for postpartum depression, it's a good idea to create -- in advance -- a comprehensive wellness plan to follow after the baby is born. "This can actually help prevent postpartum depression," says expert Shoshana Bennett, PhD. Key elements of the plan include:
Sleep: Sleep deprivation can induce or worsen postpartum depression. Even if you'll be breastfeeding, designate someone else to share nighttime duties. Consider pumping so that someone else can feed the baby on occasion, and you can get a few full sleep cycles.
Support: Who's going to help out? How will you take a break? When will you get out of the house? Line up friends and family or consider hiring a doula, a professional who helps guide women through delivery and bringing baby home. Research shows that women who have labor and postpartum doulas reduce their risk of developing postpartum depression. But be sure that people who sign up to help know what you need. "Some people who think they are 'helping' aren't," Bennett says. If your mother's idea of helping is holding the baby while you make lunch -- and that's not the kind of help you need -- be prepared to explain what you really want. "Don't worry too much about hurting people's feelings. It's more important to take care of yourself and your baby."
Creating a Postpartum Wellness Plan continued...
Exercise: What you can do physically might depend on your recovery after giving birth. Even a walk around the block with baby in a stroller or sling gets you moving in the fresh air. It might not seem like a workout, but it's a start. Hit the mall for a stroll if weather doesn't cooperate.
Food and water: A plan for nutrition and hydration might sound obvious, but many new moms are so busy caring for the baby that they don't eat right. Not getting enough water and protein, especially if you're breastfeeding, can leave you depleted and vulnerable. Drink at least half your body weight in ounces of water per day (if you weigh 150 pounds, that's about nine 8-ounce glasses), and nibble on high-protein snacks such as nuts, hard-boiled eggs, and yogurt throughout the day.
Realistic expectations: Make a list of motherhood myths you won't buy into, such as "I'm not a good mom if I can't breastfeed," "I should be madly in love with my baby from the second I see him," and "I should lose all the pregnancy weight and look like Heidi Klum before my baby is six months old."
This article was found on this website http://www.webmd.com/depression/features/postpartum-depression-more-common-than-you-know
New mothers with postpartum depression can feel very alone. But at least 20% of new mothers experience it. Here's how to cope.
By Gina Shaw
WebMD the Magazine - Feature Reviewed by Brunilda Nazario, MD
Tina Merritt, now 39, of Virginia Beach, Va., had heard of postpartum depression when she was pregnant seven years ago. But when she gave birth to her son, Graham, she expected nothing but joy as she and her husband welcomed the baby boy who would be the first grandchild on both sides of their families."It took me a while to get pregnant, and it was a huge deal for everyone," Merritt says."I worked right up to the end of my pregnancy and felt great. I'd planned so long for this baby, I really thought everything would be wonderful."
Of course she did, says Michael Silverman, PhD, assistant professor of psychiatry at the Mount Sinai School of Medicine in New York City. "Most women have bought into the belief that when you give birth to a child, you immediately feel love like you've never experienced. [But] for many women, that's not reality. They feel that they're defective, that something's wrong, and they can't talk to anyone about it."
Instead of the picture-perfect motherhood she imagined, Merritt found herself terrified of taking care of her new son, worrying she would make a mistake. She describes the first year or more of his life as a big fog. "I don't remember much at all. I don't remember how old my son was when he crawled, don't remember him taking his first steps or eating solids for the first time."
It wasn't that she didn't want to care for her son, Merritt says -- she just didn't feel that she could. "I thought my husband or my mother-in-law could do it better, that I was supposed to be this perfect mother but I couldn't be," she recalls. Merritt's husband took on most of the child care, and she returned to work when Graham was 6 weeks old. "That was the one thing I could do right. I could work. Before that, my husband would come home from the office, and I'd be in the chair in my pajamas holding the baby -- exactly where I'd been when he left. I was so afraid to be alone with my son. He was 2 before I even took him to the grocery store by myself."
Perinatal Mood Disorders
To the 800,000 women who develop one of several types of perinatal mood disorders each year (that's about 20% of new mothers), Merritt's story is painfully familiar. Postpartum depression is often used as a catch-all description, but in fact, perinatal mood and anxiety disorders include a lot more than just classic depression -- and they can start before or well after delivery. New moms can develop:
Depression: This can include the typical signs, such as sadness and crying, as well as anger and irritability.
Anxiety and panic disorder: Like Merritt, mothers might feel anxious and fearful about their ability to take care of their baby and worry they will do something wrong. Some suffer debilitating panic attacks and feel unable to go out in public.
Obsessive-compulsive disorder: Women with postpartum depression can be plagued by constant worries about germs or intrusive thoughts about harming their baby. Others are obsessed with doing everything "perfectly."
Posttraumatic stress: If something went wrong during birth -- a medical complication or an emergency cesarean -- a mother might have anxiety attacks with flashbacks.
Postpartum Depression: a Hidden Epidemic
Although perinatal mood disorders are common, more than half of all cases are unrecognized and untreated. Some doctors attribute them to the "baby blues," a short-lived state of intense emotion that comes on and disappears quickly. In some cases, women don't confess their symptoms for fear of judgment or stigma. That's particularly tragic, experts say, because perinatal mood disorders -- such as postpartum depression -- respond well to counseling, medication, and other treatment.
"Even highly intelligent women don't recognize what they have, and when they do try to reach out, people just say, 'Yeah, that's motherhood. It's tough,'" says Birdie Gunyon Meyer, RN, MA, CLC, coordinator of the Perinatal Mood Disorders Program at Clarian Health in Indianapolis and president of Postpartum Support International. "Between 1% and 3% of women get gestational diabetes, and we check all women for it. About 20% of women get perinatal mood disorders, and we still don't routinely screen for that," she says. (That could change soon; see "The MOTHERS Act" below.)
Causes of perinatal mood disorders are still poorly understood, but researchers speculate that shifting chemicals in the brain during and after pregnancy -- such as oxytocin, a hormone related to mood -- play a role. It's more complicated than that, though, because new adoptive parents and fathers -- who are never pregnant -- can also develop depression and mood disorders.
Baby Blues vs. Postpartum Depression
When Merritt talked to her doctor at her six-week follow-up visit, she told him that she was crying a lot and that things didn't feel right. "He said 'Oh, that's just the baby blues. It's your hormones; it'll go away.'"
Her doctor was wrong. The baby blues and perinatal mood disorders are two very different things. Some 80% of women do have the baby blues after delivery, and it's true some symptoms are the same as for postpartum depression, such as mood swings, sleep disturbances, and loss of appetite. Sometimes the baby blues just involve an excess of emotion -- crying often, for no reason.
Baby Blues vs. Postpartum Depression continued...
But the baby blues come and go quickly. "Generally, these symptoms start within several days of delivery and usually go away within a couple of weeks," says Silverman. At six weeks after delivery, Merritt was well past the baby blues stage.
True postpartum depression, on the other hand, can begin any time in the first year after a baby is born. "The diagnostic criteria for postpartum depression say it's a depression that starts within the first four weeks after delivery, but it can start later than that -- or even before delivery," says Shoshana Bennett, PhD, a former president of Postpartum Support International and author of Postpartum Depression for Dummies and Pregnant on Prozac: The Essential Guide to Making the Best Decision for You and Your Baby.
That's why it's so important during the first few months to pay attention to any sense that things just aren't right. If you've had a psychiatric disorder in the past or a perinatal mood disorder with a previous child, keep an eye out for symptoms."Trust your instincts," says Karen Kleiman, MSW, LSW, executive director of the Postpartum Stress Center and author of several books on the disorder. "If you think something isn't right, it probably isn't. That doesn't mean something terrible is going on, but you should get help."
Start by calling your obstetrician -- more doctors are aware of postpartum depression issues now and can refer you for treatment. But if your doctor dismisses your concerns, as Merritt's did, contact a local or national support group.
Postpartum Depression vs. Postpartum Psychosis
What if you think you're going to hurt your baby? Christina Garman, 33, of Euclid, Ohio, says she still can't shake a memory from when her daughter Molly was a baby. She was sitting on her bed breastfeeding, but even as she nursed, Molly was still crying. A frustrated, exhausted Garman, who had struggled with post-delivery abdominal pain and difficulty nursing, had reached her limit.
"All I could see myself doing was throwing her across the room," she recalls, the horror of the moment still in her voice. "Or shake her. I would never do that, but for some reason those thoughts kept coming into my head. I thought, 'Who are you, and what have you done with your brain?'"
Garman's story might remind you of Andrea Yates, the Texas mother who drowned her five children in the bathtub. But Yates had postpartum psychosis, a very different and more rare condition that should not be confused with postpartum depression. It is not an extreme form of postpartum depression but a separate condition in which a new mother has a genuine psychotic breakdown and could harm her children. Garman was eventually diagnosed with postpartum depression obsessive-compulsive disorder.
Postpartum Depression vs. Postpartum Psychosis continued...
About one in every 1,000 new mothers develops postpartum psychosis, compared to the one in five who goes through other perinatal mood disorders. It comes on "very shortly after delivery, within the first 72 hours to the first couple of weeks," says Gunyon Meyer. "Often the first sign is that the mother is speeded up, not sleeping, and yet she feels great. Then she'll be having these unusual thoughts about harming the baby or 'protecting' the baby from evil by harming him or her. Sometimes these thoughts will wax and wane a little, so she thinks it's going away and doesn't tell anyone until she has a true psychotic break."
Both women with postpartum depression and women with postpartum psychosis have thoughts about hurting the baby, but the difference is that women with postpartum depression, like Garman, are horrified by these thoughts, while women with postpartum psychosis think they're normal. With postpartum depression, "acute depression and anxiety develop in ways that make women feel as if they're going mad," Kleiman says. "They don't realize that having these thoughts doesn't mean they're going to act on them. The thoughts are horrible and scary, but the good news is that they do scare you. Women with postpartum depression don't hurt their children. In fact, they'll go to extreme lengths to protect their children, even hurting themselves to avoid harming their child."
Treating Postpartum Depression
True postpartum psychosis requires intensive treatment and often hospitalization. But most women with postpartum depression and other perinatal mood disorders can find relief relatively quickly with treatments that usually include some combination of medication and counseling. In therapy, women learn specific techniques to quell persistent anxiety and rid themselves of intrusive thoughts about harm coming to their baby.
Women are also encouraged to find a way to take care of themselves, not just the baby. "You're a pitcher of water, and if you're always giving, you're going to be empty. How do you fill back up?" Gunyon Meyer asks. "Make sure you'll have time to go to the gym or even just the grocery store alone."
Antidepressants are another element of treatment for some women. Many worry about taking antidepressants, especially if they are nursing, because medication does get into breast milk. But most experts say those fears are generally exaggerated. "Though nothing is ever 100% risk-free, we do have studies that show no long-term adverse effects from taking antidepressants while breastfeeding," Gunyon Meyer says. On the other hand, she points out, numerous studies show how being severely depressed or anxious while pregnant or breastfeeding can have a negative effect on the baby.
Garman and Merritt, much like most of the women who come to the support group Gunyon Meyer runs, took medication in addition to counseling. Garman benefited from a program developed by her health insurance company, Medical Mutual. When a routine follow-up call the company makes to check on moms revealed signs of postpartum depression, the insurer alerted Garman's doctor, who called to intervene. She spent three months on a low dose of an antidepressant and had weekly calls with a social worker provided by her insurance company.
Healing From Postpartum Depression
It took Merritt much longer to find help. It was only after Graham, then 2½, broke his leg falling out of his crib that both Merritt and her husband felt so guilty they pursued counseling. That's where they learned that Merritt's strange detachment from Graham was due to postpartum depression and anxiety. She started taking antidepressants and continued with counseling, and within several months her anxiety began to wane. "They'd give me goals: 'You're going to go do this with your son by yourself this week,'" she recalls.
For Garman, in retrospect, there were warning signs that she might be at higher risk for postpartum depression. "I had dealt with anxiety on and off when I was younger, and took medication for it," she says. "I'd even seen one of my close friends go through postpartum depression. But in myself, I just couldn't see it." Even during treatment, Garman struggled with feelings of guilt. "I kept asking my social worker, 'Why do I feel like this?' And she'd say, 'Christina, it's not you.' I really had to learn to forgive myself for feeling that way."
Merritt says her son was about 3 before she really felt confident caring for him. She says the transition to parenthood is so rough that almost every new mom could benefit from therapy. "Becoming a parent is a life-changing experience," she says. "It changes your marriage, your career, everything. People don't get it. Even though I was fortunate and had a lot of people helping me, no one really understood what was going on."
"There's nothing that's not stressful about bringing a new baby into your home," Silverman says. "For many women, it helps just to know they're not alone. Remember those pictures of Brooke Shields when her first daughter was born? She looked like the glowing mother, but now we know, because she shared her story, that she was miserable. So if you're miserable, too, it doesn't mean you're defective. You're not crazy. It's OK that you feel crappy, and it's OK that you don't feel this instant bond. But it can get better, and it will -- if you get help."
Creating a Postpartum Wellness Plan
Even if you're not at risk for postpartum depression, it's a good idea to create -- in advance -- a comprehensive wellness plan to follow after the baby is born. "This can actually help prevent postpartum depression," says expert Shoshana Bennett, PhD. Key elements of the plan include:
Sleep: Sleep deprivation can induce or worsen postpartum depression. Even if you'll be breastfeeding, designate someone else to share nighttime duties. Consider pumping so that someone else can feed the baby on occasion, and you can get a few full sleep cycles.
Support: Who's going to help out? How will you take a break? When will you get out of the house? Line up friends and family or consider hiring a doula, a professional who helps guide women through delivery and bringing baby home. Research shows that women who have labor and postpartum doulas reduce their risk of developing postpartum depression. But be sure that people who sign up to help know what you need. "Some people who think they are 'helping' aren't," Bennett says. If your mother's idea of helping is holding the baby while you make lunch -- and that's not the kind of help you need -- be prepared to explain what you really want. "Don't worry too much about hurting people's feelings. It's more important to take care of yourself and your baby."
Creating a Postpartum Wellness Plan continued...
Exercise: What you can do physically might depend on your recovery after giving birth. Even a walk around the block with baby in a stroller or sling gets you moving in the fresh air. It might not seem like a workout, but it's a start. Hit the mall for a stroll if weather doesn't cooperate.
Food and water: A plan for nutrition and hydration might sound obvious, but many new moms are so busy caring for the baby that they don't eat right. Not getting enough water and protein, especially if you're breastfeeding, can leave you depleted and vulnerable. Drink at least half your body weight in ounces of water per day (if you weigh 150 pounds, that's about nine 8-ounce glasses), and nibble on high-protein snacks such as nuts, hard-boiled eggs, and yogurt throughout the day.
Realistic expectations: Make a list of motherhood myths you won't buy into, such as "I'm not a good mom if I can't breastfeed," "I should be madly in love with my baby from the second I see him," and "I should lose all the pregnancy weight and look like Heidi Klum before my baby is six months old."
Tuesday, April 21, 2009
Postpartum Depression Is Real But Still Stigmatized
This is a brilliant article by John M. Grohol on a blog called Psyc Central. It is well worth a read! An excerpt:
"... And it saddens me even further to see people knock something like postpartum depression, a very real mental disorder that affects thousands of mothers every year who have just given birth to their child, and then feel overwhelmed with depression. They often are unable to do even basic child care for their newborn baby, and feel hopeless, despondent, and listless, without motivation or energy.
Moms are in need of being taken seriously, of having their concerns heard. You’d think nobody would be against mothers seeking to get proper diagnosis, treatment and care for something that is at the very core of having a healthy family...."
Go to this link to read further:
http://psychcentral.com/blog/archives/2009/04/21/postpartum-depression-is-real-but-still-stigmatized/
"... And it saddens me even further to see people knock something like postpartum depression, a very real mental disorder that affects thousands of mothers every year who have just given birth to their child, and then feel overwhelmed with depression. They often are unable to do even basic child care for their newborn baby, and feel hopeless, despondent, and listless, without motivation or energy.
Moms are in need of being taken seriously, of having their concerns heard. You’d think nobody would be against mothers seeking to get proper diagnosis, treatment and care for something that is at the very core of having a healthy family...."
Go to this link to read further:
http://psychcentral.com/blog/archives/2009/04/21/postpartum-depression-is-real-but-still-stigmatized/
Tuesday, March 31, 2009
Multiple Babies Mean Higher Risk of Postnatal Distress
By Kristina Fiore, Staff Writer, MedPage Today
Published: March 30, 2009
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston. Earn CME/CE credit
for reading medical news
BALTIMORE, March 30 -- Mothers who give birth to twins, triplets, or other multiples are at increased risk of postpartum depression, researchers here said.
In a prospective study, these women had a 43% increased risk of depressive symptoms at nine months after delivery compared with mothers of singletons, Yoonjoung Choi, Dr.P.H., of Johns Hopkins University, and colleagues reported in the April issue of Pediatrics.
Only about a quarter of these women, however, reported talking to a mental health professional about their depressive symptoms.
"Greater attention is needed in pediatric settings to address maternal depression in families with multiple births," the researchers said. The multiple birth rate has increased over the past two decades, reaching a record high in 2004. Yet the impact of multiple births on maternal mental health -- particularly postpartum depression -- has been understudied, the researchers said.
So they conducted the Early Childhood Longitudinal Study -- Birth Cohort, a nationally representative sample of children born in 2001, with oversampling of selected ethnic minority groups, low birthweight infants, and twins.
Mothers were given a questionnaire regarding their depressive symptoms and were also interviewed by an investigator.
The researchers found that the prevalence of moderate to severe depressive symptoms nine months after delivery was 19% in mothers of multiple births, compared with 16% for mothers of singletons.
There was also an increased risk of depressive symptoms for mothers with multiple births (OR 1.43, 95% CI 1.12 to 1.84).
Only 27% of mothers with moderate to severe depressive symptoms reported talking to a mental health professional about their emotional or psychological problems within the 12 months before their interviews with study investigators.
The researchers said that the small number of women receiving mental health counseling despite their depressive symptoms highlights the need for better referral of patients with depressive symptoms.
"Mothers of multiple births have more regular contact with healthcare providers throughout the pre-pregnancy, prenatal, and postpartum periods, which allows ample opportunities for healthcare providers to educate women about depression," the researchers said.
They said their work was limited in identifying mechanisms for the increased risk of depressive symptoms among mothers of multiple births because of a lack of data on psychosocial covariates of maternal depression such as spousal support and marital relationship.
The researchers said, too, that little documentation is available regarding hormonal changes and dysregulation in women associated with multiple births. They were also not able to factor infertility treatments into the analysis.
However, they said that parental stress in raising multiple infants has been suggested as a cause for maternal depression.
The researchers said they had no financial disclosures relevant to this study.
Primary source: Pediatrics
Source reference:
Choi Y, et al "Multiple births are a risk factor for postpartum maternal depressive symptoms" Pediatr 2009; 123(4): 1147-1154.
Published: March 30, 2009
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston. Earn CME/CE credit
for reading medical news
BALTIMORE, March 30 -- Mothers who give birth to twins, triplets, or other multiples are at increased risk of postpartum depression, researchers here said.
In a prospective study, these women had a 43% increased risk of depressive symptoms at nine months after delivery compared with mothers of singletons, Yoonjoung Choi, Dr.P.H., of Johns Hopkins University, and colleagues reported in the April issue of Pediatrics.
Only about a quarter of these women, however, reported talking to a mental health professional about their depressive symptoms.
"Greater attention is needed in pediatric settings to address maternal depression in families with multiple births," the researchers said. The multiple birth rate has increased over the past two decades, reaching a record high in 2004. Yet the impact of multiple births on maternal mental health -- particularly postpartum depression -- has been understudied, the researchers said.
So they conducted the Early Childhood Longitudinal Study -- Birth Cohort, a nationally representative sample of children born in 2001, with oversampling of selected ethnic minority groups, low birthweight infants, and twins.
Mothers were given a questionnaire regarding their depressive symptoms and were also interviewed by an investigator.
The researchers found that the prevalence of moderate to severe depressive symptoms nine months after delivery was 19% in mothers of multiple births, compared with 16% for mothers of singletons.
There was also an increased risk of depressive symptoms for mothers with multiple births (OR 1.43, 95% CI 1.12 to 1.84).
Only 27% of mothers with moderate to severe depressive symptoms reported talking to a mental health professional about their emotional or psychological problems within the 12 months before their interviews with study investigators.
The researchers said that the small number of women receiving mental health counseling despite their depressive symptoms highlights the need for better referral of patients with depressive symptoms.
"Mothers of multiple births have more regular contact with healthcare providers throughout the pre-pregnancy, prenatal, and postpartum periods, which allows ample opportunities for healthcare providers to educate women about depression," the researchers said.
They said their work was limited in identifying mechanisms for the increased risk of depressive symptoms among mothers of multiple births because of a lack of data on psychosocial covariates of maternal depression such as spousal support and marital relationship.
The researchers said, too, that little documentation is available regarding hormonal changes and dysregulation in women associated with multiple births. They were also not able to factor infertility treatments into the analysis.
However, they said that parental stress in raising multiple infants has been suggested as a cause for maternal depression.
The researchers said they had no financial disclosures relevant to this study.
Primary source: Pediatrics
Source reference:
Choi Y, et al "Multiple births are a risk factor for postpartum maternal depressive symptoms" Pediatr 2009; 123(4): 1147-1154.
Friday, December 5, 2008
New Support Site for Postnatal Dads
The Postpartum Dads Project
http:// www.postpartumdads.org
New Support Site for Postpartum Dads
(By Lauren Hale)
The Postpartum Dads Project plans to focus on collecting stories from Dads who have experienced depression themselves or have been with a partner who has experienced a Mood disorder after the birth of a child.
With the goal of getting new Dads to open up about the havoc Postpartum Depression can wreak, the Postpartum Dads Project launches today. The project will also focus on developing a close knit community which would provide Dads a safe haven in which to connect with other fathers with similar experiences.
The project is an outcome of a partnership between Lauren Hale and David Klinker, both Coordinators with Postpartum Support International. Ms. Hale serves as the Co-Coordinator for the state of Georgia while Mr. Klinker serves as the Father’s Coordinator. In June, Ms. Hale featured interviews with dads and their experiences with Postpartum Depression. Mr. Klinker was one of the Dads featured and this led to further discussion regarding the lack of resources available for Dads. The Postpartum Dads Project will also be placing emphasis on Paternal Postnatal Depression. This can occur in up to 10% of all new dads. In fact, if a father’s partner is depressed, the father has a fifty percent chance of developing depression himself.
One of the primary goals of the Postpartum Dads Project will be to create a published volume that will include submissions collected through the website. These submissions will be categorized and designed to be read in between calming a fussy baby and watching the game. The development of the website will continue and many of the stories will be found there as well as insights from professionals, tips and hints from other dads who have been in the trenches, as well as the eventual addition of a Dads only forum.
A key addition to the website in the future will be a professionals only area in which professionals will have their own forum and other tools with which to discuss this relatively new area of support.
The Postpartum Project will begin by publishing interviews with Dads and professionals in the know such as Country Music Artist Wade Bowen, Michael Lurie, David Klinker, Dr. William Courtenay and has been granted permission to reprint the interview with Dr. Shoshanna Bennett’s husband, Henry. The Project will also be featured in an upcoming segment at The FatherLife.com.
For additional information on the Postpartum Dads Project, contact Lauren Hale or visit www.postpartumdadsproject.org.
Email by linking to the website: www.postpartumdadsproject.org
Category Family, Medical, Health
Tags Fatherhood, Depression, Postnatal Paternal Depression, Postpartum Mood Disorders, Men, Therapy
http:// www.postpartumdads.org
New Support Site for Postpartum Dads
(By Lauren Hale)
The Postpartum Dads Project plans to focus on collecting stories from Dads who have experienced depression themselves or have been with a partner who has experienced a Mood disorder after the birth of a child.
With the goal of getting new Dads to open up about the havoc Postpartum Depression can wreak, the Postpartum Dads Project launches today. The project will also focus on developing a close knit community which would provide Dads a safe haven in which to connect with other fathers with similar experiences.
The project is an outcome of a partnership between Lauren Hale and David Klinker, both Coordinators with Postpartum Support International. Ms. Hale serves as the Co-Coordinator for the state of Georgia while Mr. Klinker serves as the Father’s Coordinator. In June, Ms. Hale featured interviews with dads and their experiences with Postpartum Depression. Mr. Klinker was one of the Dads featured and this led to further discussion regarding the lack of resources available for Dads. The Postpartum Dads Project will also be placing emphasis on Paternal Postnatal Depression. This can occur in up to 10% of all new dads. In fact, if a father’s partner is depressed, the father has a fifty percent chance of developing depression himself.
One of the primary goals of the Postpartum Dads Project will be to create a published volume that will include submissions collected through the website. These submissions will be categorized and designed to be read in between calming a fussy baby and watching the game. The development of the website will continue and many of the stories will be found there as well as insights from professionals, tips and hints from other dads who have been in the trenches, as well as the eventual addition of a Dads only forum.
A key addition to the website in the future will be a professionals only area in which professionals will have their own forum and other tools with which to discuss this relatively new area of support.
The Postpartum Project will begin by publishing interviews with Dads and professionals in the know such as Country Music Artist Wade Bowen, Michael Lurie, David Klinker, Dr. William Courtenay and has been granted permission to reprint the interview with Dr. Shoshanna Bennett’s husband, Henry. The Project will also be featured in an upcoming segment at The FatherLife.com.
For additional information on the Postpartum Dads Project, contact Lauren Hale or visit www.postpartumdadsproject.org.
Email by linking to the website: www.postpartumdadsproject.org
Category Family, Medical, Health
Tags Fatherhood, Depression, Postnatal Paternal Depression, Postpartum Mood Disorders, Men, Therapy
Monday, December 1, 2008
NZ National Radio programme on male PND
National Radio’s NZ 9 to noon programme ran a programme on male postnatal depression on Monday 1st December.
Auckland Coordinator of the Father and Child Trust Brendon Smith and Wellington-based Board member and GP Mark Stephenson featured in a 25-minute segment on the topic, in which both the personal and the clinical aspects of the illness were discussed. Host Kathryn Ryan also spoke to and requested a Ministry of Health representative for better recognition of the condition, which affects about one father for every two mothers.
This is the link ... well worth a listen!
http://www.radionz.co.nz/__data/assets/audio_item/0008/1798595/ntn-20081201-0925-Sad_Dads-m048.asx
Auckland Coordinator of the Father and Child Trust Brendon Smith and Wellington-based Board member and GP Mark Stephenson featured in a 25-minute segment on the topic, in which both the personal and the clinical aspects of the illness were discussed. Host Kathryn Ryan also spoke to and requested a Ministry of Health representative for better recognition of the condition, which affects about one father for every two mothers.
This is the link ... well worth a listen!
http://www.radionz.co.nz/__data/assets/audio_item/0008/1798595/ntn-20081201-0925-Sad_Dads-m048.asx
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