Maternal Connection

Postpartum depression: When moms feel out of control

2010-05-15T12:22:00.000-07:00

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

Durango Herald News, Don't suffer in silence: Therapy eases postpartum depression

2009-10-13T22:19:00.001-07:00

Durango Herald News,
Don't suffer in silence: Therapy eases postpartum depression

Shared via AddThis

Postnatal Depression: More Common Than You Know

2009-09-23T18:37:00.000-07:00

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."

Postpartum Depression Is Real But Still Stigmatized

2009-04-21T20:54:00.000-07:00

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/

Multiple Babies Mean Higher Risk of Postnatal Distress

2009-03-31T19:26:00.000-07:00

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.

New Support Site for Postnatal Dads

2008-12-05T20:15:00.000-08:00

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

NZ National Radio programme on male PND

2008-12-01T21:58:00.000-08:00

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

Dads also hit hard by postnatal depression

2008-11-17T23:13:00.000-08:00

Article from: The Australian by Stephen Lunn, Social affairs writer | November 17, 2008

FOR every two mothers suffering postnatal depression in Australia, at least one father does, too.

More than 45,000 women and 26,000 men were in the throes of the debilitating psychological condition, the Post and Antenatal Depression Association said yesterday, with the high number of men an unexpected burden on the health system.

PANDA chief executive officer Belinda Horton said the figures on male postnatal depression put paid to the widespread belief that fluctuating hormones were the prime cause of the mental illness.

"Postnatal depression isn't simply caused by hormonal changes during pregnancy and after birth," Ms Horton said.

"There isn't a great deal of evidence that shows hormone changes alone cause postnatal depression - it's one of many many factors.

"Men go through similar issues to women when a new baby comes into the world.

"Everything gets turned upside down.

"There may be financial pressures and many other challenges, and that can be very hard for people."

Parents are loath to admit they struggle emotionally and psychologically after the birth of a child when their family, friends and the broader community believe having a baby is one of the greatest times of their lives.

More than 15 per cent of new mothers are diagnosed with postnatal depression, and about 10 per cent of new fathers.

But the number of sufferers could be much higher.

PANDA estimates that 50 per cent of parents who suffer from postnatal depression are never diagnosed and the figure for men may be even higher as their particular problems, such as overuse of alcohol or work stresses that may be caused by their home life, are seen as men's issues rather than postnatal problems.

Ms Horton said another group of affected men struggled to deal with their partner's postnatal depression.

"They are basically put in the position of being prime carer for a mentally ill person and the family's child or children, as well as remaining the breadwinner.

"It is an incredibly difficult position to face, and many men develop their own stresses and anxieties around that," she said.

The scale of postnatal depression in Australia, and its cost to the community in terms of lost working hours and healthcare costs, were cause for concern, but there remained an unwillingness to take the issue seriously, PANDA said.

"Over 98,000 people have some form of postnatal mental illness. It's a phenomenal figure, yet we just don't seem to want to talk about it, as if the issue doesn't quite exist," Ms Horton said.

People with concerns about postnatal depression can call Susan 0064 9 3611327

5 Things Every New Mother Should Know About PPD

2008-10-29T15:16:00.000-07:00

By Katherine Stone.

1. PPD can and often does happen.

Many pregnancy books and childbirth educators gloss over postpartum mood disorders. They minimally describe the symptoms and emphasize how rare it is. Actually, 10-15% of new moms experience these illnesses, and some studies report it may be as high as 25%. My childbirth educator told our class that we really needn't spend too much time worrying about it, so I didn't, and thus I was completely unprepared for what hit me.

2. Postpartum depression is only one in a spectrum of postpartum illnesses.

Postpartum mood disorders include postpartum depression (PPD), postpartum obsessive compulsive disorder (PPOCD), postpartum psychosis (PPP) and postpartum post-traumatic stress disorder. PPOCD is often characterized by intrusive thoughts, which are disturbing unwanted thoughts. When I experienced my first intrusive thoughts -- about smothering my infant son with the burpcloth -- I had never heard of such things. No one ever told me they were possible. I was convinced I had just gone permanently crazy, and it never occurred to me that I had PPOCD. If I had been better informed, I would have felt comfort in knowing what was wrong and that immediate treatment was available. Instead I kept quiet for weeks because I was afraid I'd be locked up forever and lose my family. (For more information on each illness and its symptoms, visit the Postpartum Support International website at http://www.postpartum.net/brief.html )

3. Symptoms can appear anytime during the first year after birth.

Many women think that if they start feeling bad when their child is 3 or 4 months old, or even older, that it can't be related to postpartum depression. Apparently, even the DSM-IV, the manual that psychiatric professionals use to diagnose psychiatric illnesses, states that your illness can only be diagnosed as postpartum if the symptoms show up within the first four weeks after birth. This isn't necessarily true. Postpartum mood disorders can occur any time within the first year after the birth of your baby, though it is true that most are diagnosed within 2 to 4 months postpartum.

4. Ask your friends and family to be prepared.

It's important to talk about the possibility that you might experience some form of postpartum mood disorder with the people closest to you. Ask them to educate themselves. Sometimes we can't see that we're acting differently, or we try to convince ourselves we're fine and purposefully ignore our symptoms. In that case, it often takes someone close to us to point out that we might need help. Neither my husband nor my mother knew about what to look for or what to do about it, which made it harder on all of us.

5. The sooner you get treatment the better.

Many recent studies show that children of mothers with postpartum mood disorders who go untreated for long periods can be negatively impacted over the long term with behavioral problems. A study published in 2006 in the Journal of the American Medical Association (http://jama.ama-assn.org/cgi/content/short/295/12/1389), for instance, found that children of mothers who have received treatment via medication for major depression or anxiety are less likely to be diagnosed with anxiety, disruptive and depressive disorders themselves, compared to children of women who remain untreated. You MUST push past the fear and speak up to lessen the impact of these illnesses on yourself and your children. You must be willing to say how you are feeling and seek treatment so that not only you, but your whole family can heal.

From: http://postpartumprogress.typepad.com/weblog/2007/09/5-things-every-.html

The Mother's Dilemma: Should You Take Time for Yourself?

2008-10-23T21:24:00.000-07:00

By Christy Cuellar-Wentz.
Posted by NDK Team Labels

You may think it's more important to tend constantly to the needs of other people rather than yourself. This appears at first glance to be the selfless, even saintly, way to behave. Aren't mothers supposed to put the needs of their family first?

In actuality, you will care for your loved ones better by taking time to refill your own well. If you are constantly on call, with no time for yourself, you will eventually run out of energy. Giving yourself a brief time to tune in and recharge will help ensure you are able to respond to the very real needs of your children as well as the rest of your family.

If taking care of yourself seems foreign, think about this for a moment. You are a primary role model for your children's lives. They will copy your actions more often than follow your advice. Many a mom has shed tears after becoming aware of the lack of self care they modeled during their children's formative years. You love your children and want to do right by them. Therefore, you need to show them how to take care of themselves by taking care of you! This will increase their capacity to be healthy, well balanced adults.

While meditation can be extremely helpful, you don't need to sit down and meditate to take 10 minutes for yourself. You can go for a short walk, just sit in a quiet spot inside, outside, or even in the car (while you're not driving). Sometimes I actually have to lock myself in the bathroom for 10 minutes to get the time and space I need, but it is worth it.

If you work away from your home, you may find it a bit easier to set a little time for yourself aside away from your family. If you are at home twenty four hours a day, I recommend brainstorming to find a way to take some time away once a week for an hour or so while a responsible adult is caring for your baby or child. This will allow you to ease up on yourself and decompress. When you return, even a short time later, you may feel warmer and more appreciative of your little ones than when you left. Even over-tired, over-worked moms can open up their hearts more easily by having a window of opportunity to feel ever so briefly "off duty."

As you follow through with your new "self care" strategy, your unconscious mind will begin to trust the process. Your sense of well being and even body image may unexpectedly improve. When you behave as though you are a loved person, worthy of taking up space in the world, you will start to believe that it is actually O.K. for you to exist in the world. This cannot help but translates into feelings of better health and an increased sens of balance in the world, allowing you respond more easily and gracefully as a mother, partner or wife.

Found on http://article.zuiwahe.com/2008/10/mothers-dilemma-should-you-take-time.html

About the Author:

Christy Cuellar-Wentz, M.A. is an author and mental health professional dedicated to providing support for the life-changing transition to new motherhood. She offers free weekly MP3 downloads filled with empowering ideas for new moms as well as current information on postpartum stress, postnatal depression and baby blues.

Counselling Preferred Over Medication

2008-10-16T13:52:00.000-07:00

Main Category: Psychology / Psychiatry
Article Date: 16 Oct 2008 - 4:00 PDT

People suffering from anxiety and depression prefer to receive counselling over medication because they feel it addresses their underlying problems and not just their symptoms.

This is one of the key findings in a review of UK and international research studies into the clinical-effectiveness, cost-effectiveness and acceptability of counselling. The review, Counselling in primary care: a systematic review of the evidence, published by the British Association for Counselling & Psychotherapy is available now from www.bacp.co.uk/newpubs.

All the studies in the review relating to treatment preferences found that counselling was preferred to pills because it addressed the underlying causes of depression while providing an opportunity for personal contact. Antidepressants were also seen as addictive.

One study found that 15% of patients with depression preferred treatment by medication, while 24% preferred counselling and 61% wanted both. Another study into patients' attitudes towards depression care found that 86% felt that counselling was an acceptable treatment, while just 70% viewed antidepressant medication as acceptable.

The review also included a number of studies looking at the most effective treatments for conditions such as depression, post-natal depression and chronic fatigue. Counselling was found to be as effective as CBT.

It is also clear from the review that while participants of all ages report a stronger preference for counselling than for medication, older adults seem to hold a preference for psychodynamic or supportive therapies, whereas younger participants prefer more skills-based therapies such as CBT. This therefore suggests there is a need for services to have an understanding of age-differential treatment preferences in order to design interventions that optimise utilisation among both younger and older adults.

The review comes at a time when the government has recently committed £170 million over three years to be spent on its Improving Access to Psychological Therapies (IAPT) programme.

One of the authors, Andrew Hill stated: "At a time when the use of psychological therapies in primary care is expanding, this study found that counselling is an effective treatment for a range of psychological problems and is, in many cases, as effective as CBT. This demonstrates a clear need for the expansion of the Government's IAPT programme to incorporate other methods of talking treatments in addition to CBT."

1 - Counselling in primary care: a systematic review of the evidence is published by the British Association of Counselling & Psychotherapy and is available from www.bacp.co.uk/newpubs.

For Men, Postpartum Depression Not Uncommon

2008-10-15T13:00:00.000-07:00

Rob Sandler couldn’t wait to welcome his son Asher to the family, but remembers how his feelings changed shortly after the child was born.

“It became an overwhelming feeling,” said Sandler. “I felt like I lost control of my life.”

It turns out that Sandler had developed a form of postpartum depression.

Postpartum depression is one of the most common complications for women during and after pregnancy, but one out of every four new fathers may also experience symptoms.

Psychotherapists say mixing feelings of increased financial stress, lack of sleep and hormonal changes can lead to depression.

“It's a double whammy. Not only do our testosterone levels go down, but our estrogen levels go up, and these female hormones coursing through our body can really wreck havoc on a man's functioning,” said Dr. Will Courtenay.

Courtenay recommends seeking professional help for those who think they may be suffering from postpartum depression.

Sandler received therapy and started taking antidepressants.

Now he can’t wait to spend time with his baby.

“It’s night and day how I feel, and I know that's only going to get better as he gets older,” said Sandler.

Men, like women, suffer postpartum depression that can be mild, moderate, or severe that often goes unrecognized and untreated.

From http://www.thepittsburghchannel.com/health/17714581/detail.html

Postpartum Depression Strikes New Fathers, Too

2008-10-15T12:54:00.000-07:00

After the birth of a child, both men and women are susceptible.
How to respond. By Dana Scarton

..."Long recognized as a problem afflicting some new mothers, postpartum depression can also grip men—though mental health professionals acknowledge that until recently they largely overlooked that fact. Male postpartum depression took a step out of obscurity this month when it was for the first time the subject of a workshop at the annual meeting of the American Psychiatric Association.

Ten percent of new fathers and 14 percent of new mothers are affected by depression, says psychologist James F. Paulson, assistant professor of pediatrics at Eastern Virginia Medical School in Norfolk, Va. Yet most men and their partners fail to recognize the condition when it arises. The symptoms are similar in both sexes, but the causes may be different. Hormonal changes can contribute to a woman's suffering, experts suspect, whereas sudden and unexpected lifestyle changes are thought to trigger a father's depression. "After the baby is born, there's a change in family structure," says Thomas Newmark, chief of psychiatry at Cooper University Hospital in Camden, N.J., and organizer of the APA workshop. "There might be pressure to take care of the child economically. The man may not get the attention from his wife that he was used to. And, of course, his sleep is affected."

Depressed dads are more likely than moms to display destructive behaviors, including increased use of alcohol or drugs, shows of anger, engagement in conflicts, and risk-taking such as reckless driving or extramarital sex. Some, like Hyman, elect to work longer hours. Other signs: a depressed or sad mood, loss of interest or pleasure, weight gain or loss, oversleeping or trouble sleeping, restlessness, fatigue, feelings of worthlessness or guilt, impaired concentration, and thoughts of suicide or death. The depression can begin within days or weeks of delivery and last for a year or more.

If untreated, a father's postpartum depression can be harmful to the child as well as to both parents. Children born into such families receive less attention from the depressed parent and are at increased risk for developing physical and emotional problems, Paulson says. Depression in the father is thought to increase the likelihood that his children will act out or behave destructively. (Depression in the mother, by contrast, is associated with decreased overall health, learning problems, and a greater risk for developing depression.) Postpartum depression can typically be treated with therapy, medication, or a combination.

A partner's involvement is usually critical to identifying depression in a new father. "Often times, it will be the wife who is first to notice," says Berkeley, Calif., psychotherapist Will Courtenay, who specializes in men's health. "She'll say, 'He just hasn't been himself lately.' "

Vigilance is most called for when one's partner has been previously depressed. Having a history of depression or mental illness puts a father at greater risk of postpartum depression, as does having a spouse with postpartum depression. This is true even if the couple is separated, divorced, or unmarried, says Paulson, whose Eastern Virginia team earlier this year completed a study, now under peer review, involving noncohabitating parents..."

From http://health.usnews.com/articles/health/sexual-reproductive/2008/05/21/postpartum-depression-strikes-new-fathers-too.html

Post-Traumatic Stress Disorder (PTSD) Following Childbirth

2008-10-12T13:16:00.000-07:00

From other blogs

Post-Traumatic Stress Disorder (PTSD) after childbirth is an understudied condition. Traditionally, much of the data have been based on case reports, indicating that PTSD can occur following a range of childbirth and child loss situations, including long or complicated labor, severe pain with labor or delivery, cesarean section, and unanticipated pregnancy outcome, such as child loss, miscarriage or infant birth defects. PTSD related to childbirth is frequently overlooked by physicians; the relative newness of the diagnosis and lack of literature on this topic are factors which may hinder recognition of this disorder.

These studies have reported a wide range of PTSD symptoms, including flashbacks, nightmares, hypervigilance, and avoidance of reminders of the trauma. Women with PTSD also may experience feelings of numbness, anger, depression, social isolation, and chronic sleep problems.

While earlier reports suggested that PTSD after childbirth appeared to be precipitated by delivery trauma, a recent study by [1] Zaers and colleagues suggests that there are certain predisposing factors which raise the likelihood that a woman will develop PTSD after childbirth. In this study, 6% of 60 postpartum women reported clinically significant PTSD symptoms at six weeks postpartum. At six months postpartum, 14.9% reported PTSD symptoms. The strongest predictor for post-traumatic stress symptoms was anxiety late in pregnancy. Other predictors included psychiatric symptoms in late pregnancy, stressful life events, and the delivery experience. Nearly one quarter of the women in this study also reported depressive symptoms at 6 weeks and 6 months postpartum.

The long-term consequences of PTSD after childbirth can be devastating for the mother and/or her family. Women who have experienced PTSD may experience nightmares resulting in conditioned insomnia, difficulties with breastfeeding, impaired bonding with the child, difficult sexual relations with their partner, and poor sense of self-worth. Women with PTSD may avoid childbearing in the future or may opt for an elective Cesarean section in subsequent pregnancies in order to avoid recurrent trauma.

Careful screening for PTSD symptoms in postpartum women by healthcare professionals is warranted, with special attention being paid to depressive symptoms and anxiety, particularly in cases where the woman presented with anxiety or other psychiatric symptoms during pregnancy or experienced a complicated delivery or an unexpected pregnancy outcome.

Laura Petrillo, MD

Posted By mghcwmh On October 8, 2008 @ 9:17 am In Anxiety, Postpartum Disorders, Postpartum Psychiatric Disorders

Read more:

llard CG, Stanley AK, Brockington IF. [2] Post-traumatic stress disorder (PTSD) after childbirth. Br J Psychiatry. 1995;166(4):525-8.

Reynolds JL. [3] Post-traumatic stress disorder after childbirth: the phenomenon of traumatic birth. CMAJ. 1997; 156(6):831-5.

Zaers S, Waschke M, Ehlert U. [1] Depressive symptoms and symptoms of post-traumatic stress disorder in women after childbirth. J Psychosom Obstet Gynaecol. 2008; 29(1):61-71.

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Article printed from MGH Center for Women’s Mental Health: http://www.womensmentalhealth.org

URL to article: http://www.womensmentalhealth.org/posts/post-traumatic-stress-disorder-ptsd-following-childbirth/

PND Pamphlet

2008-10-10T22:22:00.000-07:00

Go to this website to see a great brouchure written about postnatal depression and birth trauma. http://www.mentalhealth.org.nz/resources/PND-EGG-Brochure.pdf

You can print it out to give to someone you care about or to use for yourself.

The Usefulness of Couples Counselling in PND

2008-10-09T13:51:00.000-07:00

As anyone who has experienced it already knows, PND can put a severe strain on the couple relationship. The usual stresses that any new baby brings, together with the mother being somewhat incapacitated, is a lot to manage. Just when good communication becomes more important than ever, the opportunities to talk about anything other than the immediate parenting tasks at hand are drastically diminished. Often, both parents are reduced to operating in crisis mode, exhausted and struggling to get from one day to the next. The demands of the new baby are paramount and the relationship between the parents gets pushed to the side.

Of course, to some extent, exhaustion and feelings of being overwhelmed at times, are to be expected with a new baby in the house. Research shows that couple relationship satisfaction tends to decline after the birth of the first child, rises when children attend primary school, declines when children are adolescent and rises again when children leave home (Bradbury, 2003). Parenting is a challenging job. Usually relationships are robust enough to manage the increased demands parenting brings or the stresses don’t become severe enough to exceed the couple’s ability to cope. But the arrival of PND can be the stressor that becomes ‘the straw that breaks the camels back’ and although there are recognised factors that can make women more vulnerable to it, no-one can be guaranteed that it won’t happen to them.

We all respond in unique ways when we are under stress and the greater the stress, the more likely we are to reverting to coping behaviours that we learned much earlier in our life. These strategies may be useful and constructive or they may be adding to the problem. We may realise that what we are doing is not always helping but be unsure of how to do it differently. It can be hard to see things objectively when you are in the middle of it. In this situation, couple counselling may help to improve communication between the couple so they can support eachother in more constructive ways than might otherwise happen.

Also, unfortunately, PND is often not amenable to a quick solution – for most women recovery takes time, which can also increase the strain on the couple relationship. Once the woman has recovered and things have returned to the more usual managed ‘chaos’ of family life, it may become apparent that there are some unresolved issues that are continuing to cause conflict in the relationship.
Again, at this point it may be helpful to use a couple counsellor to talk about what the couple have been through. The PND may have exacerbated conflicts that were already present prior to the onset of PND, or given rise to issues that were not previously apparent. Counselling can help the couple to understand eachother more fully and make sense of what they have experienced together. It may be that some renegotiation is required for both partners to feel that their needs are being acknowledged.

Another common situation is that there are usually networks and sources of support for the mothers, but fathers (typically at work full-time), do not have access to these. And I doubt whether they would want to attend a mothers group even if they could! Men are often uncomfortable talking about difficulties they are having in managing themselves and/or what is happening in the relationship, which means they can feel quite isolated. Men can also become depressed in this situation but it can take a lot longer to recognise because a man suffering from depression is more likely to be angry than tearful, and may be stoically trying to hold himself together while trying to support his partner. So couples counselling can provide a space where they can get some help and support in a private setting.

PND can be a tough experience, but as with any life situation that presents a challenge to the couple, it can also strengthen the relationship in the long term. Making use of couples counselling to help find your way through it is not an admission of any intrinsic ‘failure’ in yourself or your relationship. On the contrary, it can signal the commitment of the couple to the relationship and to their motivation to heal and strengthen it, both for themselves and for their children.

From: May Sahar is a counsellor in private practice, please go to her website at www.maysahar.net

50% or more of PND cases go undiagnosed

2008-10-09T13:48:00.000-07:00

Chris Rikard-Bell, a child and adolescent psychiatrist at Sutherland Hospital, says the stigma attached to postnatal depression is one of the reasons why ''50 per cent or more'' of cases go undiagnosed.

While the hospital screens pregnant women for signs of the condition, 60 per cent of Sutherland Shire women give birth at hospitals where screening may not be carried out.

Dr Rikard-Bell said this meant GPs and child and family health clinics were left to pick up the slack.

He says it is ''never too late to seek treatment'' but the longer it took to diagnose the harder it was to treat.

''About 80 per cent of women who leave it untreated will still be depressed at the end of a year, so it's a very significant part of the child's life,'' he said.

''And having a depressed mum is a significant risk factor for the baby [due to] the lack of bonding and attachment and decrease in quality of the attachment between the baby and the mother. There is also the risk that it can develop and become a chronic depressive condition.''

Dr Rikard-Bell said the majority of women are diagnosed in the mild to moderate range affecting their sleep, eating and enjoyment of the baby and their lives.

''They might be able to function adequately, that is why a lot of women in the mild to moderate range do not think they have a problem [but] if they have a persistent low mood and are not able to enjoy themselves, and their self-esteem is low, that is not normal.''

The good news is that about 90 per cent of women respond well to treatment - which includes counselling, healthy-thinking courses and medication - and recover within six months. About one in 1000 cases suffer the more serious postnatal psychosis and may require hospitalisation.

Dr Rikard-Bell said women with postnatal depression rarely wish to harm their baby but misconceptions such as this are partly why many fail to seek help.

''There is a lot more awareness that postnatal depression exists and needs treatment but I think there is still a long way to go before it's destigmatised totally,'' he said.

''I think [the stigma] is a measure of why women do not seek help. A lot of women believe it is a sign of weakness.''

Women who think they might be suffering postnatal depression should talk to their GP or other health professional.

From http://stgeorge.yourguide.com.au/news/local/news/general/why-mums-should-seek-help/1329393.aspx

Australian Government commits $55 million to Perinatal Depression

2008-10-09T13:08:00.000-07:00

Australian Government commits $55 million to Perinatal Depression
What is the National Perinatal Depression Plan?

* The National Perinatal Depression Plan aims to improve prevention and early detection of antenatal and postnatal depression and provide better support and treatment for expectant and new mothers experiencing depression.
* Responsibility for the National Perinatal Depression Plan rests with the Australian Government Department of Health and Ageing.

Why is this important?

Each year around one in 10 Australian women experience depression during pregnancy and almost one in five experience depression in the weeks and months after giving birth. If left untreated, this can have a negative impact on new mothers, their families and friends.

Who will benefit?

This initiative will benefit all women who are at risk of or experience depression during pregnancy or in the first year following childbirth.

What will the National Perinatal Depression Plan deliver?

The initiative will enable provision of:

* routine screening for depression - once during pregnancy and a follow-up check at around the time the baby is two months old;
* follow-up support and care for women who had been assessed as at risk of or experiencing antenatal or postnatal depression; and
* training for health professionals to help them screen expectant and new mothers and identify those at risk of or experiencing depression.

How will it work?

Each state and territory will roll out universal screening, support services and training for health professionals in a nationally agreed approach. Divisions of General Practice will assist by providing localised support services, and beyondblue will support implementation of the initiative.

What funding is attached to this program?

The Australian Government has committed $55 million over five years – $30 million to the states and territories, $20 million to the Access to Allied Psychological Services (ATAPS) component of the Better Outcomes in Mental Health Care program, and $5 million to beyondblue, a national organisation working to address issues associated with depression. An additional $30 million will be sought from the states and territories over the five years, bringing the total to $85 million nationally.

When will the National Perinatal Depression Plan start?

The initiative was announced as part of the 2008-09 Federal Budget. The five-year funding will commence in 2008-09.

Further information

For further information on the National Perinatal Depression Plan, please contact mentalhealth@health.gov.au

From http://www.health.gov.au/internet/mentalhealth/publishing.nsf/Content/perinatal-depression-2