POST PARTUM DEPRESSION AND MOOD DISORDERS
Giovannina M. Anthony, M.D.
Within a few days of having a baby, I recall finding myself crying for no particular
reason. As an ob/gyn, I have counseled many postpartum patients about moods and
sadness, but to experience this myself was a huge wakeup call as I realized how
commonly these symptoms occur. After delivering a baby, many women are joyous
in the hospital, and “doing great” again at their six week post partum visit. Little did
I know that many of them during those six weeks had been through hell and back! I
fully realized during my own postpartum period that the time after giving birth is
intense: emotionally, physically, and mentally. Compound all of these changes with
sleep deprivation and the stress of having a newborn, and the risk of postpartum
blues, depression, anxiety, or even full blown postpartum psychosis does not seem
all that remote.
Pregnant women, their partners, families, and friends often expect the postpartum
period to be a happy time, characterized by the joyful homecoming of the newborn.
As joyful as this event can be, however, many women will experience short term or
long-term mood disturbances postpartum. This problem can be mild, called “post
partum blues,” or severe, potentially even becoming full-blown postpartum
psychosis which can be life-threatening.
Postpartum blues are just that: a mild but persistent sad feeling after the birth of a
baby. Some of the symptoms include rapid mood swings, irritability, anxiety, and
crying spells. Incredibly, 40-80% of postpartum women develop these mood
changes, generally within two to three days of delivery. The symptoms typically
peak on the fifth postpartum day and resolve within 2-4 weeks.
By comparison, a diagnosis of postpartum depression is more severe in that
symptoms are more debilitating and present constantly, most of the day, for at least
2 weeks and lasting up to several months. What are some of the signs of postpartum
depression? It is sometimes hard to tell, since the symptoms might also be caused
by the stress of taking care of a newborn. For example, it is normal for new mothers
to sleep little, feel tired and have no energy, and have changes in their appetite,
weight, and desire to have sex. Obsessional thoughts about harming oneself or the
baby are common, but often concealed. These thoughts, which are described as
"scary thoughts," are usually not revealed unless the woman is questioned directly.
I think it is reassuring however for women to know that thoughts of this kind are
common and talking about them will help alleviate anxiety in this regard.
Full blown depression however also causes a new mother to feel sad, down,
hopeless, cry frequently, and even occasionally to feel suicidal or like she might
harm the baby. Women with post partum depression may not be able to sleep when
their babies sleep, or they might have so little energy they cannot get out of bed for
hours. They may also feel guilty, overwhelmed, unable to care for their baby, or
even feel like a failure as a mother. Anywhere from 5-9% of post partum women
will experience postpartum depression. Interestingly, the depression can occur up
to twelve months after the baby is born. Also, not surprisingly, many women who
have postpartum blues will find that the symptoms progress to depression instead
of resolving. In the worst case scenario, all of these symptoms can progress to
postpartum psychosis: hearing voices, hallucinating, irrational obsessional thoughts,
and a desire for suicide or to hurt the baby. Fortunately this is rare, but it remains a
very real problem.
How might your healthcare provider screen you for postpartum depression? One of
the options is a screening tool called the Edinburgh Postnatal Depression Scale, a 10
item self-report questionnaire designed specifically for the detection of depression
in the postpartum period. It has been validated and computerized as well as
translated into more than 12 languages. So if your OB or midwife hands you this
screening tool, know that it has worked to detect this problem in thousands of
women.
Which women are at high risk of developing the postpartum blues or depression?
Women who have a history of depression are more likely to have postpartum
depression than women who have never been depressed. Other risk factors include
depressive feelings while pregnant, a family history of depression, prior problems
with premenstrual syndrome, stress around child care, psychosocial problems at
work or in relationships, and poor emotional and financial support from the partner.
Interestingly, postpartum depression affects women from diverse cultures, so there
is nothing special in this regard about the modern, Western lifestyle that increases
risk. Also, the mode in which the baby delivers, vaginal versus cesarean section,
does not affect risk.
A lot of dads will ask me if this is all because of their partner’s “hormones.” In spite
of much research on the subject, no particular hormone imbalance or deficiency has
been implicated. The likely cause is unknown, although we know that women who
have had mood disorders prior to pregnancy are at high risk. One other fascinating
potential cause occurs in women who are iron deficient while pregnant. For this
reason, I replace iron aggressively in my pregnant patients who are even borderline
anemic.
Speaking of dads, paternal postpartum depression also occurs in fathers after
childbirth. This is more common than one might think, but is also an important
cause of problems in the postpartum family unit.
How is postpartum depression treated? Treatments for non-pregnancy related
depression can also be used to treat this special type of mood disorder. The two
primary treatments are medications and therapeutic counseling with a psychiatrist,
psychologist, or social worker. Some women, especially breastfeeding mothers,
might be nervous about taking medications. However, NOT treating the depression
can be harmful for both the mother and her baby. The newborn baby needs her
mother to be present, emotionally and physically. In this scenario, the benefits of
medication clearly outweigh the risks to the baby.
Why should postpartum depression be treated? This problem can interfere with
bonding and child development, which only makes a new mom’s feelings of shame
and guilt even worse. These patterns, which lead to negative interaction between
mom and baby may impact later child development, even if the new mom fully
recovers from the problem.
In recognition of this common problem that affects so many new mothers and
fathers, I’m happy to report that the town of Jackson, Wyoming, has declared May to
be “Maternal Mental Health Awareness Month,” as put forth by Mayor Mark Barron,
officially on May 7th, 2012. As part of a community effort to address this issue,
Mayor Mark Barron and the Jackson Town Council have joined maternal mental
health support programs to make maternal mental health a public health priority.
I also would like to make our community aware of the Jackson Hole Perinatal
Advocacy Project. This is an amazing resource available locally that can make a
huge difference for struggling moms and dads. They offer a FREE weekly support
group, facilitated by local counselor Elizabeth Cheroutes, LCSW. The group is open
to all moms and dads suffering from perinatal (“around pregnancy”) anxiety,
depression, and mood disorders, and babies are welcome! The mission of the JHPAP
is to provide outreach and support to healthcare providers, families, and mothers
regarding the prevention and treatment of mental health issues related to
childbearing.
Contact the Perinatal Advocacy Project at 307-200-7190 or at
info@jhpostpartum.org. It says a lot about our unique but very special community
that a resource such as this is available. Also, find a wealth of information and
resources at www.postpartum.net.
Without further ado, I would like to officially wish our community a very happy,
fruitful, and abundant MATERNAL MENTAL HEALTH AWARENESS MONTH in honor
of all of our babies, new moms, and new dads. Don’t hesitate to seek help if you
need it. The future of our families and our community depends on it!