It's more than baby blues: postpartum depression

When postpartum depression makes the news, it’s usually because either a celebrity is involved or because some woman hurt her baby. Despite its common occurrence-1 out of 8 women will experience it-it is still not openly talked about. Maureen O’Hara in this month’s Mothering magazine talks about depression, including PPD and how it’s still stigmatized in our society. It’s even more pronounced in a society where we’re expected to raise our children isolated from the extended family support systems that humans have lived in since before we walked upright.

According to Ruta Nonacs, MD, on emedicine.com, most women will experience minor mood disturbances in the postpartum period. 10-15% of women will have the more serious postpartum depression. Postpartum psychosis, the most severe form, is seen in only 1-2 women out of 1000 births. Risk factors or PPD include prenatal depression or anxiety, childcare stress, marital or family issues, low social support, history of previous depression, low socioeconomic status, unwanted pregnancy, history of genetic mental illness and substance abuse (Wikipedia). Even with increased awareness, PPD often goes unnoticed and untreated. In addition to the toll this takes on mom, it can affect relationships with other family members and can inhibit the normal development of mother-child attachment. Research suggests that untreated PPD can have long term affects on baby’s development and behavior (Nonacs).

It’s no surprise that women go through significant changes immediately following birth. Hormone levels of progesterone and estrogen that rose gradually throughout the pregnancy now drop off sharply. So how can you differentiate between “Baby Blues” and depression? It can be common for women to have mood swings, irritability and tearfulness after the baby is born. These usually peak on the 4th -5th day following birth and are resolved within a few weeks. Most importantly, they do not interfere with the woman’s ability to care for herself or her baby.
Postpartum depression usually sneaks up over the first three months, although it can have a rapid onset. PPD is persistent and debilitating. Symptoms of PPD include: depressed mood, tearfulness, inability to find pleasure in events that were formerly pleasurable, insomnia, fatigue, appetite disturbance, suicidal thoughts, and recurrent thoughts of death. Women with PPD may have incessant fears about their babies’ health or, conversely, be ambivalent towards or have thoughts of harming their babies. I think this last one often causes women to hide or ignore their symptoms. When I had my first daughter I was a poor, single mom with a history of depression. Her father did not help with her care and I was afraid to go to take my problems to my family for fear of looking like a failure. Several weeks after she was born I started having images of accidentally putting her in the oven or the freezer and forgetting her there. I couldn’t get it out of my mind and I really thought I was going crazy.
My silver lining was my support network. At the time I had several friends who were pregnant and gave birth around the same time as me. We babysat for each other, laughed and cried with each other. We had someone who never tired of hearing every minute detail of the newborn experience. Another thing that helped was breastfeeding. Nursing releases prolactin, a hormone that stimulates the mammary glands to produce milk. Prolactin has also been shown to increase feelings of satisfaction. In a study done by Maureen Groer, at the University of Tennessee School of Nursing, women who breastfed were more likely to report less stress and negative moods in the postpartum period than formula feeding mothers. She reports that breastfeeding seems to be protective of women’s moods in the postpartum period.
Some women may need more help. There are traditional and non-traditional therapies for PPD. There’s no shame in taking antidepressants to get you over a tough spot. If you are breastfeeding and think you need to go on antidepressants, talk with your doctor about the best medicine and when to take it. kellymom.com is a great resource on breastfeeding and has information on BF and antidepressants, alternative therapies and PPD. In April, 2006, Governor Corzine signed a bill requiring health care professionals to screen new mothers and provide information on PPD> The NJ Department of Health and Senior Services has a web page on PPD, http://www.state.nj.us/health/fhs/ppd/index.shtml or call the 24 hour hotline(in NJ)1-800-328-3838. If you think you may have PPD, or if you think someone you love might have it, get the help you need, it’s the best thing you can do for yourself and your baby.