Postpartum Depression
What Is Postpartum
Depression? For most women, having a baby is a very exciting, joyous, and often anxious time. But for women with postpartum, or peripartum, depression it can become very distressing and difficult. Postpartum depression is a serious, but treatable medical illness involving feelings of extreme sadness, indifference and/or anxiety, as well as changes in energy, sleep, and appetite. It carries risks for the mother and child. Women can also experience depression during pregnancy. Peripartum depression refers to depression occurring during pregnancy or after childbirth. The use of the term peripartum recognizes that depression associated with having a baby often begins during pregnancy. An estimated one in seven women experiences peripartum depression.1 Pregnancy and the period after delivery can be a particularly vulnerable time for women. Mothers often experience immense biological, emotional, financial, and social changes during this time. Some women can be at an increased risk for developing mental health problems, particularly depression and anxiety. Up to 70 percent of all new mothers experience the “baby blues,” a short-lasting condition that doesn’t interfere with daily activities and doesn’t require medical attention. Symptoms of this emotional condition may include crying for no reason, irritability, restlessness, and anxiety. These symptoms last a week or two and generally resolve on their own without treatment. Peripartum depression is different from the “baby blues” in that it is emotionally and physically debilitating and may continue for months or more. Getting treatment is important for both the mother and the child. Peripartum depression is not the “baby blues.” In January 2016, the U.S. Prevention Services Task Force updated its recommendation for depression screening in adults to include screening pregnant and postpartum women. Untreated peripartum depression is not only a problem for the mother’s health and quality of life, but can affect the well-being of the baby who can be born prematurely, with low birth weight. Peripartum depression can cause bonding issues with the baby and can contribute to sleeping and feeding problems for the baby. In the longer-term, children of mothers with peripartum depression are at greater risk for cognitive, emotional, development and verbal deficits and impaired social skills. 2, 3 Symptoms of peripartum depression 4
A woman experiencing depression usually has several of these symptoms, and the symptoms and their severity may change. These symptoms may cause new mothers to feel isolated, guilty, or ashamed. To be diagnosed with peripartum depression, symptoms must begin within four weeks following delivery. However, symptoms of depression may occur at any time Many women with peripartum depression also experience symptoms of anxiety. One study found that nearly two-thirds of women with peripartum depression also had an anxiety disorder. 5 While there is no specific diagnostic test for peripartum depression, it is a real illness that should be taken seriously. Any pregnant woman or new mother who experiences the symptoms of peripartum depression should seek evaluation by a medical professional – an internal medicine doctor or an OB-GYN, who can make referrals to a psychiatrist or other mental health professional. Assessment should include a psychiatric evaluation and a medical evaluation to rule out physical problems that may have symptoms similar to depression (such as thyroid problems or vitamin deficiencies). You should contact your doctor if
Who Is at Risk? Any new mother can experience the symptoms of peripartum depression or other mood disorder. Women are at increased risk of depression during or after pregnancy if they have previously experienced (or have a family history of) depression or other mood disorders, if they are experiencing particularly stressful life events in addition to the pregnancy, or if they don’t have the support of family and friends. Research suggests that rapid changes in sex and stress hormones and thyroid levels during and after delivery have a strong effect on moods and may contribute to peripartum depression. Other factors that may contribute include physical changes with pregnancy, changes in relationships and at work, worries about parenting and lack of sleep. Fathers: Pregnancy/childbirth and Depression New fathers can also experience symptoms of postpartum depression. Symptoms may include fatigue and changes in eating or sleeping. An estimated 4 percent of fathers experience depression in the first year after their child’s birth. Younger fathers, fathers with a history of depression and fathers with financial difficulties are at increased risk of experiencing depression. 1 Treatment Many women may suffer in silence, dismissing their struggles as a normal part of pregnancy and childbirth and not seek care. Treatment for depression during pregnancy is essential. Greater awareness and understanding can lead to better outcomes for women and their babies. Like other types of depression, peripartum depression can be treated with psychotherapy (talk therapy), medication, lifestyle changes and supports, or a combination of these. Women who are pregnant or nursing should discuss the risks and benefits of medication with their doctors. In general, the risk of birth defects to the unborn baby are low, and the decision should be made based on the potential risks and benefits. APA guidelines for treating women with major depressive disorder who are pregnant or breastfeeding recommend psychotherapy without medication as a first-line treatment when the depression or anxiety is mild. For women with moderate or severe depression or anxiety, antidepressant medication should be considered as a primary treatment, according to the guidelines. 6 Antidepressant options during pregnancy:
For more information on pregnancy/depression and psychiatric medications, see MotherToBaby from the Organization of Teratology Information Specialists, and Breastfeeding and Psychiatric Medications from Massachusetts General Hospital, Center for Women’s Mental Health. With proper treatment, most new mothers find relief from their symptoms. Women who are treated for peripartum depression should continue treatment even after they feel better. If treatment is stopped too soon, symptoms can recur. Self-help and Coping The support of family and friends, joining a mom’s support group, and good nutrition and exercise can be helpful. Other suggestions for helping to cope with depression around pregnancy include resting as much as you can (sleep when your baby sleeps) and make time to go out or visit friends. How Partners, Family and Friends Can Help Strong support from partners, family and friends is very important. Here are some suggestions from the Moms’ Mental Health Matters, a National Institutes for Health initiative, for how loved ones can help: Know the Signs. Learn to recognize the symptoms of depression and anxiety and if you see signs, urge her to see a health care provider. Listen to Her. Let her know you want to hear her concerns. For example, "I notice you are having trouble sleeping, even when the baby sleeps. What's on your mind?" Give Her Support. Let her know she's not alone and you are here to help. Try offering to help with household tasks or watching the baby while she gets some rest or visits friends. Encourage her to get help if needed. She may feel uncomfortable and not want to seek help. Encourage her to talk with a health care provider. Share some information on peripartum conditions. Offer to make an appointment for her talk with someone. National Suicide Prevention Lifeline at 1-800-273-TALK (8255) for free and confidential emotional support—they talk about more than just suicide. For those more comfortalble texting, Text "SOS" to 741741. Related conditions during pregnancy and after childbirth Peripartum anxiety – Although estimates vary, a recent study found that about 16 percent of women experience an anxiety disorder during pregnancy and about 17 percent during the postpartum period. 7 After giving birth, some women develop intense anxiety, with rapid heart rate, a sense of impending doom and irrational fears and obsessions. Feeling guilty and blaming oneself when things go wrong, worrying and feeling panicky for no good reason are signs of anxiety in the peripartum period. 8 Treatment may include medication and therapy, alone or in combination. Peripartum bipolar disorder – Bipolar disorder has 2 phases, the depression phase (the ‘lows’) and the manic phase (the ‘highs’). When the ‘lows’ and ‘highs’ happen at the same time, it is considered a ‘mixed’ episode. Bipolar illness can emerge during pregnancy or the postpartum period. Risk factors include a previous mood disorder and family history of mood disorders. Symptoms of depression and mania:
Treatment can include mood stabilizers and antipsychotic medications 9 along with therapy. Postpartum Psychosis – Postpartum
psychosis is an extremely rare but serious condition —
it occurs in only one or two out of every 1,000 deliveries.
The symptoms of postpartum psychosis are extreme and may
include insomnia, excessive energy, agitation, hearing
voices, and extreme paranoia or suspiciousness. Many women
with postpartum psychosis have a personal or family history
of bipolar disorder. Symptoms of postpartum psychosis can be
a serious medical emergency and require immediate
attention. Postpartum
depression By Mayo Clinic The birth of a baby can trigger a jumble of powerful emotions, from excitement and joy to fear and anxiety. But it can also result in something you might not expect — depression. Many new moms experience the "postpartum baby blues" after childbirth, which commonly include mood swings, crying spells, anxiety and difficulty sleeping. Baby blues typically begin within the first two to three days after delivery, and may last for up to two weeks. But some new moms experience a more severe, long-lasting form of depression known as postpartum depression. Rarely, an extreme mood disorder called postpartum psychosis also may develop after childbirth. Postpartum depression isn't a character flaw or a weakness. Sometimes it's simply a complication of giving birth. If you have postpartum depression, prompt treatment can help you manage your symptoms — and enjoy your baby. Symptoms Signs and symptoms of depression after childbirth vary, and they can range from mild to severe. Postpartum baby blues symptoms Signs and symptoms of baby blues — which last only a few days to a week or two after your baby is born — may include:
Postpartum depression symptoms Postpartum depression may be mistaken for baby blues at first — but the signs and symptoms are more intense and last longer, eventually interfering with your ability to care for your baby and handle other daily tasks. Symptoms usually develop within the first few weeks after giving birth, but may begin later — up to six months after birth. Postpartum depression symptoms may include:
Untreated, postpartum depression may last for many months or longer. Postpartum psychosis With postpartum psychosis — a rare condition that typically develops within the first week after delivery — the signs and symptoms are even more severe. Signs and symptoms may include:
Postpartum psychosis may lead to life-threatening thoughts or behaviors and requires immediate treatment. When to see a doctor If you're feeling depressed after your baby's birth, you may be reluctant or embarrassed to admit it. But if you experience any symptoms of postpartum baby blues or postpartum depression, call your doctor and schedule an appointment. If you have symptoms that suggest you may have postpartum psychosis, get help immediately. It's important to call your doctor as soon as possible if the signs and symptoms of depression have any of these features:
If you have suicidal thoughts If at any point you have thoughts of harming yourself or your baby, immediately seek help from your partner or loved ones in taking care of your baby and call 911 or your local emergency assistance number to get help. Also consider these options if you're having suicidal thoughts:
Helping a friend or loved one People with depression may not recognize or acknowledge that they're depressed. They may not be aware of signs and symptoms of depression. If you suspect that a friend or loved one has postpartum depression or is developing postpartum psychosis, help them seek medical attention immediately. Don't wait and hope for improvement. Causes There's no single cause of postpartum depression, but physical and emotional issues may play a role. Physical changes. After childbirth, a dramatic drop in hormones (estrogen and progesterone) in your body may contribute to postpartum depression. Other hormones produced by your thyroid gland also may drop sharply — which can leave you feeling tired, sluggish and depressed. Emotional issues. When you're sleep deprived and overwhelmed, you may have trouble handling even minor problems. You may be anxious about your ability to care for a newborn. You may feel less attractive, struggle with your sense of identity or feel that you've lost control over your life. Any of these issues can contribute to postpartum depression. Risk factors Postpartum depression can develop after the birth of any child, not just the first. The risk increases if:
Complications Left untreated, postpartum depression can interfere with mother-child bonding and cause family problems. For mothers. Untreated postpartum depression can last for months or longer, sometimes becoming a chronic depressive disorder. Even when treated, postpartum depression increases a woman's risk of future episodes of major depression. For fathers. Postpartum depression can have a ripple effect, causing emotional strain for everyone close to a new baby. When a new mother is depressed, the risk of depression in the baby's father may also increase. And new dads are already at increased risk of depression, whether or not their partner is affected. For children. Children of mothers who have untreated postpartum depression are more likely to have emotional and behavioral problems, such as sleeping and eating difficulties, excessive crying, and attention-deficit/hyperactivity disorder (ADHD). Delays in language development are more common as well. Preparing for your appointment After your first appointment, your doctor may refer you to a mental health provider who can create the right treatment plan for you. You may want to find a trusted family member or friend to join you for your appointment to help you remember all of the information discussed. What you can do Before your appointment, make a list of:
Questions to ask your doctor include:
Don't hesitate to ask other questions. What to expect from your doctor A doctor or mental health provider who sees you for possible postpartum depression may ask:
Tests and diagnosis Your doctor will usually talk with you about your feelings, thoughts and mental health to distinguish between a short-term case of postpartum baby blues and a more severe form of depression. Don't be embarrassed. Share your symptoms with your doctor so that a useful treatment plan can be created for you. As part of your evaluation, your doctor may:
The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is often used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment. Treatments and drugs Treatment and recovery time vary, depending on the severity of your depression and your individual needs. If you have an underactive thyroid or an underlying illness, your doctor may treat those conditions or refer you to the appropriate specialist. Your doctor also may refer you to a mental health provider. Baby blues The baby blues usually fade on their own within a few days to one to two weeks. In the meantime:
Postpartum depression Postpartum depression is often treated with psychotherapy (also called talk therapy or mental health counseling), medication or both.
With appropriate treatment, postpartum depression usually goes away within six months. In some cases, postpartum depression lasts much longer, becoming chronic depression. It's important to continue treatment after you begin to feel better. Stopping treatment too early may lead to a relapse. Postpartum psychosis Postpartum psychosis requires immediate treatment, often in the hospital. Treatment may include: Medication. When your safety is assured, a combination of medications — such as antidepressants, antipsychotic medications and mood stabilizers — may be used to control your signs and symptoms. Electroconvulsive therapy (ECT). If your postpartum depression is severe and does not respond to medication, ECT may be recommended. During ECT, a small amount of electrical current is applied to your brain to produce brain waves similar to those that occur during a seizure. The chemical changes triggered by the electrical currents can reduce the symptoms of psychosis and depression, especially when other treatments have failed. Treatment for postpartum psychosis can challenge a mother's ability to breast-feed. Separation from the baby makes breast-feeding difficult, and some medications used to treat postpartum psychosis aren't recommended for women who are breast-feeding. If you're experiencing postpartum psychosis, your doctor can help you work through these challenges. Lifestyle and home remedies Postpartum depression isn't generally a condition that you can treat on your own — but you can do some things for yourself that build on your treatment plan and help speed recovery.
Remember, the best way to take care of your baby is to take care of yourself. Coping and support The already stressful, exhausting period following a baby's birth is more difficult when depression occurs. But remember, postpartum depression is never anyone's fault. It's a common medical condition that needs treatment. So, if you're having trouble coping with postpartum depression, talk with a therapist. Ask your doctor or therapist about local support groups for new moms or women who have postpartum depression. The sooner you get help, the sooner you'll be fully equipped to cope with depression and enjoy your new baby. Prevention If you have a history of depression — especially postpartum depression — tell your doctor if you're planning on becoming pregnant or as soon as you find out you're pregnant. During pregnancy, your doctor can monitor you closely for signs and symptoms of depression. He or she may have you complete a depression-screening questionnaire during your pregnancy and after delivery. Sometimes mild depression can be managed with support groups, counseling or other therapies. In other cases, antidepressants may be recommended — even during pregnancy. After your baby is born, your doctor
may recommend an early postpartum checkup to screen for
signs and symptoms of postpartum depression. The earlier
it's detected, the earlier treatment can begin. If you have
a history of postpartum depression, your doctor may
recommend antidepressant treatment or psychotherapy
immediately after delivery. Postpartum
Depression Facts What is postpartum depression? Postpartum depression is a mood disorder that can affect women after childbirth. Mothers with postpartum depression experience feelings of extreme sadness, anxiety, and exhaustion that may make it difficult for them to complete daily care activities for themselves or for others. What causes postpartum depression? Postpartum depression does not have a single cause, but likely results from a combination of physical and emotional factors. Postpartum depression does not occur because of something a mother does or does not do. After childbirth, the levels of hormones (estrogen and progesterone) in a woman’s body quickly drop. This leads to chemical changes in her brain that may trigger mood swings. In addition, many mothers are unable to get the rest they need to fully recover from giving birth. Constant sleep deprivation can lead to physical discomfort and exhaustion, which can contribute to the symptoms of postpartum depression. What are the symptoms of postpartum depression? Some of the more common symptoms a woman may experience include:
How can a woman tell if she has postpartum depression? Only a health care provider can diagnose a woman with postpartum depression. Because symptoms of this condition are broad and may vary between women, a health care provider can help a woman figure out whether the symptoms she is feeling are due to postpartum depression or something else. A woman who experiences any of these symptoms should see a health care provider right away. How is postpartum depression different from the “baby blues”? The “baby blues” is a term used to describe the feelings of worry, unhappiness, and fatigue that many women experience after having a baby. Babies require a lot of care, so it’s normal for mothers to be worried about, or tired from, providing that care. Baby blues, which affects up to 80 percent of mothers, includes feelings that are somewhat mild, last a week or two, and go away on their own. With postpartum depression, feelings of sadness and anxiety can be extreme and might interfere with a woman’s ability to care for herself or her family. Because of the severity of the symptoms, postpartum depression usually requires treatment. The condition, which occurs in nearly 15 percent of births, may begin shortly before or any time after childbirth, but commonly begins between a week and a month after delivery. Are some women more likely to experience postpartum depression? Some women are at greater risk for developing postpartum depression because they have one or more risk factors, such as:
Postpartum depression can affect any woman regardless of age, race, ethnicity, or economic status. How is postpartum depression treated? There are effective treatments for postpartum depression. A woman’s health care provider can help her choose the best treatment, which may include:
These treatment methods can be used alone or together. What can happen if postpartum depression is left untreated? Without treatment, postpartum depression can last for months or years. In addition to affecting the mother’s health, it can interfere with her ability to connect with and care for her baby and may cause the baby to have problems with sleeping, eating, and behavior as he or she grows. How can family and friends help? Family members and friends may be the first to recognize symptoms of postpartum depression in a new mother. They can encourage her to talk with a health care provider, offer emotional support, and assist with daily tasks such as caring for the baby or the home. If you or someone you know is in crisis or thinking of suicide, get help quickly.
Where can I find more information? For more information on conditions
that affect mental health, resources, and research, go to
MentalHealth.gov at www.mentalhealth.gov
National Institute of Mental
Health U.S. Department of Health and Human
Services The Symptoms
of Postpartum Depression & Anxiety (in Plain Mama
English) Below we will explain the signs of postpartum depression and anxiety, but in what we call “plain mama English.” We won’t use words like hypomania or dysthymia—the kind of confusing terms you might see elsewhere. We will use the words thousands of other moms have used who have already been through this. Words that make sense. After that, we’ll give you some links to some really helpful resources and information. You are not alone. Here at Postpartum Progress we understand and we’re happy to help. When you read the two different symptoms lists below, one for postpartum depression and the one after it for postpartum anxiety and OCD, please remember a few very important things:
Postpartum Depression Symptoms Okay. Here we go. You may have postpartum depression if you have had a baby within the last 12 months and are experiencing some of these symptoms:
Postpartum Anxiety & OCD You may have postpartum anxiety or postpartum OCD if you have had a baby within the last 12 months and are experiencing some of these symptoms:
Now that you’ve gone through these lists, are you thinking, “How the heck does this lady know me? Is there a hidden camera in here?” Nope. What this should tell you is that you are not alone and you are not a freak and you are not highly unusual. If you are having these feelings and symptoms then it is possible you are experiencing common illnesses that 15 to 20% of new mothers have, and they are completely treatable. We’re happy to be here to support you. Postpartum Depression Help Postpartum Progress is a nonprofit created by moms for moms with maternal mental illness. We know what it’s like and we know how hard it is. Here are some of our best resources for moms with postpartum depression, postpartum anxiety and related illnesses:
Other Things You Should Know
Source:
www.postpartumprogress.com/the-symptoms-of-postpartum-depression-anxiety-in-plain-mama-english
Adele's words
about postpartum depression are profane, raw, and
honest.
Like many new moms dealing with postpartum depression, she didn't even realize that's what she was feeling at first. "My knowledge of postpartum — or post-natal, as we call it in England — is that you don’t want to be with your child; you’re worried you might hurt your child; you’re worried you weren’t doing a good job. But I was obsessed with my child. I felt very inadequate; I felt like I’d made the worst decision of my life. ... It can come in many different forms." An estimated 900,000 new mothers in the U.S. experience postpartum depression every year — and an alarmingly low 15% of these women actually receive treatment for it. There's still a huge stigma surrounding postpartum depression (PPD), and a lot of misconceptions about what such a diagnosis means. Society places high expectations on mothers and motherhood, and women often feel guilty if they don't take to their new role naturally. This means that many new mothers are hesitant to admit if motherhood isn't everything they're told it should be. For mothers experiencing postpartum depression, symptoms can range from unexplainable sadness to uncontrollable anger, and asking for help can feel like admitting you're a bad parent. Adele said she was also reluctant to seek help, though eventually, she found comfort in talking to other new moms. Of course, she described it to Vanity Fair in true Adele fashion — bluntly and with lots of raw emotion and f-bombs: "I didn’t talk to anyone about it. I was very reluctant ... My boyfriend said I should talk to other women who were pregnant, and I said, 'F**k that, I ain’t hanging around with a f**kin' bunch of mothers.' Then, without realizing it, I was gravitating towards pregnant women and other women with children, because I found they’re a bit more patient." Postpartum depression, of course, has many layers to it and presents differently in different people. But it was through these conversations with other mothers that Adele said she realized she wasn't alone. "One day I said to a friend, 'I f**kin' hate this,' and she just burst into tears and said, 'I f**kin' hate this, too.' And it was done. It lifted." By using her powerful voice to shine a light on the issue of postpartum depression, Adele is empowering mothers to recognize that they aren't alone and shouldn't be ashamed or afraid seek the help they need. Too often, mothers are expected to sacrifice everything for their kids and to do so without complaining and at the expense of their own mental health. There's a lot of pressure on moms to be perfect and to be incredibly hard on themselves if they take any time away from their kids, especially when their kids are still young. At the end of the day, you shouldn't need to justify what you need to feel good or to force yourself into a box of what you think a perfect mother looks like. The best way to take care of your kid and to be a great mom, especially if you're experiencing PPD, is to make sure you're taking care of yourself. Which is exactly what Adele did: "Eventually I just said, I'm going to give myself an afternoon a week, just to do whatever the f**k I want without my baby. A friend of mine said, 'Really? Don’t you feel bad?' I said, I do, but not as bad as I'd feel if I didn’t do it. Four of my friends felt the same way I did, and everyone was too embarrassed to talk about it; they thought everyone would think they were a bad mom, and it's not the case. It makes you a better mom if you give yourself a better time." Source: postpartumprogress.org/the-facts-about-postpartum-depression/
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