Postpartum Depression

Breakfast in Bed by Mary Cassatt

Postpartum depression is the cruelest form of depression, coming when it does. Your most joyful (albeit totally sleep-deprived) time becomes your most torturous. After I had my son, I was certainly sleep deprived, but my overwhelming emotion was wonder and absolute content. My parents told me that I was a natural mother. Certainly taking care of my son came much more easily than I had expected, and I had less self-doubt than I had anticipated.

Of course, with my history of depression, I went back on antidepressants right away (I decided not to breastfeed, since I also had to immediately start taking the medication for my Multiple Sclerosis again). I didn’t want to lose one minute of my time with my son to depression, and I knew that a mother’s depression could affect her infant. Luckily, I didn’t have one moment of postpartum depression. I didn’t even suffer from the “baby blues,” a milder form of postpartum depression, that usually starts a few days after the birth. The baby blues generally lasts less than 2 weeks, and is thought to be caused by the hormonal change and loss of endorphins after the birth.

Postpartum depression is different from the baby blues that occurs after about 75% of births. The baby blues is a mild form of depression, often with severe mood swings, that usually starts a few days after the birth. The baby blues generally lasts less than 2 weeks, and is thought to be caused by the hormonal change and loss of endorphins after the birth.

Postpartum depression, which occurs in 10-15% of births, is often mistaken for the baby blues, but it is much more severe and longer in duration. It usually starts within 6 to 8 weeks after the birth, although it can begin up to a year afterwards. Factors that are thought to contribute to or cause it are:

  • the pregnancy was unplanned
  • stress
  • hormonal changes
  • lack of a support system or a poor support system
  • lack of sleep
  • medical complications for the mother or baby, i.e., a difficult pregnancy or birth
  • a prior depressive episode
  • family history of depression
  • predisposition to depression

Symptoms are:

  • anxiety
  • insomnia
  • feelings of guilt and/or inadequacy
  • difficulty making decisions
  • difficulty concentrating
  • sadness/weepiness

Some women with postpartum depression will also have postpartum psychosis, as in the case of Andrea Yates, but it is rare (1 in 1,000). If, however, you have any of the symptoms below, you must seek medical attention immediately.

  • hallucinations (hearing voices or seeing things that are not there)
  • delusions (having ideas that you believe despite all the evidence, i.e. that your baby is possessed)
  • severe insomnia
  • extreme anxiety and agitation
  • suicidal or homicidal thoughts

There are a few factors that make it difficult for a woman and her family to recognize postpartum depression and get treatment. A woman who suspects that she might have postpartum depression often has trouble overcoming the sense of shame that her “failure” will engender. Woman are used to taking care of others and putting themselves last. Women with postpartum depression have to deal with not only the numbing paralysis of depression, but also the feeling that she should be a superwoman and not indulge herself by seeking help.

In addition, postpartum depression is underdiagnosed and underpublicized compared to other forms of depression. The American medical community has been slow to recognize it, and it was not added to the DSM, the official bible of psychiatry, until 1994. Because of this, women and their families must often be persistent about getting treatment in the face of skepticism from medical professionals who insist that a woman’s postpartum depression is just the baby blues or difficulty adjusting to the new situation. It is imperative for a woman who thinks she has postpartum depression to get treatment. Depression is very likely to interfere with the bonding of mother and child.

If a woman is diagnosed with postpartum depression, she has several ways to attack it in addition to medical treatment. Antidepressants are generally recommended as part of treatment, as they are the most effective form of treatment. Tricyclic antidepressants are thought to be the safest if the mother is breastfeeding.

Support groups with other mothers are extremely helpful. It is a relief for the mother to know that she is not alone. She can let go of the myth of the bliss of a new baby, and find out that she is not the only one with a messy house, a baby who seems to cry all the time, and a wardrobe that now seems to consist of only sweatpants and sweatshirts. Women in support groups can also share coping strategies.

Estrogen therapy is also used in the treatment of postpartum depression. A British study reported that women using an estrogen patch showed greater and more rapid relief than women using a placebo patch.

Therapy for the mother and her partner can be extremely helpful, especially if her depression has been of a long duration. The new father is often feeling overwhelmed about being a parent, and is trying to deal with the complexities of having a partner with depression.

A new mother who is suffering from postpartum depression should also try to fit time in to exercise, as it releases endorphins that lift the mood as well as making her feel better about her post-pregancy body. Along those lines, it is very important for her to find time for herself, to go see a movie, get together with a friend, or have a pedicure. Along those lines, it’s important not to feel that asking for help from family and friends means you can’t cope with being a mother. Your wellbeing is essential for you, your partner and your baby.

If you’re a new mother with postpartum depression, take comfort in the fact that you’re not alone, and there is treatment that can bring you and your life back to normal. You will be able to enjoy this new life and your baby, and regain the closeness you had with your partner.

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