Editor’s note: Having faced postpartum (“post-birth” in plain English) depression in both my mother and my wife, I’ve seen how difficult it is for a new mother to even recognize the problem, let alone determine what to do about it. I have first-hand experience as a partner who has no idea what’s gone wrong or how to respond. In this first article in a two-part series, Dr. Shoshana Bennett will explain the basics of postpartum depression. In the next article (to be published in January), she will let you know what you can do when someone you love is battling this condition.
I’m a survivor of two life-threatening postpartum depressions. At the time of my illnesses, there was no help for me. The great news is that, if you know someone who is suffering from depression in pregnancy or postpartum, there’s help now. For the last 20 years my mission has been to educate medical and mental health professionals, and work directly with women and their families around the world to make sure they don’t suffer the way my family and I did. I’ve worked with over 15,000 women, and I’ve never met one who did not fully recover when given proper help.
Women are most vulnerable to mood disorders during pregnancy and the postpartum period. If depression or anxiety is going to surface, it typically happens at this time. Postpartum depression (PPD) is one of six postpartum mood disorders and is the most common, affecting about 15 percent of mothers around the world. The primary cause for PPD is thought to be the huge hormonal drop after the baby is delivered. This hormone shift then affects the neurotransmitters (brain chemicals). There are also psychosocial factors such as moving, illness, poor partner support, financial hardship, and social isolation that will negatively affect the woman’s emotional state. If the normal Baby Blues don’t go away within two weeks, it is considered then to be PPD. The condition often worsens if the mother doesn’t receive help. Although the onset of PPD is usually gradual, it can be rapid and may occur immediately after delivery. PPD can begin any time during the first year postpartum. It is extremely important to treat PPD, because if it goes untreated, the symptoms may become chronic. Twenty-five percent of mothers untreated for PPD remain depressed after one year. PPD can occur after the birth of any child, not just the first. Once a woman has had one occurrence, she is at high risk for another after a subsequent birth. Common symptoms are excessive worry, anger, feelings of guilt, sadness, hopelessness, sleep problems, uneasiness around the baby, poor concentration, loss of pleasure, decreased sex drive, and changes in appetite. Although there are factors that make some women high risk, no one is immune. Risk factors include: 50 to 80 % chance of PPD if there was a previous PPD, depression or anxiety during pregnancy, personal or family history of depression/anxiety, abrupt weaning, social isolation or poor support (especially poor partner support), history of mood problems with her menstrual cycle, mood changes while taking a birth control pill, or health problems with the mother or baby.
There are warning signs for which professionals, family, and friends can watch. She may need help if she exhibits some of these behaviors: misses her doctor appointments, worries excessively about her health or the health of the baby, looks unusually tired, requires a support person to accompany her to appointments, loses or gains a lot of weight, has physical complaints without any apparent cause, has poor milk production, evades questions about herself, cries easily, shows discomfort being with her baby, is not willing to let another person care for the baby, loses her appetite, cannot sleep at night when her baby is sleeping, and expresses concern that her baby does not like her. Warning signs in the baby include excessive weight gain or loss, delayed cognitive or language development, decreased responsiveness to the mother, and breastfeeding problems.
There are many important reasons why a new mother with PPD should receive help as soon as possible. If she remains untreated, there is an increased risk of her child(ren) developing psychiatric disturbances. There is a potential for child abuse or neglect, an increased risk for the woman to develop chronic depression or relapse, and there is a negative impact on the marriage and on all the family relationships.
The serious consequences of untreated maternal depression on children have been studied extensively. Infants with depressed mothers often weigh less, vocalize less, have fewer facial expressions and higher heart rates. They may be less active, slower to walk, fussier and less responsive to others. Toddlers with depressed moms are at higher risk for affective disorders. Studies show an increase in poor peer relationships, poor self-control, neurological delays and attention problems. Their symptoms mimic the mom’s depressed behavior. At 36 months, children with depressed mothers are often less cooperative and more aggressive. They also exhibit less verbal comprehension, lower expressive language skills, more problem behaviors and they perform poorly on measures of school readiness. Only one to two months of exposure to severe maternal depression increases the child’s risk to develop depression by age 15.
The recovery plan should include support (both personal and professional), specific nutrition which fights depression, a few hours of uninterrupted nighttime sleep (breastfeeding moms can do this too), medication if necessary, and regular breaks for herself. If her depression is so severe that she cannot exercise, just going outside, standing up straight, breathing deeply and getting some sunshine can help her. Since each woman’s circumstances and symptoms differ, it is important for each to receive an individual assessment and wellness plan. For instance, one may need more uninterrupted sleep at night and breaks during the day, and another may require more social support and thyroid balancing.
One thing is sure it is possible for each woman to regain her old self (or even a better self) and achieve 100% wellness when provided proper help. The earlier she receives help, the faster she recovers and the better her prognosis. The sooner a new mom starts enjoying her life, the better it is for her whole family.
Although not caused, of course, by reproductive hormones, new fathers also experience depression at the rate of at least 10 percent. Their symptoms differ from the fluctuating moods that moms with PPD exhibit. Fathers seem to have more tension and short-temperedness as their main symptoms, accompanied with some fear, anger, frustration, and feelings of helplessness. Dads with postpartum depression are often concerned about their partners, disrupted family life, and finances. They typically have increased expectations for themselves and confusion about their new role.
The strongest predictor of whether a new dad will become depressed postpartum is the presence of PPD in the mother. A father whose partner has PPD has between a 24 and 50 percent risk of developing depression after the baby is born. The onset of his PPD is usually later then the onset of PPD in the mother. In Chapter 16 of Postpartum Depression For Dummies I discuss why partners, if they aren’t receiving adequate help themselves, sometimes become depressed as the moms recover.
When fathers suffer from depression after the baby is born, their baby boys are negatively affected the most. These boys have been found to have twice as many behavioral problems in their early years as other children without depressed fathers.
Often dads contact me directly for help through www.drshosh.com or they go to www.postpartumdads.org or www.postpartum.net for further information. What’s most important for kids is that both the mom and the dad are healthy and happy.
Dr. Shoshana Bennett is a licensed psychologist who founded Postpartum Assistance for Mothers in 1987 after her second undiagnosed postpartum illness. Dr. Bennett is the Immediate Past President of Postpartum Support International and a past president of California’s state organization Postpartum Health Alliance. She is an author and noted guest lecturer, and her work has been the subject of numerous newspaper articles around the country.