New York Daily News -

Baby blues
BY STACEY COLINO
Tuesday, November 16th, 2004

For some women, the joy of pregnancy
is clouded by an unexpected depression.

When Jennifer Mainiero became pregnant in 2000 with her first child, she developed chronic vomiting that lasted for nearly six months. But what was worse were the emotional changes the pregnancy brought.
"I became extremely anxious and depressed," recalls Mainiero, now 32, of Port Chester, N.Y. "My mind was constantly racing, and I was so jumpy that I felt like I was going insane. I kept thinking, 'I can't even take care of myself right now. How am I going to take care of a baby?' "

Postpartum depression receives considerable attention but depression and anxiety during pregnancy remain a fairly well-kept secret. So does the fact that the two often go hand in hand. Yet the truth is, prenatal depression and anxiety are fairly common. In one study, researchers at the University of Linkoping in Sweden found that 17% of pregnant women met the criteria for depression on a screening questionnaire when they were 35 weeks pregnant. (The prevalence of anxiety during pregnancy isn't known.)

"One of the reasons this issue hasn't been out of the closet is that usually one brings to the pregnancy experience an expectation of pleasure and joy," says Catherine Monk, Ph.D., an assistant professor in the psychiatry department at Columbia University. "To have an experience that is so discordant with the anticipation adds to the pain. There's a lot of shame about this among women who experience it."

The concern isn't just that an expectant mother may feel emotionally lousy throughout her pregnancy. A growing body of research suggests that untreated prenatal depression and anxiety may have negative effects on the developing fetus, as well as increasing the mother's chances of experiencing postpartum mood disorders.

"People think the only harmful thing they could do to their unborn baby is ingest a pharmaceutical compound," says Diana Dell, M.D., an assistant professor of psychiatry and obstetrics-gynecology at Duke University Medical Center in Durham, N.C. "The truth is, the condition itself may have a direct effect on the fetus as well as an indirect effect based on a woman's willingness to seek prenatal care."


Detrimental to development

An expectant mother suffering from depression or anxiety also may be less likely to eat as well as she should or more likely to self-medicate through smoking or drinking alcohol ” all of which are detrimental to a developing fetus. And research suggests that depressed or anxious mothers may be at higher risk for premature delivery.

Moreover, untreated anxiety or depression may affect a fetus' development in its own right. In a study at the Touch Research Institute at the University of Miami School of Medicine in Florida, researchers discovered that the fetuses of women who were classified as having high anxiety ” as well as high scores on depression and anger scales ” during the second trimester experienced growth delays, compared to those of less anxious moms. After birth, the anxious mothers' babies had depressed levels of mood-enhancing neurotransmitters such as dopamine and serotonin.


Anxious moms, anxious kids

Meanwhile, research at Catholic University of Leuven, Belgium, found that women who experienced anxiety between weeks 12 and 22 of their pregnancies were considerably more likely to have children who exhibited attention, hyperactivity, acting out or anxiety problems at age 8 or 9.

Yet mood disorders are frequently overlooked during pregnancy. A recent study at Yale University School of Medicine found that only 26% of pregnant women who screened positive for a psychiatric illness such as major depression or panic disorder were recognized as having the condition by their health-care provider.

Mood disorders are not caught as often as they should be during pregnancy, Monk says, because primary-care doctors and ob-gyns aren't screening for them routinely. "The ob visits are more focused on below the waist than above the neck," agrees Joyce A. Venis, R.N.C., a psychiatric nurse in Princeton, N.J., and president of Depression After Delivery, Inc. "Doctors need to realize that you can't separate what's happening to a woman's mind while her body is changing so rapidly."

Complicating matters, "there are some problems with diagnosing depression during pregnancy because some of the somatic symptoms ” fatigue, loss of appetite, sleep disturbances and impaired concentration ” can be normal in pregnancy," Dell says.

The key is to focus on sustained mood changes ” feeling helpless or hopeless, having thoughts of death or dying, losing pleasure in normally enjoyable activities, feeling enveloped by a black cloud, worrying about minor matters, and having intense worries about the baby's well-being or your ability to function as a mom.

Some women may be reluctant to seek treatment for depression or anxiety during pregnancy because they don't like the idea of taking medication in their condition. But experts agree that prenatal mood disorders should be treated one way or another.


Antidepressants as an option

Antidepressants are one option for both depression and anxiety. While there isn't definitive proof that using any anti-depressant is entirely risk-free during pregnancy, research has found no increased risk for intrauterine death or major birth defects associated with the use of the newer selective serotonin reuptake inhibitors (SSRIs) ” Prozac, Paxil, Zoloft and the like ” or other antidepressants, such as Effexor or Wellbutrin, Dell says.


Among the offspring of mothers who take SSRI antidepressants, "there may be transient neurological effects” the babies seem more irritable and cry more after birth ” which is why some doctors now recommend tapering the medication toward the end of pregnancy, if it would be safe for the mother," notes Margaret Altemus, M.D., an associate professor of psychiatry at Weill Medical College of Cornell University in New York City.

Of course, nonpharmacological treatments are also available, especially for milder forms of mood disorders during pregnancy. Psychotherapy ” particularly a form called inter-personal psychotherapy, which focuses on role transitions, expectations and conflicts ” can be especially useful, but couples counseling can also help treat depression during pregnancy, Monk says.

Meanwhile, cognitive-behavioral therapy can help with depression and anxiety during pregnancy.

Experts say the course of treatment should be decided on an individual basis, depending on a woman's history, whether there are coexisting conditions (such as bipolar or obsessive-compulsive disorder) and the severity of her symptoms.

In January 2001, Mainiero gave birth to a baby girl three months prematurely; she weighed only 2 pounds. Today, her daughter is a healthy, happy 3-year-old and shows no ill effects from the combination of medications Mainiero took to treat her emotional turmoil during pregnancy. But the experience left a lasting imprint on Mainiero. "It was traumatizing," she says.

"We are now wonderfully attuned to parenting, but we often forget that development starts before birth," Monk says. "A woman's state of mind during pregnancy can have a profound effect on the mother, the baby and their future relationship."


Jennifer Mainiero
32, Port Chester, N.Y.


Because of her experience with depression and anxiety during pregnancy, Jennifer Mainiero was initially "scared to death to get pregnant again." But she did.

"My doctor assured me that I could safely take medication going into my next pregnancy, so I started taking a combination of antidepressants and mood stabilizers. I got pregnant in March 2002, and I was monitored throughout the pregnancy by a high-risk obstetrician and a psychiatrist. This time, I loved being pregnant. I felt upbeat, and I took more enjoyment out of feeling the baby move inside me as the pregnancy progressed.

"For me, the benefits of taking medication outweighed the risks because I gained more weight ” I'd gained only 5 pounds with the first pregnancy ” and delivered him closer to term. Even though he was born six weeks prematurely in November 2003, he was healthy and weighed 6 pounds, 8 ounces.

"I'm glad the doctors were willing to try different medications going into this pregnancy because they really helped. "After this, I'm living proof that pregnancy can be done in a happier way even if you have depression during a previous one. Now, we're trying to have a third child."


Judith Babeu
39, East Brunswick, N.J


When Judith Babeu was pregnant in 1999 with her first child, she couldn't understand why she wasn't happier.

"My daughter was an in vitro baby so I should have felt overjoyed when I was pregnant because I had what I wanted. But I felt melancholy, and I couldn't understand why. When I told my obs how I was feeling, they kept saying I was just anxious because I was a first-time mom.

As I got closer to my due date, the sadness got worse and I was crying all the time. After I had the baby, I felt like everything turned black and started crashing around me. Fortunately, my obs recognized it as postpartum depression. But I really wish they had picked up on my depression during the pregnancybecause if I'd gotten treatment before the baby was born, I wouldn't have felt so bad afterward.

When I unexpectedly became pregnant with my son in 2003, I began feeling really sad during the second trimester and I started questioning whether I'd be able to take care ofhim or handle two kids. I was also petrified of having depression again, so I began seeing a therapist who was very action-oriented, and I started taking a low dose of Zoloft at the beginning of the third trimester. It made all the difference.

After I delivered my son in June, my dosage was bumped up. I'm feeling much better than when my daughter was this age."


Kathy Renye
37, New Jersey

When Kathy Renye, a mother of five, developed depression during her first pregnancy, little was known about the prenatal use of antidepressants so "I had to just stick it out," she says.


"I had a history of depression, and when I was pregnant with twins in 1992, I became severely depressed during the third trimester. It was so bad that I couldn't get out of bed in the morning. I wanted to sleep all the time to get away from the pain.

My mother had to take a leave of absence from work so she could take care of me. My ob didn't know what to do, and I went through five therapists before I found someone who could help.


After the babies were born, I was put on Prozac right away. It took about three weeks for the medication to kick in, and I suffered unbearable anxiety in the meantime. The worst part was: I kept crying and wondering when I would love my babies. Once the medication started working, I was able to care for them physically, and slowly it started to feel good. Then, I got those overwhelming feelings every mother has about how much she loves her children. Little by little, the depression and anxiety lifted until one day I was myself again.


I suffered three miscarriages, then in 1995 I got pregnant with another set of twins. By then, doctors knew antidepressants were safe to take during pregnancy so I took Zoloft. With my last child, I stayed on it through pregnancy and nursing - it was really gratifying to have it all go so smoothly."


RESOURCES


DEPRESSION AFTER DELIVERY, INC., a national, nonprofit organization, offers information, support and professional referrals to women with pregnancy and postpartum mood disorders. Log on to www.depressionafterdelivery.com or call 1-800-944-4773.

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More than Just œbaby blues.? Boot Camp For New Dads Provides Tips for Recognizing Postpartum Depression.

Boot Camp For New Dads, a non-profit program offered at more than 250 hospitals, clinics, schools and churches across the U.S. and bringing "rookie" fathers-to-be together with "veteran" recent dads and their newborns, warns that what might appear to be the baby blues, may in fact be a more serious condition known as postpartum depression.

Irvine, CA (PRWEB) December 30, 2004 -- About a month after giving birth, mom began to feel a little down. Her appetite waned and she never wanted to get out of the house, or out of bed for that matter. She just couldn't seem to shake the œbaby blues?.

According to Greg Bishop, founder of Boot Camp For New Dads, Stanford MBA and active Boot Camp coach, œMany new moms experience the baby blues, which can include symptoms of crying and mood swings, restlessness and fatigue that lasts for a few hours to two weeks after delivery. Postpartum depression, or PPD, doesn't always happen immediately after birth. It can take hold months after the baby is born and moms usually experience exaggerated symptoms of the baby blues. PPD is a serious condition that can affect any mom “ whether she's just given birth to her first child or fifth. PPD may be attributed to changes in hormone levels, the stress of a new baby, lack of sleep or a combination of things. It's important to know how to recognize the signs of the condition because moms with PPD will not get well without counseling and medication.?

Baby blues or postpartum? Boot Camp For New Dads advises moms and dads of several signs that indicate the serious disorder:

- Self-esteem issues “ Mom may have very negative feelings about herself. She may think she is worthless, unattractive or a bad mother. If she does feel this way, a simple œpep talk? is not going to help.
- Constant fatigue “ It's a fact that when the baby arrives, mom probably won't get as much sleep as she needs. One of the signs to watch for is constant fatigue, even upon waking. Fatigue is a symptom of depression.
- Weight loss or weight gain “ Yes, while some moms lose a little of the pregnancy weight within the first few months after birth, other moms stay the same weight. Significant weight loss from a lack of appetite or weight gain from overeating is sign that something is wrong.
- Crying often “ Mom's occasional crying is normal as her hormones fluctuate and she has difficulty getting that extra, much needed rest. But, crying every day and/or more than once a day is a red flag.
- Disinterest - When mom is not interested in herself, her baby, family or other activities, it's an indication that something is wrong.
- Mood swings “ Similar to a roller coaster ride, mood swings are extreme changes in mood. Mom's joyfulness immediately followed by sadness and despair are not healthy moods.
- Being afraid of hurting the baby or herself “ If mom is afraid of hurting the baby or herself, get medical attention immediately.

Postpartum depression is not selective. It can affect any woman who is pregnant, has had a baby or who has miscarried. Pay attention to mom and if you notice changes and/or recognize one or more of the symptoms above, take it seriously. First, find a way to take care of your baby, then get professional help for your spouse immediately. Talk to an experienced counselor or your physician. Most of all, continue to support and love her through this.

Battle the Blues
So, how can dad help mom battle a case of the less serious œbaby blues??

According to Bishop, œJust making mom feel appreciated will help. Here is where dads play a key role. Let her know how much you love everything about her. Get mom out of the house and provide a change of scenery. Take mom out even if it's for a drive on a sunny day or a trip to the mall. Reassure her of the great job she is doing. Most importantly, if she is feeling down, get her to open up and talk about how she's feeling.?

Badge of Honor
œI can't imagine a more rewarding activity than helping new dads step up to the challenge," rejoiced Bishop. "These guys are inspiring and should make all men proud, because once they understand how much they are needed, they deliver the goods.?

Boot Camp For New Dads' program is available to all dads-to-be regardless of cultural, economic or age level. For more information about Boot Camp programs or to obtain a copy of Boot Camp For New Dads' book, Hit the Ground Crawling: The Ultimate Guide For New Fathers, contact (714) 838-9392 or visit http://www.newdads.com.

Boot Camp Beginnings
Boot Camp For New Dads is a unique program that brings "rookie" fathers-to-be together with "veteran" recent dads and their newborns. Having a child is an awesome gift, and joy, and an immense challenge. Boot Camp For New Dads is helping dads prepare for their mission. A Boot Camp For New Dads session is a single three-hour program often on the first Saturday morning of each month.

Greg Bishop, founder of Boot Camp For New Dads, has had lots of hands-on experience caring for babies, with 12 siblings, 4 children of his own and numerous nieces and nephews. Bishop noticed that many men didn't seem to enjoy custody of their babies. After extensive research, he founded Boot Camp For New Dads at Irvine Medical Center (CA) in 1990 and has volunteered as Head Coach ever since.

National media, including news segments on ABC, CBS, NBC, and CNN as well as articles in Life, CHILD, Ladies Home Journal magazines, Reader's Digest and others, have helped fuel the expansion of Boot Camp For New Dads to over 250 programs reaching thousands of new dads. The program is designed to bring a dad's perspective to the 1.5 million men who become fathers each year across America.

Spanish and English
Determined to reach fathers everywhere, Boot Camp For New Dads has 12 Spanish language sites throughout the United States. The organization has created the only curriculum in Spanish for new fathers. Boot Camp For New Dads believes the key to improving the quality of life for many young children lies in helping fathers be capable and caring.

The Spanish version of the Boot Camp video helps support the facilitator and the œveterano? father in teaching the new dads to take care of the newborn baby and mother.

Roll Call
For more information about Boot Camp For New Dads, please call (714) 838-9392 or visit http://www.newdads.com.

Editors:
To arrange an interview with Greg Bishop, founder of Boot Camp For New Dads, or a coach at a Boot Camp program in your region, please contact Steve Dubin, Drool Sergeant & PR counsel at, e-mail protected from spam bots, (781) 878-9533.

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Pregnancy and Postpartum Psychiatric Illness
Perinatal (during pregnancy and postpartum) mood disorders are caused primarily by hormonal changes which then affect the neurotransmitters (brain chemicals). Life stressors, such as moving, illness, poor partner support, financial problems, and social isolation are certainly also important and will negatively affect the woman's mental state. Conversely, strong emotional, social, and physical support will greatly facilitate her recovery.

Any of the five postpartum mood disorders discussed in this chapter can also occur during pregnancy. These perinatal mood disorders behave quite differently from other mood disorders because the hormones are fluctuating. A woman with a perinatal mood disorder often feels as if she's œlosing it,? since she can never predict how she will feel at any given moment. For instance, at 8:00 A.M., she may be gripped with anxiety, at 10:00 A.M. feel almost normal, and at 10:30 A.M. become depressed and lethargic.

Our clients who have had personal histories of depression tell us that postpartum depression feels very different (and usually much worse) than depressions at other times in their lives. One of Shoshana's postpartum clients is a survivor of breast cancer. At a support group, she eloquently explained:

When I had cancer, I thought that was the worst experience I could ever have. I was wrong ” this is. With cancer, I allowed myself to ask for and receive help, and expected to be depressed. My friends and family rallied around me, bringing me meals, cleaning my house, and giving me lots of emotional support. Now, during postpartum depression, I feel guilty asking for help and ashamed of my depression. Everyone expects me to feel happy and doesn't accept that this illness is just as real as cancer.

Women who experience these symptoms need to speak up and be persistent in getting proper care. In the past, these illnesses have been trivialized and even dismissed. Research has shown how important it is to treat perinatal mood disorders for the health and well-being of the mother, baby, and entire family.

The Psychiatric Issues of Pregnancy

Contrary to popular mythology, pregnancy is not always a happy, glowing experience! Approximately 15-20 percent of pregnant women experience depression. Of these, about 15 percent are so severely depressed that they attempt suicide.

It can be confusing that normal pregnancy experiences such as fatigue, appetite changes, and poor sleep are similar to symptoms of mood disorders. It is easy to make a blanket dismissal of these symptoms as just part of pregnancy. However, for that 10 percent, it is essential that the proper questions are asked and intervention is given when symptoms Pregnancy and Postpartum Psychiatric Illness 31 are outside the normal realm.

When symptoms of depression or other mood disorders cause limitations in the client's ability to function on a day-today basis, intervention is necessary. This may include traditional (counseling and medication) or nontraditional modalities (such as Yoga or acupressure), or any combination thereof. The goal is to use whatever the individual woman needs in order to feel like herself again.

Depression during pregnancy has been associated with low birth weight (less than 2,500 grams) and preterm delivery (less than 37 weeks). Severe anxiety during pregnancy may cause harm to a growing fetus due to constriction of the placental blood vessels and higher cortisol levels.

Some women become pregnant while taking psychotropic medications for depression, anxiety, and other mood problems. Many of these medications are considered acceptable during pregnancy. A practitioner who is familiar with the current research about the safety of taking medications during pregnancy should be consulted. Often it is safer to continue a medication than risk a relapse.

The rate of relapse for a major depressive disorder (MDD) in women who discontinue their medication before conception is between 50-75 percent. The rate of relapse for MDD in those who discontinue medications at conception or in early pregnancy is 75 percent, with up to 60 percent relapsing in the first trimester. In one study, 42 percent of women who discontinued medications at conception resumed medications at some time during their pregnancy. Resources listed in the back of this manual provide helpful guidelines regarding the use of medications.

Mood Disorders

There are five postpartum mood disorders. This list details each of the principal disorders, some of their most common symptoms, and risk factors. It is important to note that symptoms and their severity can change over the course of an illness.

"Baby Blues" Not Considered a Disorder

This is not considered a disorder since the majority of mothers experience it.

• Occurs in about 80 percent of mothers
• Usual onset within first week postpartum
• Symptoms may persist up to three weeks

Symptoms

• Mood instability
• Weepiness
• Sadness
• Anxiety
• Lack of concentration
• Feelings of dependency

Etiology

• Rapid hormonal changes
• Physical and emotional stress of birthing
• Physical discomforts
• Emotional letdown after pregnancy and birth
• Awareness and anxiety about increased responsibility
• Fatigue and sleep deprivation
• Disappointments including the birth, spousal support, nursing, and the baby

Deborah's story:

For about a week and a half after my baby was born I would cry for no reason at all. Sometimes I would feel overwhelmed, especially when I was up at night with my son. Once I even thought that I had made a big mistake having a child. I felt resentment toward my husband since his life stayed pretty much the same and mine was turned upside down. When I started going to the mother's club at two weeks, I felt so relieved that all these other moms felt the same way.

Deborah's treatment:

Since Deborah was experiencing normal postpartum adjustment, she did not require any formal treatment. Her hormones were balancing out by themselves. All she needed in order to enjoy her new life was a combination of socializing with other moms, taking time to care for herself, and working out a plan of sharing child and household responsibilities with her husband.

Depression and/or Anxiety

• Occurs in 15 to 20 percent of mothers
• Onset is usually gradual, but it can be rapid and begin any time in the first year
• Excessive worry or anxiety
• Irritability or short temper
• Feeling overwhelmed, difficulty making decisions
• Sad mood, feelings of guilt, phobias
• Hopelessness
• Sleep problems (often the woman cannot sleep or sleeps too much), fatigue
• Physical symptoms or complaints without apparent physical cause
• Discomfort around the baby or a lack of feeling toward the baby
• Loss of focus and concentration (may miss appointments, for example)
• Loss of interest or pleasure, decreased libido
• Changes in appetite; significant weight loss or gain

Risk factors

• 50 to 80 percent risk if previous postpartum depression
• Depression or anxiety during pregnancy
• Personal or family history of depression/anxiety
• Abrupt weaning
• Social isolation or poor support
• History of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD)
• Mood changes while taking birth control pill or fertility medication, such as Clomid
• Thyroid dysfunction

Lori's story:

I was so excited about having our baby girl. My pregnancy had gone smoothly. I had been warned about the œBlues,? but I just couldn't shake the tears and sadness that seemed to get deeper and darker every day. My appetite was non-existent, although I forced myself to eat because I was nursing. I lost about 30 pounds the first month. At night I was having trouble sleeping. My husband and baby would be asleep but I would have one worry after another going through my head. I was exhausted. I felt like my brain had been kidnapped. I couldn't make decisions, couldn't focus, and didn't want to be left alone with the baby.

I wanted to run away. I withdrew from friends and felt guilty about not returning phone calls. I couldn't understand why I felt so bad; I had the greatest, most supportive husband, a house I loved, and the beautiful baby I had always wanted. At times I felt close to her, but at other times I felt like I was just going through the motions ” she could have been someone else's child. I thought I was the worst mother and wife on the face of the earth.

Lori's treatment:

Lori began psychotherapy and also saw a psychiatrist for medication. She was started on an antidepressant and the dosage was gradually increased. Initially she took medication to help her sleep as well. She began taking regular breaks to take care of herself. She also started attending a postpartum depression support group and met other moms with similar stories. After several months she felt like herself.

Obsessive-Compulsive Disorder

• 3 to 5 percent of new mothers develop obsessive symptoms

Symptoms

• Intrusive, repetitive, and persistent thoughts or mental pictures
• Thoughts often are about hurting or killing the baby
• Tremendous sense of horror and disgust about these thoughts (ego-alien)
• Thoughts may be accompanied by behaviors to reduce the anxiety (for example, hiding knives)
• Counting, checking, cleaning or other repetitive behaviors

Risk factors

• Personal or family history of obsessive-compulsive disorder

Tanya's story:

Each time I went near the balcony I would clutch my baby tightly until I was in a room with the door closed. Only then did I know he was safe one more time from me dropping him over. The bloody scenes I would envision horrified me. Passing the steak knives in the kitchen triggered images of my stabbing the baby, so I asked my husband to hide the knives. I never bathed my baby alone since I was afraid I might drown him.

Although I didn't think I would ever really hurt by baby son, I never trusted myself alone with him. I was terrified I would œsnap? and actually carry out one of these scary thoughts. If my baby got sick it would be all my fault, so I would clean and clean to make sure there were no germs. Although I had always been more careful than other people, now I would check the locks on the windows and doors many times a day.

Tanya's treatment:

After meeting with Tanya twice individually, her therapist suggested that her husband join her in the next session. Tanya needed reassurance that her husband knew she wasn't œcrazy? and would never really harm the baby. She did not want to tell him the specific graphic thoughts, so she referred to them generally as œscary thoughts.? After being educated, her husband's aggravation with her being œnervous all the time? subsided.

Tanya started taking an antidepressant and within two weeks the scary thoughts were occurring far less frequently. Her therapist suggested that she wait another few weeks to join a support group since she was still too vulnerable to hear about the anxieties of others. In the meantime, she was given the names and numbers of a few women to connect with who had survived this disorder.

Panic Disorder

• Occurs in about 10 percent of postpartum women

Symptoms

• Episodes of extreme anxiety
• Shortness of breath, chest pain, sensations of choking or smothering, dizziness
• Hot or cold flashes, trembling, palpitations, numbness or tingling sensations
• Restlessness, agitation, or irritability
• During attack the woman may fear she is going crazy, dying, or losing control
• Panic attack may wake her up
• Often no identifiable trigger for panic
• Excessive worry or fears (including fear of more panic attacks)

Risk factors

• Personal or family history of anxiety or panic disorder
• Thyroid dysfunction

Chris's story:

At about three weeks postpartum I stopped leaving my house at all except for pediatrician appointments. I was afraid I might have a panic attack in the store and not be able to take care of my baby. I never knew when that wave would begin washing over me and I would œlose it.? The windows had to be open all the time or else I thought I would suffocate if I had an attack.

The first time I had a panic attack I thought I was having a major heart attack. A friend drove me to the emergency room and the doctor on call told me it was only stress. He gave me some medicine but I was too afraid to take it. I went home feeling stupid, like I had made a big deal out of nothing.

Everyone told me that breastfeeding would relax me, but it did just the opposite. I never knew how much milk my baby was getting and that really worried me. Sometimes when my milk would let down I would get a panic attack. The first therapist I saw told me I must have had issues bonding with my own mother, but I knew that wasn't true and I didn't see that therapist again. On many nights I woke up in a sweat, with my heart beating so fast and hard. My head was racing with anxious thoughts about who would take care of the baby when I die. I thought I was going crazy. I was so scared.

Chris's treatment:

Chris had her first therapy appointment over the telephone since she felt she could not go outside. Her therapist talked her through taking a bit of the medication her MD prescribed, so Chris would know she had something that would help in an emergency.

Driving was too scary for her, especially in tunnels and over bridges. Her husband drove her to her next session, following a route that avoided those obstacles. Chris needed to sit near the door during the appointment just in case she felt the need to run outside for some air. Her therapist urged her to sleep for at least half the night, every night. Chris's husband began taking care of his baby for the first half of the night on a regular basis. Chris noticed immediately how sleep lowered her stress level. She attended a stress management class which also helped. P

Psychosis

• Occurs in one to two per thousand
• Onset usually two to three days postpartum
• This disorder has a 5 percent suicide and 4 percent infanticide rate

Symptoms

• Visual or auditory hallucinations
• Delusional thinking (for example, about infant's death, denial of birth, or need to kill baby)
• Delirium and/or mania

Risk factors

• Personal or family history of psychosis, bipolar disorder, or schizophrenia
• Previous postpartum psychotic or bipolar episode

Mike's story:

My wife, Gloria, had a great pregnancy and a long labor. We were thrilled to have our first child, a son. But within days of his birth my wife began to withdraw into her own world. She became less and less communicative and she became more and more confused and suspicious. I almost had to carry her into the therapist's office; by that time she could hardly speak or answer questions, nor write her name on the forms her therapist gave us. I was told to take her to the hospital immediately.

When we arrived at the hospital, she became fearful and then violent. She ended up in restraints. Fortunately, she responded pretty quickly to the anti-psychotic medication, and was able to come home after about a week. She continued to improve, and when she was back to herself again, she slowly weaned off all the medications.

We had always wanted two kids, so we consulted with our therapist and psychiatrist. With careful planning, we now have our second child with a very different story to tell.

Gloria's treatment:

After being released from the hospital, Gloria continued therapy and saw the psychiatrist, who carefully monitored her medication. She worked to understand and process what had happened to her. Eventually she joined a postpartum support group which was quite helpful. Since there were no other moms present in the group who had experienced a postpartum psychosis, the group leader gave her the names and numbers of women who had œbeen there? and who wanted to help.

Postpartum Psychiatric Illness Posttraumatic Stress Disorder

• There is no available data regarding the prevalence or onset

Symptoms

• Recurrent nightmares
• Extreme anxiety
• Reliving past traumatic events (for example, sexual, physical, emotional, and childbirth)

Risk factors

• Past traumatic events

Jennifer's story:

During the delivery it all came flooding back. I felt terrorized and vulnerable. I thought I had already dealt with the abuse in my childhood. It seemed that all the years of therapy were a waste of time and money. I was so embarrassed for losing control during labor. I was angry that what happened to me as a kid was still affecting me after all this time.

My therapist told me the nightmares and flashbacks would go away but I just didn't know. It was so real ” like the abuse was happening again over and over. I couldn't even leave my poor husband alone with my baby. I got the sick feeling that I couldn't even trust him. I was so messed up. I thought maybe I'd never be a normal mother.

Jennifer's treatment:

Jennifer hired a postpartum doula who took care of her and the baby for two months. Having this trusted female companion with her almost everywhere she went gave Jennifer comfort. She began weekly therapy sessions and eventually joined a support group. She and her therapist agreed that she did not need medication at this point.

Consequences of Untreated Mood Disorders

Maternal depression was placed at the top of the list entitled, œMost significant mental health issues impeding children's readiness for school? (Mental Health Policy Panel, Department of Health Services, 2002). There is a tremendous amount of data regarding the profoundly negative impact of untreated maternal depression on infants, toddlers, preschoolers, school age children and adolescents. There is an increased incidence of childhood psychiatric disturbance, behavior problems, poor social functioning, and impaired cognitive and language development. When a depressed mother goes untreated, every member of the family and all the relationships within the family are affected. The quicker the mother is treated, the better the prognosis for the entire family.

Perinatal Loss

No matter how a pregnancy is terminated, whether by nature or by choice, depression and anxiety commonly follow. Not only should grief be addressed through counseling, but medications may also be useful in reducing symptoms due to loss and hormonal changes. When a stillbirth or neonatal death occurs, depression is, of course, to be expected. Counseling for the couple will be helpful, and medications may be needed to treat anxiety and depression. These women need to be monitored carefully for emotional symptoms in subsequent pregnancies and the postpartum period.


~ Shoshana S. Bennett, Ph.D. and Pec Indman, Ed.D., MFT
Moodswings Press, 2003

PostPartum.net

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POSTPARTUM DEPRESSION


Why do women get postpartum depression?
What is postpartum depression? Are the "baby blues" the same thing as postpartum depression?
What are the signs of postpartum depression?
Who is at risk for getting postpartum depression?
What causes postpartum depression?
How is postpartum depression treated?
What can I do to take better care of myself if I get postpartum depression?

See also¦



DEPRESSION FAQ

Why do women get postpartum depression?
Having a baby can be one of the biggest and happiest events in a woman's life. While life with a new baby can be thrilling and rewarding, it can also be hard and stressful at times. Many physical and emotional changes can happen to a woman when she is pregnant and after she gives birth. These changes can leave new mothers feeling sad, anxious, afraid, or confused. For many women, these feelings (called the baby blues) go away quickly. But when these feelings do not go away or get worse, a woman may have postpartum depression. This is a serious condition that requires quick treatment from a health care provider.

What is postpartum depression? Are the "baby blues" the same thing as postpartum depression?
Postpartum depression (PPD) is a condition that describes a range of physical and emotional changes that many mothers can have after having a baby. PPD can be treated with medication and counseling. Talk with your health care provider right away if you think you have PPD.

There are three types of PPD women can have after giving birth:

The baby blues happen in many women in the days right after childbirth. A new mother can have sudden mood swings, such as feeling very happy and then feeling very sad. She may cry for no reason and can feel impatient, irritable, restless, anxious, lonely, and sad. The baby blues may last only a few hours or as long as 1 to 2 weeks after delivery. The baby blues do not always require treatment from a health care provider. Often, joining a support group of new moms or talking with other moms helps.

Postpartum depression (PPD) can happen a few days or even months after childbirth. PPD can happen after the birth of any child, not just the first child. A woman can have feelings similar to the baby blues - sadness, despair, anxiety, irritability - but she feels them much more strongly than she would with the baby blues. PPD often keeps a woman from doing the things she needs to do every day. When a woman's ability to function is affected, this is a sure sign that she needs to see her health care provider right away. If a woman does not get treatment for PPD, symptoms can get worse and last for as long as 1 year. While PPD is a serious condition, it can be treated with medication and counseling.

Postpartum psychosis is a very serious mental illness that can affect new mothers. This illness can happen quickly, often within the first 3 months after childbirth. Women can lose touch with reality, often having auditory hallucinations (hearing things that aren't actually happening, like a person talking) and delusions (seeing things differently from what they are). Visual hallucinations (seeing things that aren't there) are less common. Other symptoms include insomnia (not being able to sleep), feeling agitated (unsettled) and angry, and strange feelings and behaviors. Women who have postpartum psychosis need treatment right away and almost always need medication. Sometimes women are put into the hospital because they are at risk for hurting themselves or someone else.

What are the signs of postpartum depression?
The signs of postpartum depression include:

Feeling restless or irritable.

Feeling sad, depressed or crying a lot.

Having no energy.

Having headaches, chest pains, heart palpitations (the heart being fast and feeling like it is skipping beats), numbness, or hyperventilation (fast and shallow breathing).

Not being able to sleep or being very tired, or both.

Not being able to eat and weight loss.

Overeating and weight gain.

Trouble focusing, remembering, or making decisions.

Being overly worried about the baby.

Not having any interest in the baby.

Feeling worthless and guilty.

Being afraid of hurting the baby or yourself.

No interest or pleasure in activities, including sex.

A woman may feel anxious after childbirth but not have PPD. She may have what is called postpartum anxiety or panic disorder. Signs of this condition include strong anxiety and fear, rapid breathing, fast heart rate, hot or cold flashes, chest pain, and feeling shaky or dizzy. Talk with your health care provider right away if you have any of these signs. Medication and counseling can be used to treat postpartum anxiety.

Who is at risk for getting postpartum depression?
Postpartum depression (PPD) affects women of all ages, economic status, and racial/ethnic backgrounds. Any woman who is pregnant, had a baby within the past few months, miscarried, or recently weaned a child from breastfeeding can develop PPD. The number of children a woman has does not change her chances of getting PPD. New mothers and women with more than one child have equal chances of getting PPD. Research has shown that women who have had problems with depression are more at risk for PPD than women who have not had a history of depression.

What causes postpartum depression?

No one knows for sure what causes postpartum depression (PPD). Hormonal changes in a woman's body may trigger its symptoms. During pregnancy, the amount of two female hormones, estrogen and progesterone, in a woman's body increase greatly. In the first 24 hours after childbirth, the amount of these hormones rapidly drops and keeps dropping to the amount they were before the woman became pregnant. Researchers think these changes in hormones may lead to depression, just as smaller changes in hormones can affect a woman's moods before she gets her menstrual period.

Thyroid levels may also drop sharply after giving birth. (The thyroid is a small gland in the neck that helps to regulate how your body uses and stores energy from foods eaten.) Low thyroid levels can cause symptoms that can feel like depression, such as mood swings, fatigue, agitation, insomnia, and anxiety. A simple thyroid test can tell if this condition is causing a woman's PPD. If so, thyroid medication can be prescribed by a health care provider.

Other things can contribute to PPD, such as:

Feeling tired after delivery, broken sleep patterns, and not enough rest often keeps a new mother from regaining her full strength for weeks. This is particularly so if she has had a cesarean (C-section) delivery.

Feeling overwhelmed with a new, or another, baby to take care of and doubting your ability to be a good mother.

Feeling stress from changes in work and home routines. Sometimes women think they have to be "super mom" or perfect, which is not realistic and can add stress.

Having feelings of loss - loss of identity (who you are, or were, before having the baby), loss of control, loss of a slim figure, and feeling less attractive.

Having less free time and less control over time. Having to stay home indoors for longer periods of time and having less time to spend with the baby's father.

How is postpartum depression treated?

It is important to know that postpartum depression (PPD) is treatable and that it will go away. The type of treatment will depend on how severe the PPD is. PPD can be treated with medication (antidepressants) and psychotherapy. Women with PPD are often advised to attend a support group to talk with other women who are going through the same thing. If a woman is breastfeeding, she needs to talk with her health care provider about taking antidepressants. Some of these drugs affect breast milk and should not be used.

What can I do to take better care of myself if I get
postpartum depression?

The good news is that if you have PPD, there are things you can do to take care of yourself.

Get good, old-fashioned rest. Always try to nap when the baby naps.

Stop putting pressure on yourself to do everything. Do as much as you can and leave the rest! Ask for help with household chores and nighttime feedings.

Talk to your husband, partner, family, and friends about how you are feeling.

Do not spend a lot of time alone. Get dressed and leave the house - run an errand or take a short walk.

Spend time alone with your husband or partner.

Talk to your health care provider about medical treatment.
Do not be shy about telling them your concerns. Not all health care providers know how to tell if you have PPD. Ask for a referral to a mental health professional who specializes in treating depression.

Talk with other mothers, so you can learn from their experiences.

Join a support group for women with PPD. Call a local hotline or look in your telephone book for information and services.

For More Information...

You can find out more about postpartum depression by contacting the National Women's Health Information Center (NWHIC) at 1-800-994-9662 or the following organizations:

National Institute of Mental Health
Phone Number(s): (301) 496-9576
Internet Address: http://www.nimh.nih.gov/

Depression After Delivery, Inc.
Phone Number(s): (800) 944-4773
Internet Address: http://www.depressionafterdelivery.com/

Postpartum Education for Parents
Phone Number(s): (805) 564-3888
Internet Address: http://www.sbpep.org

American Psychological Association
Phone Number(s): (800) 374-2721
Internet Address: http://www.apa.org

American College of Obstetricians and Gynecologists (ACOG)
Phone Number(s): (800) 762-2264
Internet Address: http://www.acog.com

All material contained in the FAQs is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Women's Health in the Department of Health and Human Services; citation of the source is appreciated.

This FAQ has been reviewed by Peter J. Schmidt, M.D. of the National Institute of Mental Health, National Institutes of Health

--------------------------------------------------------------------------------

Contact NWHIC
or call 1-800-994-WOMAN

NWHIC is a service of the
U.S. Department of Health and Human Services'
Office on Women's Health


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Below is a list of self-help suggestions that may ease the sting of your symptoms throughout the course of your recovery. Keep in mind that you may not feel well enough to do many of the things listed here. They are, however, reminders, that you continue to hold more power than you think you do, over the way you feel while you are healing.

The most important thing for you to do right now is to follow your doctor's treatment plan, continue to take your medication if it has been prescribed for you, and keep in touch with those close to you, letting them know how you are feeling. After that, do what you are able, no more and no less. Take small steps, try not to be too hard on yourself and take one day at a time....

Rest when your baby sleeps.
Let your partner know how you are feeling.
Make your needs a priority.
Let others know what they can do to help.
Avoid strict or rigid schedules.
Give yourself permission to have negative feelings.
Screen phone calls.
Do not expect too much from yourself right now
Allow yourself a moment to laugh.
Avoid overdoing anything.
Be careful asking too many people for advice.
Trust your instincts.
Set limits with your guests.
Avoid people who make you feel bad.
Set boundaries with people you can't avoid.
Eat well.
Avoid caffeine and alcohol.
Take a walk.
Set small goals for yourself.
Stay on all medications you have been instructed to take.
Don't be afraid to ask for help.
Get out of the house.
Don't feel guilty, it wastes energy.
Play.
Expect some good days and some bad days.
Prioritize what needs to be done and what can wait.
Thank your partner for helping you.
Don't compare yourself to others.
Be very specific about what you need from your partner.
Do not blame yourself.
Delegate household duties.
Do the best you can. If it doesn't feel like enough, it's enough for now.
Encourage your partner to seek support from friends and outside activities.
Confide in someone you trust.
Remind yourself that all adjustments take time.

Copyright © The Postpartum Stress Center
www.postpartumstress.com

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The following is a list of possible referral sources. When you call, ask if they have the name of a therapist who specializes in the treatment of women and depression. Expertise in postpartum depression is not as essential as finding a good, qualified therapist with whom you feel comfortable. (In some cases, you may need a physician/psychiatrist for medication and/or a therapist)

Obstetrician
Pediatrician
General practitioner/family doctor
Breastfeeding support group (Call even if you're not breastfeeding)
Local mental health agency (Usually has a reasonable sliding fee scale)
Local Family Services agency
Parenting or new mother support group
Locate a therapist in your area
Local hospital (Try Social Services Dept / Childbirth Education Dept Maternity Services Dept)
Local teaching hospital (Psychiatry Dept)
Personal referral from friend, neighbor, someone you trust
Yellow pages
Church or synagogue
Postpartum Support, International (PSI) (Click on "need social support": lists of state coordinators who can direct you to a local therapist)
Depression After Delivery (D.A.D.) (Call and ask for list of local practitioners in your area)
Local Women's Center (These are popping up all over. Some are free- standing and some are affiliated with hospitals)
And remember: always be a strong consumer advocate. If you think you aren't getting adequate care, if you are concerned about the medications you are taking, if you have concerns about your treatment “ ask questions until you are satisfied with the answer. If you're not satisfied, get another opinion. YOU may be the best judge of how you are feeling and how your treatment is progressing. If you have recently had a baby and are not feeling yourself or think something is wrong... it is probably time to get help. PPD can occur anytime within the first year after childbirth. Without proper treatment, symptoms can linger or get worse.

PPD is very treatable. You will feel better again.


Stress Center
www.postpartumstress.com

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Links:

http://www.4woman.gov/faq/postpartum.htm

http://www.nlm.nih.gov/medlineplus/postpartumdepression.html

http://www.postpartum.net/

http://www.thelaboroflove.com