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 New treatments available for postpartum depression By Dr. Naomi Vilko The Medical Center at Princeton Friday, February 26, 1999 Having a baby is usually a joyful event, but it is also one of the most stressful times in a woman's life. After delivery, a mother copes with middle of the night feedings, soreness from nursing, round-the-clock diaper changes and tears — the baby's and very often, her own. Nearly 80 percent of women get the "baby blues" or an intense feeling of letdown after having a baby. They may have bouts of crying, feel stressed, tired and discombobulated. The blues are normal, brought on by fluctuating hormone levels and the stress of motherhood. Generally, the blues usually happen 48 hours to a week after the baby's birth. The symptoms tend to come and go and usually subside in a few days. If moodiness and depression persist, though, and a woman feels overwhelmed most of the time and can't function, she is likely experiencing postpartum depression. Postpartum depression is more serious, yet less common, than typical baby blues. PPD affects about 10 percent of women who give birth. Symptoms usually don't start right away like they do with baby blues. In fact, they can actually occur up to a year after the baby's birth. They can also last for months. And unlike baby blues, PPD usually requires more intense intervention. Just about any new mom can use support from family and friends, but women who suffer from PPD should seek professional help right away. PPD can not only threaten the mother's health, but it can be detrimental to her marriage, other relationships and her baby's welfare. A woman with PPD doesn't need to suffer. There are effective treatments, including improved social supports, psychotherapy and, if needed, medication, to help her feel better. Women tend to get a great deal of information about baby care before their babies arrive, but unfortunately they may not know much about PPD beforehand or whether they might be at risk for it. Even when they are experiencing signs of PPD, women often feel embarrassed to tell their obstetrician. They feel guilty, because they think they should be feeling happy about their new baby. It's important for these new mothers to realize that PPD is a physical disorder, not something they bring on themselves. They can't "pull themselves together" any more than someone with the flu could. Women who are most susceptible to PPD are those who have a prior psychiatric history or those who have a family member with psychiatric problems. Also, PPD tends to affect women who have a history of having pre-menstrual stress, mood swings or depression during their pregnancies, and stress from pregnancy, marriage or a transition from being a working woman to a stay-at-home mom. Once a woman experiences PPD, she has as 30 to 50 percent chance of having another episode with another child. Small minorities of women — one in 1,000 — actually experience postpartum psychosis, a break with reality that often results in hallucinations. Often, they may start out feeling depressed and their symptoms intensify. They can't sleep, they can't eat, and they become paranoid or experience suicidal thoughts. Only a small percentage of those women obsess about harming their babies or actually harm them, but they certainly are not attuned to a baby's needs. And studies have shown that children are at risk for developing depression and other mental disorders later in life if their mothers are depressed for extended periods. It takes a lot of energy to take care of a baby, and women who are depressed and suffering from PPD can't cope with the demands a new baby places on them. The baby may be colicky and the mother gets upset, or the mother may feel so anxious that the baby picks up on the mother's nervousness and gets fussy. The sooner the mother gets treatment, the better the prognosis for both mother and child. Often, these feelings of anxiety and isolation can be triggers for PPD. In some cultures, other women take care of a new mother during birth and afterward. Yet, in our culture, many women feel socially isolated. Their husbands may not be available to give a helping hand because they work long hours or work far from home, and family members may live far away. Having friends in or having family members come stay for a while can be a great support for a woman with PPD. If friends and family aren't available, a woman might consider hiring help. It's not always helpful to have someone take over total care of the baby, however, because that may make the new mother feel inept and helpless. Sometimes, just having company can make her feel better and less alone. There are also support groups women can join. Husbands often get frightened when their wives experience PPD. They may feel as if their wives are losing control or going a little crazy. Yet, by understanding more about the condition and participating in their wives' therapy, they can not only help their spouses, but themselves. They too may need help coping and reducing their stress. If a woman gets that support from her husband or from other family members and friends, and is still struggling because of PPD, she should be referred to a psychiatrist. PPD doesn't always require medication, but a woman should talk to her doctor about her symptoms so he or she can assess them. An antidepressant can give women with PPD more energy and ability to concentrate. It's not altogether clear whether an antidepressant is safe for those women who are nursing. Therefore, many doctors may encourage women to stop breast-feeding while on medication. Women who are more prone to PPD should also take care of themselves during pregnancy and after delivery, making sure they eat properly, get enough sleep and exercise. After the baby is born, it's important that they catch their breath and not try to get back to that prepartum weight and into the power suit too quickly. That kind of stress can make things worse. By taking care of themselves and reaching out for help, women with PPD can recover and better enjoy their new babies. Dr. Vilko is a psychiatrist on staff at The Medical Center at Princeton who specializes in the treatment of women. Health Matters appears Fridays in the Lifestyle section of The Packet and is contributed by The Medical Center at Princeton. |
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