Postpartum Depression

                                      

 

Postpartum depression is a term that has been widely used to explain the depressive symptoms following the birth of a child. Postpartum is NOT the same as “baby blues” that a majority of mothers experience within days and up to 2-3 weeks post pregnancy. Postpartum depression meets the same criteria for Major Depressive Disorder, and is much more persistent and enduring, and can also be accompanied with more seriously indicated symptoms of psychosis, although psychotic symptoms are extremely rare in most cases.

 

PMADs

 

Further research in the field has worked to expand the definition of Postpartum depression to Perinatal Mood and Anxiety Disorders, otherwise known as PMADs. This shift is important to help individuals as well as professionals to start looking at the broader spectrum of potential accompanied symptoms of postpartum, such as Anxiety, Trauma, Obsessive Compulsiveness, Panic Disorder, and Bipolar Disorder.

 

Baby Blues

 

Does not meet criteria for PMAD but rather a period of normal adjustment.

 

  • Up to 80% of women experience the Baby Blues, usually lasting 2-3 weeks.

  • Usually occurs in the first weeks after delivery and resolves with support from family and friends and increased rest.

  • Symptoms Include: sudden mood swings, sadness, crying spells, loss of appetite, sleeping problems, irritability, restlessness, anxiety, and loneliness. Symptoms are not severe and treatment isn’t usually needed.

  • These symptoms are unsettling, but do not interfere with ability to function.

 

Depression

 

Most common complication next to anxiety as a result of childbirth:15-20% of new mothers.

 

  • Feels like the baby blues, but does not quite resolve.

  • Symptoms: sadness, irritability,  loneliness, hopelessness, lack of energy or enjoyment, guilt, lack of connection with baby, sleep problems (too little or too much), appetite change, loss of interest in things you once felt pleasurable, hopelessness, worthlessness, physical ailments, and/or potential thoughts of death and dying.

 

Anxiety

 

Most common complication next to depression as a result of childbirth:15-20% of new mothers.

 

  • Feels like the baby blues, but does not quite resolve.

  • Symptoms: excessive worry, anxiety, irritability, feeling overwhelmed, phobias, restlessness, easily fatigued, muscle tension, problems with sleep, difficulty concentrating.
     

Obsessive Compulsive Disorder

 

Typically occurs during the first year after delivery and causes a great deal of anxiety. Women often experience persistent thoughts, impulses or images, and during the postpartum period, these thoughts are often focused on the baby.

 

  • Symptoms; intrusive recurrent thoughts, usually involving the baby, often about the baby coming to harm, avoidance of baby or anything that will cause fear, establishing repetitive rituals (i.e., touching, counting, washing, cleaning, hoarding), anxiety and fears.

  • These symptoms causes disruptions in daily routine, are time consuming and interfere with mom’s ability to care for new baby and maintain relationships.

  • Most women experience horror and disgust about these recurring thoughts.

  • Women who have a personal or family history of OCD are at an increased risk.  

  • OCD develops in 3-5% of new mothers. Thankfully, few mothers with this disorder are likely to actually cause harm to themselves or their baby.

 

 

Post Traumatic Stress Disorder (PTSD)

 

PTSD includes 2 key elements: (1) experiencing or witnessing an event involving actual or threatened danger to the self or others, and (2) responding with intense fear, helplessness or horror. Many women report unresolved previous trauma.

 

  • Symptoms: obsessive thoughts about birth, feelings of panic when near the site where the birth occurred, feelings of detachment, disturbing memories of the birth experience, recurring nightmares, flashbacks, extreme anxiety, sleep difficulties.

  • Key point: mothers feel that the birth was traumatic, despite medical outcomes.

 

Panic Disorder

 

Women who experience excessive concerns and fears regarding their child as well as their own actions during the first year after delivery. Causes women to suffer from debilitating panic attacks, experience overwhelming anxiety, and possibly even agoraphobia (an abnormal fear of open or public spaces). Many women feel anxious and fearful of having another panic attack. Having just one panic attack does not necessarily qualify for panic disorder.

 

  • Symptoms: anxiety/panic attacks, trouble concentrating, making decisions or remembering things, difficulty relaxing, insomnia, exhaustion, extreme uneasiness, possible suicidal thoughts, and fear of another panic attack.

  • Symptoms of panic attack: shortness of breath, feeling of being choked or smothered, chest pain, increased heart rate, palpitations, hot flashes, chills, perspiration, trembling, feeling faint, dizziness, depersonalization, fear of going crazy or doing something uncontrolled, sense of impending doom or death. At least four of these symptoms will be present in a woman having a panic attack.

  • Past history and/or family history of anxiety or panic attacks are risk factors.

Bipolar Disorder

 

Some women experience their 1st onset of bipolar disorder in postpartum period. May be brought about by lack of sleep. It is likely a result of underlying bipolar illness that hasn’t been yet diagnosed.

 

Symptoms: inflated self esteem or grandiosity, decrease need for sleep, excessive talking, racing thoughts, flights of ideas, easily distracted, increased goal directed activity, engaging in high risk behaviors (spending sprees, hyper-sexuality, poor business decisions) causes marked impairment in daily functioning…or does not cause impairment in functioning, depending on the type of Bipolar. Bipolar disorder may also include a mood component.

 

Postpartum Psychosis (MEDICAL EMERGENCY)

 

An extreme reaction that usually occurs within the first six weeks postpartum. This disorder is RARE, occurring in 1 or 2/1000 births.

 

  • Symptoms: a break with reality, an inability to control violent thoughts, a feeling of inadequacy or that the baby would be better without you, thoughts that the baby is evil, a disconnect between mother and child, visual or auditory hallucinations, delusional thinking about infant’s death, denial of birth, or need to harm baby, delirium, paranoia or mania.

  • Risks increases if there is a personal or family history of psychosis, bipolar disorder, schizophrenia or a previous postpartum psychotic or bipolar episode.

  • If you or someone you love is experiencing these symptoms it a medical emergency, and requires immediate medical attention at your local emergency room. Psychotherapy is contraindicated at this point until woman can be stabilized with psychiatric care.

 

Causes of Postpartum Depression- According to DSM-5

With the latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), postpartum disorder is no longer recognized as a distinct diagnostic disorder and is now considered Major Depression Disorder, with a peripartum onset specifier. The DSM also only classifies this period as 4 months after birth. As mentioned above, the symptoms of postpartum can be quite complex, with more indications than just depressive symptoms that your treatment provider will help you to determine. These symptoms are usually still considered related to postpartum up to one 1 year. In terms of cause, much like most mood and anxiety disorders, a history of anxiety/depression whether individual or within your family may increase chances of developing PMADs, while some women may have never had any history prior to giving birth. The development of PMADs in many ways, is very individual, and can happen to any woman. Buffers against the development of PMADs often include a strong support system of friends and loved ones. 

 

Integrative Treatment Approach

Treatment of PMADs begins with a thorough history of onset of symptoms as well as understanding the birth experience, both prenatally and postnatally. Collaboration with other health providers is also recommended such as your general practitioner and/or gynecologist.  If you are not already on medication to treat your depressive/anxious symptoms, a psychiatric consult is often highly recommended in order to stabilize hormones, sleep and anxious/depressive symptoms. Medication also helps aid in your ability to be receptive to psychotherapy. Talk therapy focusing on the here and now has been proven effective for PMADs. Tools and techniques will also be taught to stabilize distressing symptoms such as mindfulness and insight oriented techiques. In addition, because social support is crucial to the healing process, interpersonal therapy is also used in order to help one improve important relationships with others in one's life. Once a woman begins to transition from the postpartum stage, deeper psychodynamic work can be explored if symptoms still persist. The good news is that, with the proper treatment, most women fully recover from they symptoms experienced in PMADs.