Are you at risk for postpartum mood disorder?
July 31, 2009
By: Marisa Cohen
When Holly Betten, 28, came home from the hospital after a rough delivery, she had one day to adjust to her new life as a mom before her husband went back to working 12-hour days as a computer-software architect.
Postpartum depression can strike anyone; it has nothing to do with how strong you are or your love for the baby.
Her son, Henry, became severely jaundiced, wouldn't breastfeed, and almost landed back in the hospital for losing too much weight. "All I could think was, 'What did I get myself into? I should never have become a mom,'" recalls Betten, of Grand Rapids, Michigan. "I felt totally overwhelmed and inadequate -- I couldn't even feed my child." Then Henry developed colic and began to wail all the time. Not surprisingly, so did Betten: "I'd be happy one minute, then crying hysterically the next. I just wanted to leave the baby in his room and walk away."
Her husband worried that Betten was becoming depressed, but she insisted that she could soldier on. "I just attributed it to stress and exhaustion, and refused to ask for help," Betten recalls. And she knew that "the baby blues" could make you feel sad, moody, or irritable. In fact, the condition, triggered by hormone shifts, can affect as many as 50 to 80 percent of new moms. Parenting.com: One mom's battle with postpartum depression
Such confusion about what life with a new baby is supposed to be like is a major reason women don't seek help. Another problem: "The shame and embarrassment that surround postpartum mood disorders also keep moms from acknowledging the issue," adds psychiatrist Ariel Dalfen, M.D., Toronto author of "When Baby Brings the Blues." "But without treatment, postpartum depression can linger and become more severe."
Promoting acceptance
Postpartum depression (PPD) can strike anyone, and it has nothing to do with how strong you are or how much you love your baby. When Brooke Shields wrote about her devastating bout with the illness in her memoir, "Down Came the Rain," she helped put a very public face on the issue. "Her book showed that nobody, no matter how rich, famous, or beautiful, is immune to PPD," points out Margaret Howard, Ph.D., director of the Postpartum Depression Day Hospital at Women & Infants Hospital in Providence, Rhode Island.
Even Tom Cruise's diatribe on national television against antidepressants and Shields' use of them wound up doing a lot of good by bringing the postpartum-depression discussion into America's living rooms, says Birdie Gunyon Meyer, R.N., the president of Postpartum Support International (PSI), a nonprofit organization that promotes awareness, prevention, and treatment of mental health issues related to childbirth. In speaking out, Shields joined singer Marie Osmond, who also wrote a book about suffering from PPD, and Mary Jo Codey, wife of the former governor of New Jersey, who not only opened up about her own experiences but also helped New Jersey become the first (and thus far only) state to mandate that all pregnant women be screened for and educated about postpartum depression. Parenting.com: 9 health symptoms you shouldn't ignore
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Soon such help may be available nationwide. A piece of legislation known as the Melanie Blocker Stokes Mothers Act -- named for a young mother who committed suicide after suffering postpartum psychosis, an extreme form of PPD -- would help fund related research and education, provide training to medical professionals about the disorder, and increase treatment options and support services. At press time, the bill had been passed in the U.S. House of Representatives and was headed for the Senate. (To learn more and to sign a petition in support of the act, go to PSI's Web site, http://postpartum.net/.)
Understanding your risk
New moms should expect to feel overwhelmed at times, incompetent now and then, nervous about being left on their own to take care of the baby, and to overreact and tear up over seemingly minor things. What's not normal: a darkening storm of anxiety and panic. "The big difference between baby blues and PPD is duration and intensity," Howard explains. "It is a prolonged sense of sadness lasting for two weeks or more." Parenting.com: How to get over new-mom guilt
There are also different degrees of PPD, notes Dalfen. Women who are not enjoying motherhood but can go through the motions of taking care of the baby and themselves may have mild PPD, but are getting by. Those who feel down all the time, have trouble connecting with their baby, and find it hard to get through every day have a stronger case of the illness. Severe PPD sufferers are extremely depressed and unable to take care of themselves or their babies. All of these women need treatment, Dalfen emphasizes.
Scientists still don't know the exact mechanics of PPD, but they do know it is the brain's complex reaction to several forces beyond a woman's control. "The hormones progesterone and estrogen drop after the baby is born," explains Dalfen. "These hormones interact with brain chemicals such as serotonin, which controls your mood." For some women, PPD symptoms begin during pregnancy. Moms with a personal or family history of depression, or a history of premenstrual syndrome, are at increased risk.
Social factors come into play, too: Women who have a conflicted relationship with the baby's father, have limited finances and health care, have limited social support (friends, a sister, a mom to help with the baby), or who give birth to multiples or a demanding, colicky infant are also at higher risk for depression. Parenting.com: Depression during pregnancy -- why it's often overlooked
Getting the right help
The first step in treating PPD is to see your health-care provider or find a specialist on postpartum.net. Therapy and, in some cases, medication, as prescribed by a doctor, can be essential. Several antidepressants, including Zoloft and Paxil, are effective and safe for breastfeeding women. "The top priority is for the mom to get well so she can care for her baby," notes Dalfen.
Health Library
MayoClinic.com: Postpartum depression
On the home front, new moms need to take care of themselves (get more sleep, eat healthier, take breaks from baby care) and ask for the help that makes that possible. Emotional support is also crucial: A recent study in the British Medical Journal found that simply talking on the phone with other mothers who had recovered from PPD helped at-risk new moms cut their chances of developing depression nearly in half. Find a support group in your area at postpartum.net. Or log on to our community board on babytalk.com.
When Betten's husband finally persuaded her to see her doctor, an antidepressant brought quick relief from her six-month siege. "Within a week it evened out my moods and gave me a lot more patience," she says. "If the baby started screaming, I didn't freak out and start sobbing myself. I thought, 'OK, he can cry for a minute and then I'll pick him up.'" Parenting.com: When postpartum depression lingers
Now expecting her second baby, Betten is prepared to ask for help: "Now I realize that anyone who has ever had a kid understands that you can't do it alone."
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Copyright 2009 The Parenting Group. All rights reserved. Reproduction in whole or in part without permission is prohibited.
Marisa Cohen is a mom and the author of "Deliver This! Make the Childbirth Choice That's Right for You."
article taken from http://edition.cnn.com/2009/HEALTH/07/31/postpartum.mood.disorder/?imw=Y
Saturday, November 14, 2009
Tuesday, November 10, 2009
Does PPD serve some evolutionary purpose?
So it has been awhile since I have been able to update my blog. On my recent quest to post information I did find this article. After reading it I take offense to a few things said on this view. Even though I suffered from PPD I do not think that my parenting skills were lacking. I took care of my baby each and everyday. He was breastfed, changed, had clean clothes and most of all, he was loved and held all the time. I held myself together for him. I knew that he needed me to be there and to take care of him. Babies cannot take care of themselves, but I do not think that my PPD had anything to do with my wanting help or thinking that I was unable to do it alone.
I would welcome comments on what others think of this theory...
Does postpartum depression serve some evolutionary purpose?—Clint Johnson, Ridgecrest, Calif.
Anthropologist Edward H. Hagen of Washington State University replies:
Postpartum depression (PPD), which afflicts 10 to 15 percent of new mothers, may have evolved as a strategic response to a lack of social support because it helped in passing on genes successfully. Many doctors believe PPD is triggered by the changes in a mother’s hormones after giving birth, yet studies have failed to find much evidence for a link between extreme hormone fluctuations and PPD. The fact that fathers, who do not experience such changes, also suffer from PPD is strong evidence that it is not “just hormones.”
The finding that PPD often plagues people who have marital problems or little outside support led biologists Randy Thornhill and F. Bryant Furlow of the University of New Mexico and me independently to propose that PPD has an evolved function. Many animals improve their chances of passing on their genes if they desert their young when food or parenting help is scarce and invest instead in future offspring that are more likely to survive and reproduce.
This “parental investment theory” should apply especially well to humans. Human children are “expensive” to raise, requiring years of parenting before they can survive on their own. When a mother lacks support from the father or other family members, she may unconsciously conclude she cannot successfully raise her infant. The ensuing emotional pain from PPD operates somewhat like physical pain: stop what you’re doing—it’s harming your reproductive fitness! Studies confirm that mothers with PPD do significantly reduce parenting efforts and often have thoughts of harming their baby.
This “psychic pain hypothesis” cannot explain the whole story, however, because few parents suffering from PPD abandon their newborn. I propose an additional function of PPD that is like a labor strike, in which a mother’s reduced interest in her baby may serve to elicit help from others. Studies do suggest that higher levels of PPD symptoms in mothers motivate more child care by fathers, and increased social support is one of the best predictors for the remission of PPD.
These hypothesized functions for PPD are far from proved. If you or a loved one is suffering from PPD, contact a doctor immediately—treatments, including antidepressants and talk therapy, are available and effective.
taken from http://www.scientificamerican.com/article.cfm?id=ask-the-brains-does-postpartum-depression
I would welcome comments on what others think of this theory...
Does postpartum depression serve some evolutionary purpose?—Clint Johnson, Ridgecrest, Calif.
Anthropologist Edward H. Hagen of Washington State University replies:
Postpartum depression (PPD), which afflicts 10 to 15 percent of new mothers, may have evolved as a strategic response to a lack of social support because it helped in passing on genes successfully. Many doctors believe PPD is triggered by the changes in a mother’s hormones after giving birth, yet studies have failed to find much evidence for a link between extreme hormone fluctuations and PPD. The fact that fathers, who do not experience such changes, also suffer from PPD is strong evidence that it is not “just hormones.”
The finding that PPD often plagues people who have marital problems or little outside support led biologists Randy Thornhill and F. Bryant Furlow of the University of New Mexico and me independently to propose that PPD has an evolved function. Many animals improve their chances of passing on their genes if they desert their young when food or parenting help is scarce and invest instead in future offspring that are more likely to survive and reproduce.
This “parental investment theory” should apply especially well to humans. Human children are “expensive” to raise, requiring years of parenting before they can survive on their own. When a mother lacks support from the father or other family members, she may unconsciously conclude she cannot successfully raise her infant. The ensuing emotional pain from PPD operates somewhat like physical pain: stop what you’re doing—it’s harming your reproductive fitness! Studies confirm that mothers with PPD do significantly reduce parenting efforts and often have thoughts of harming their baby.
This “psychic pain hypothesis” cannot explain the whole story, however, because few parents suffering from PPD abandon their newborn. I propose an additional function of PPD that is like a labor strike, in which a mother’s reduced interest in her baby may serve to elicit help from others. Studies do suggest that higher levels of PPD symptoms in mothers motivate more child care by fathers, and increased social support is one of the best predictors for the remission of PPD.
These hypothesized functions for PPD are far from proved. If you or a loved one is suffering from PPD, contact a doctor immediately—treatments, including antidepressants and talk therapy, are available and effective.
taken from http://www.scientificamerican.com/article.cfm?id=ask-the-brains-does-postpartum-depression
Tuesday, October 6, 2009
Top Ten Myths about PPD
Article taken from http://mededppd.org/mothers/myths.asp
Top 10 Myths About PPD
Myth 1: PPD is normal -- all new mothers feel tired and depressed.
Fact: New mothers often feel tired and overwhelmed. They may be experiencing "baby blues." Women with baby blues may feel tired, weepy, and have no energy. However, the feelings that go with PPD are stronger and longer lasting. A mother with PPD may not want to play with her baby. She may have trouble paying attention to things and may not be able to meet her baby's needs for warmth and affection. She may feel guilty or worthless.
Myth 2: If you don't get PPD right after you give birth, you won't get it at all.
Fact: PPD can happen any time in the first year after a woman gives birth.
Myth 3: PPD will go away on its own without treatment.
Fact: The "baby blues" may last up to 4 weeks but usually goes away on its own. Like many illnesses, PPD almost never goes away without treatment. The good news is that there are available treatments that work.
Myth 4: All women with PPD have thoughts about hurting their children.
Fact: Women with postpartum psychosis, which is a life-threatening disorder separate from PPD, are at risk for hurting their babies or themselves. If you have thoughts about harming yourself or your child you should ask for help right away from your family and your doctor.
Myth 5: Women with PPD look depressed or stop taking care of themselves.
Fact: You can't tell someone has PPD by looking at her. A woman with PPD may look perfectly "normal" to everyone else. She may even try especially hard to look polished or put together – keeping her makeup done, and her hair styled – to turn attention away from the pain she is feeling on the inside.
Myth 6: Women with PPD are bad mothers.
Fact: Having PPD does not make someone a bad mother.
Myth 7: If you have PPD, you must have done something wrong.
Fact: PPD is nobody's fault. There is nothing that a woman with PPD could have done to avoid having this disorder.
Myth 8: You'll get over your PPD if you just get more sleep.
Fact: Although it's important for women with PPD to get enough sleep, sleep by itself will not cure PPD.
Myth 9: Women with PPD can't take antidepressants if they are breastfeeding.
Fact: Studies have shown that there is a very small risk to the baby with the antidepressants most likely to be prescribed for PPD. If it is necessary for a woman with PPD to take an antidepressant, her doctor will carefully choose one that is most likely to help her and least likely to hurt her baby.
Myth 10: Pregnant and postpartum women don't get depressed.
Fact: Being pregnant, or having just given birth, is not a guarantee against getting depression. In other words, pregnancy does not protect a woman from depression, and in fact, studies show that the childbearing years are when a woman is most likely to experience depression in her lifetime.
Top 10 Myths About PPD
Myth 1: PPD is normal -- all new mothers feel tired and depressed.
Fact: New mothers often feel tired and overwhelmed. They may be experiencing "baby blues." Women with baby blues may feel tired, weepy, and have no energy. However, the feelings that go with PPD are stronger and longer lasting. A mother with PPD may not want to play with her baby. She may have trouble paying attention to things and may not be able to meet her baby's needs for warmth and affection. She may feel guilty or worthless.
Myth 2: If you don't get PPD right after you give birth, you won't get it at all.
Fact: PPD can happen any time in the first year after a woman gives birth.
Myth 3: PPD will go away on its own without treatment.
Fact: The "baby blues" may last up to 4 weeks but usually goes away on its own. Like many illnesses, PPD almost never goes away without treatment. The good news is that there are available treatments that work.
Myth 4: All women with PPD have thoughts about hurting their children.
Fact: Women with postpartum psychosis, which is a life-threatening disorder separate from PPD, are at risk for hurting their babies or themselves. If you have thoughts about harming yourself or your child you should ask for help right away from your family and your doctor.
Myth 5: Women with PPD look depressed or stop taking care of themselves.
Fact: You can't tell someone has PPD by looking at her. A woman with PPD may look perfectly "normal" to everyone else. She may even try especially hard to look polished or put together – keeping her makeup done, and her hair styled – to turn attention away from the pain she is feeling on the inside.
Myth 6: Women with PPD are bad mothers.
Fact: Having PPD does not make someone a bad mother.
Myth 7: If you have PPD, you must have done something wrong.
Fact: PPD is nobody's fault. There is nothing that a woman with PPD could have done to avoid having this disorder.
Myth 8: You'll get over your PPD if you just get more sleep.
Fact: Although it's important for women with PPD to get enough sleep, sleep by itself will not cure PPD.
Myth 9: Women with PPD can't take antidepressants if they are breastfeeding.
Fact: Studies have shown that there is a very small risk to the baby with the antidepressants most likely to be prescribed for PPD. If it is necessary for a woman with PPD to take an antidepressant, her doctor will carefully choose one that is most likely to help her and least likely to hurt her baby.
Myth 10: Pregnant and postpartum women don't get depressed.
Fact: Being pregnant, or having just given birth, is not a guarantee against getting depression. In other words, pregnancy does not protect a woman from depression, and in fact, studies show that the childbearing years are when a woman is most likely to experience depression in her lifetime.
Sunday, October 4, 2009
Saturday, October 3, 2009
National Depression Screening Day
Upcoming Screening Day:October 08, 2009
http://www.mentalhealthscreening.org/events/ndsd/register.aspx
-->
Find a National Depression Screening Day (NDSD) event in your area or take an anonymous screening online.
Register NOWfor National Depression Screening Day® : online, or download a PDF form.
Check-out the NEW Online Screening Assessments for: Community, College, and Military.
Find a local event offering
free, anonymous screenings.
For 18 years, Screening for Mental Health’s National Depression Screening Day® (NDSD) has offered health care providers evidence-based, affordable and easy-to-use mental health education and screening resources. Reaching community members with undetected and untreated mental disorders has never been more important. Studies show that most Americans wait years before they seek treatment for a mental health disorder, and many never seek treatment at all.
National Depression Screening Day® 2009 registration available now!
Community program: Register online or download the PDF to host an screening event in your community or to purchase the online screening program
College program: Register online or download the PDF to host an event on your campus or to purchase the online screening program
Military program: Register online or download the PDF to host an event at your installation or to receive the online screening program (all materials free of charge for military organizations thanks to funding by the Department of Defense)
We are pleased to presentStop a Suicide Today! as the theme for
National Depression Screening Day® 2007. Stop a Suicide Today! is an
effort to bring suicide prevention to the forefront of our NDSD program. Our
goal is to help you educate the public about the link between suicide and
mental illness.
If you would like more information about NDSD, please email ndsd@mentalhealthscreening.org.
http://www.mentalhealthscreening.org/events/ndsd/register.aspx
-->
Find a National Depression Screening Day (NDSD) event in your area or take an anonymous screening online.
Register NOWfor National Depression Screening Day® : online, or download a PDF form.
Check-out the NEW Online Screening Assessments for: Community, College, and Military.
Find a local event offering
free, anonymous screenings.
For 18 years, Screening for Mental Health’s National Depression Screening Day® (NDSD) has offered health care providers evidence-based, affordable and easy-to-use mental health education and screening resources. Reaching community members with undetected and untreated mental disorders has never been more important. Studies show that most Americans wait years before they seek treatment for a mental health disorder, and many never seek treatment at all.
National Depression Screening Day® 2009 registration available now!
Community program: Register online or download the PDF to host an screening event in your community or to purchase the online screening program
College program: Register online or download the PDF to host an event on your campus or to purchase the online screening program
Military program: Register online or download the PDF to host an event at your installation or to receive the online screening program (all materials free of charge for military organizations thanks to funding by the Department of Defense)
We are pleased to presentStop a Suicide Today! as the theme for
National Depression Screening Day® 2007. Stop a Suicide Today! is an
effort to bring suicide prevention to the forefront of our NDSD program. Our
goal is to help you educate the public about the link between suicide and
mental illness.
If you would like more information about NDSD, please email ndsd@mentalhealthscreening.org.
Thursday, October 1, 2009
Post Partum Depression: Information for husbands and families
Great Information taken from www.pregnancy.org for husbands and family members.
by Karen Kleiman
Understanding Postpartum Depression
Postpartum depression (PPD) affect 20% of all postpartum women.
PPD is a medical condition that can be treated successfully.
PPD is a clinical depression that can occur any time immediately after birth up to a year postpartum.
If your wife has been diagnosed with PPD, it's very important for you to be informed and part of the treatment.
PPD can strike without warning -- in women with no history of depression or women who have had it before. It can happen to women who are highly successful in their careers or women who stay home with their children. It can strike women in stable marriages and conflictual marriages, as well as single women, and adoptive mothers. It can happen to women who love their baby more than anything in the world. It can happen after the first baby, or after the fourth.
It can happen to women who swore it would never happen to them.
It is not completely understood why PPD affects some women and not others -- why women who have many risk factors may no experience it, and others who have no risk factors may end up with a full blown episode.
Women are twice as likely to experience depression than men.
Women are most at risk to experience emotional illness following the birth of a baby than at any other time.
PPD is a real illness.
She is not making this up.
This did not happen because she's a bad mother, or doesn't love her baby enough.
It did not happen because she's having negative thoughts about herself or about you or about your baby.
It did not happen because she is weak and not working hard enough to get better.
She cannot "snap out of it."
This is not fair. This is not what you expected. But if your wife has been diagnosed with PPD, it will take a while for her to recover. Recovery may take weeks to months.
She will get better. She will return to her "normal" self. She will begin to experience pleasure again. This will not happen overnight.
The more supportive you are of her treatment, the smoother her recovery will be.
PPD is nobody's fault. It is not your wife's fault. It is not your fault.
Try to reassure your wife that there is nothing she has done to make this happen.
Often, when we are struck by something we do not understand, we try to cast blame on someone or something. This will be counterproductive.
Remember that we do not know exactly why this happened. What we do know is what to do to maximize the healing process.
Do not spend excessive energy trying to figure out what went wrong or why this happened. Your search for reason will frustrate you and it will keep your wife spinning along side of you. Save your energy for navigating through this unfamiliar territory.
What to say
Her moods and emotional vulnerability will get in the way of good communication for now. Here's what you're up against:
-If you tell her you love her, she won't believe you.
-If you tell her she's a good mother, she'll think you're just saying that to make her feel better.
-If you tell her she's beautiful, she'll assume you're lying.
-If you tell her not to worry about anything, she'll think you have no idea how bad she feels.
-If you tell her you'll come home early to help her, she'll feel guilty.
-If you tell her you have to work late, she'll think you don't care.
But you can:
Tell her you know she feels terrible.
Tell her she will get better.
Tell her she is doing all the right things to get better (therapy, medication, etc.).
Tell her she can still be a good mother and feel terrible.
Tell her it's okay to make mistakes, she doesn't have to do everything perfectly.
Tell her you know how hard she's working at this right now.
Tell her to let you know what she needs you to do to help.
Tell her you know she's doing the best she can.
Tell her you love her.
Tell her your baby will be fine.
What NOT to say
Do not tell her she should get over this.
Do not tell her you are tired of her feeling this way.
Do not tell her this should be the happiest time of her life.
Do not tell her you liked her better the way she was before.
Do not tell her she'll snap out of this.
Do not tell her she would feel better if only: she were working, she were not working, she got out of the house more, stayed home more, etc.
Do not tell her she should lose weight, color her hair, buy new clothes, etc.
Do not tell her all new mothers feel this way.
Do not tell her this is just a phase.
Do not tell her if she wanted a baby, this is what she has to go through.
Do not tell her you know she's strong enough to get through this on her own and she doesn't need help.
Things you should know about her treatment
Good therapy can be expensive. But expensive therapy isn't always good.
Getting help for your wife has to be the priority here. If you are more worried about how much it costs, she will stay sick longer.
Her illness is real. She needs treatment.
So, how do you know if her therapist or doctor is good? Ask yourself these questions:
Did you feel comfortable with this person? (Yes, you should attend a session).
Does your wife like him/her? (This is more important than you might think. Connecting with this person is half the battle)
How does your wife feel about her sessions?
Does she think it's helping?
Does she feel good about going?
Does she trust this person and feel comfortable talking?
Try to find someone who works short-term and focuses on the here-and-now, rather than issues from the past. These issues are important, but not necessarily productive at the outset, when we want to manage symptoms.
The cost of treatment is a very real concern. But so is her staying sick, isn't it? Please do not let the financial issues get in the way of her getting the help she needs. There are options. Sliding scales. Insurance plans. Payment schedules. Bringing up your worries about the money can actually sabotage her recovery by making her feel guilty. Be careful how you do that.
Encourage your wife to discuss any financial concerns with her therapist. Contact your insurance company. Depending on your particular plan, find out whether you need a referral from your primary and if so, try to find a therapist who is a provider for your network. If not, find out whether or not they reimburse this particular therapist. Most insurance companies will ask you the therapist's credentials to determine reimbursement. If the therapist is not covered at all, find out what arrangement can be made.
Yes, you should go to a session with her. Some women like their husbands to join them for the first one. Others prefer their husbands wait until a relationship has been established with the therapist. Ask your wife if she'd like you to go with her and when. Then do it.
You are going for a few reasons:
To show your support;
To meet her therapist and see who's "taking care" of her;
To ask questions, to get information, to receive support;
To provide information to the therapist about your wife, your relationship, relevant history, etc.
PPD becomes a family issue. Do not let your wife carry the load of this illness alone. Supporting her decision to go to therapy is vital for her recovery. Remember, therapy for PPD should be short-term. In therapy terms, this usually means 3-5 months. But she should receive initial relief right away. Depending on the severity of her illness, she should start feeling somewhat better in the first few weeks.
Emergency situations
If your wife tells you she cannot take this pain anymore, it's a very serious statement that means it's time for an evaluation by someone who specializes in the treatment of depression.
Remember, her thoughts are distorted and it is possible that things feel much worse to her than they appear to you.
It is not up to you to determine whether she's at risk for hurting herself or someone else. A professional should determine it.
Stay with her. Ask her if she feels safe from harm. Help her make an appointment with some she feels can help her. Call her doctor. Do not leave her alone.
The following situations are rare, but warrant immediate intervention. Emergency situations mean you should take her to the closest hospital, call 911. DO NOT LEAVE HER ALONE FOR ANY REASON:
Talk of hurting herself;
Bizarre thinking patterns, hallucinations, delusions;
No sleep in several days. This means NO sleep, usually coupled with manic-like symptoms. Sleep deprivation can worse symptoms;
Noticeable withdrawal from all social contact;
Preoccupation with death, morbid ideas, or religious ideation;
Persistent feelings of despair and hopelessness;
Expressions such as: "My children would be better off without me here."
Karen Kleiman, MSW, Licensed, Clinical Social Worker, co-author of This Isn't What I Expected: Overcoming Postpartum Depression and author of The Postpartum Husband: Practical Solutions for Living with Postpartum Depression, has been working with women and their families for over 20 years. A native of Saint Louis, MO., Karen has lived in the Philadelphia area since 1982 with her two children and her husband. After graduating in 1980 from the University of Illinois at Chicago with her Masters in Social Work, she began her practice as a psychotherapist, specializing in women's issues. In 1988 she founded The Postpartum Stress Center where she provides treatment for prenatal and postpartum depression and anxiety
by Karen Kleiman
Understanding Postpartum Depression
Postpartum depression (PPD) affect 20% of all postpartum women.
PPD is a medical condition that can be treated successfully.
PPD is a clinical depression that can occur any time immediately after birth up to a year postpartum.
If your wife has been diagnosed with PPD, it's very important for you to be informed and part of the treatment.
PPD can strike without warning -- in women with no history of depression or women who have had it before. It can happen to women who are highly successful in their careers or women who stay home with their children. It can strike women in stable marriages and conflictual marriages, as well as single women, and adoptive mothers. It can happen to women who love their baby more than anything in the world. It can happen after the first baby, or after the fourth.
It can happen to women who swore it would never happen to them.
It is not completely understood why PPD affects some women and not others -- why women who have many risk factors may no experience it, and others who have no risk factors may end up with a full blown episode.
Women are twice as likely to experience depression than men.
Women are most at risk to experience emotional illness following the birth of a baby than at any other time.
PPD is a real illness.
She is not making this up.
This did not happen because she's a bad mother, or doesn't love her baby enough.
It did not happen because she's having negative thoughts about herself or about you or about your baby.
It did not happen because she is weak and not working hard enough to get better.
She cannot "snap out of it."
This is not fair. This is not what you expected. But if your wife has been diagnosed with PPD, it will take a while for her to recover. Recovery may take weeks to months.
She will get better. She will return to her "normal" self. She will begin to experience pleasure again. This will not happen overnight.
The more supportive you are of her treatment, the smoother her recovery will be.
PPD is nobody's fault. It is not your wife's fault. It is not your fault.
Try to reassure your wife that there is nothing she has done to make this happen.
Often, when we are struck by something we do not understand, we try to cast blame on someone or something. This will be counterproductive.
Remember that we do not know exactly why this happened. What we do know is what to do to maximize the healing process.
Do not spend excessive energy trying to figure out what went wrong or why this happened. Your search for reason will frustrate you and it will keep your wife spinning along side of you. Save your energy for navigating through this unfamiliar territory.
What to say
Her moods and emotional vulnerability will get in the way of good communication for now. Here's what you're up against:
-If you tell her you love her, she won't believe you.
-If you tell her she's a good mother, she'll think you're just saying that to make her feel better.
-If you tell her she's beautiful, she'll assume you're lying.
-If you tell her not to worry about anything, she'll think you have no idea how bad she feels.
-If you tell her you'll come home early to help her, she'll feel guilty.
-If you tell her you have to work late, she'll think you don't care.
But you can:
Tell her you know she feels terrible.
Tell her she will get better.
Tell her she is doing all the right things to get better (therapy, medication, etc.).
Tell her she can still be a good mother and feel terrible.
Tell her it's okay to make mistakes, she doesn't have to do everything perfectly.
Tell her you know how hard she's working at this right now.
Tell her to let you know what she needs you to do to help.
Tell her you know she's doing the best she can.
Tell her you love her.
Tell her your baby will be fine.
What NOT to say
Do not tell her she should get over this.
Do not tell her you are tired of her feeling this way.
Do not tell her this should be the happiest time of her life.
Do not tell her you liked her better the way she was before.
Do not tell her she'll snap out of this.
Do not tell her she would feel better if only: she were working, she were not working, she got out of the house more, stayed home more, etc.
Do not tell her she should lose weight, color her hair, buy new clothes, etc.
Do not tell her all new mothers feel this way.
Do not tell her this is just a phase.
Do not tell her if she wanted a baby, this is what she has to go through.
Do not tell her you know she's strong enough to get through this on her own and she doesn't need help.
Things you should know about her treatment
Good therapy can be expensive. But expensive therapy isn't always good.
Getting help for your wife has to be the priority here. If you are more worried about how much it costs, she will stay sick longer.
Her illness is real. She needs treatment.
So, how do you know if her therapist or doctor is good? Ask yourself these questions:
Did you feel comfortable with this person? (Yes, you should attend a session).
Does your wife like him/her? (This is more important than you might think. Connecting with this person is half the battle)
How does your wife feel about her sessions?
Does she think it's helping?
Does she feel good about going?
Does she trust this person and feel comfortable talking?
Try to find someone who works short-term and focuses on the here-and-now, rather than issues from the past. These issues are important, but not necessarily productive at the outset, when we want to manage symptoms.
The cost of treatment is a very real concern. But so is her staying sick, isn't it? Please do not let the financial issues get in the way of her getting the help she needs. There are options. Sliding scales. Insurance plans. Payment schedules. Bringing up your worries about the money can actually sabotage her recovery by making her feel guilty. Be careful how you do that.
Encourage your wife to discuss any financial concerns with her therapist. Contact your insurance company. Depending on your particular plan, find out whether you need a referral from your primary and if so, try to find a therapist who is a provider for your network. If not, find out whether or not they reimburse this particular therapist. Most insurance companies will ask you the therapist's credentials to determine reimbursement. If the therapist is not covered at all, find out what arrangement can be made.
Yes, you should go to a session with her. Some women like their husbands to join them for the first one. Others prefer their husbands wait until a relationship has been established with the therapist. Ask your wife if she'd like you to go with her and when. Then do it.
You are going for a few reasons:
To show your support;
To meet her therapist and see who's "taking care" of her;
To ask questions, to get information, to receive support;
To provide information to the therapist about your wife, your relationship, relevant history, etc.
PPD becomes a family issue. Do not let your wife carry the load of this illness alone. Supporting her decision to go to therapy is vital for her recovery. Remember, therapy for PPD should be short-term. In therapy terms, this usually means 3-5 months. But she should receive initial relief right away. Depending on the severity of her illness, she should start feeling somewhat better in the first few weeks.
Emergency situations
If your wife tells you she cannot take this pain anymore, it's a very serious statement that means it's time for an evaluation by someone who specializes in the treatment of depression.
Remember, her thoughts are distorted and it is possible that things feel much worse to her than they appear to you.
It is not up to you to determine whether she's at risk for hurting herself or someone else. A professional should determine it.
Stay with her. Ask her if she feels safe from harm. Help her make an appointment with some she feels can help her. Call her doctor. Do not leave her alone.
The following situations are rare, but warrant immediate intervention. Emergency situations mean you should take her to the closest hospital, call 911. DO NOT LEAVE HER ALONE FOR ANY REASON:
Talk of hurting herself;
Bizarre thinking patterns, hallucinations, delusions;
No sleep in several days. This means NO sleep, usually coupled with manic-like symptoms. Sleep deprivation can worse symptoms;
Noticeable withdrawal from all social contact;
Preoccupation with death, morbid ideas, or religious ideation;
Persistent feelings of despair and hopelessness;
Expressions such as: "My children would be better off without me here."
Karen Kleiman, MSW, Licensed, Clinical Social Worker, co-author of This Isn't What I Expected: Overcoming Postpartum Depression and author of The Postpartum Husband: Practical Solutions for Living with Postpartum Depression, has been working with women and their families for over 20 years. A native of Saint Louis, MO., Karen has lived in the Philadelphia area since 1982 with her two children and her husband. After graduating in 1980 from the University of Illinois at Chicago with her Masters in Social Work, she began her practice as a psychotherapist, specializing in women's issues. In 1988 she founded The Postpartum Stress Center where she provides treatment for prenatal and postpartum depression and anxiety
Tuesday, September 29, 2009
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