Again, depression can start when you are pregnant. Please consult your doctor at once. This article is taken from the March of Dimes website.
Depression During Pregnancy
Out of every 10 women who are pregnant, one or two have symptoms of major depression. Women who have been depressed before are at higher risk.
Depression is a serious medical condition. It poses risks for the woman and her baby. But a range of treatments are available. These include counseling, psychotherapy, support groups, therapy with light, and medications.
It is usually best for a team of health care professionals to work with a pregnant woman who is depressed or who has a history of depression. Team members include:
The provider who is caring for her during her pregnancy
A mental health professional
The provider who will take care of the baby after birth
Together, the team and the woman decide what is best for her and her baby. The team can connect her to support groups, help her consider counseling and psychotherapy, and assess the need for light therapy or medication.
Often a pregnant woman wonders whether antidepressant drugs, such as Zoloft and Prozac, will harm her baby or herself. There are no simple answers. Each woman and her health care providers must work together to make the best decision for her and her baby. The drugs used to treat depression have both risks and benefits.
IMPORTANT: If you are taking an antidepressant and find that you are pregnant, do not stop taking your medication without first talking to your health provider. Call him or her as soon as you discover that you are expecting. It may be unhealthy to stop taking an antidepressant suddenly.
What Is Depression?Depression is an illness that involves the body, mood and thought. It affects the way a woman feels about herself and the way she thinks about things. This article addresses two types of depression:
Major depression: This serious illness interferes with a person's ability to work, study, sleep, eat and enjoy oneself. It may appear once in a person's life, but more often occurs several times.
Dysthymia: This is a less severe type of depression. Persons with this illness have long-term symptoms. They are able to conduct day-to-day activities, but they don't always function well or feel good. They may also have episodes of major depression.
Depression carries serious risks for the pregnant woman and her baby. These risks include:
Poor weight gain
Use of drugs or alcohol to self-medicate
Suicide
Depressed mothers are often less able to care for themselves or their children, or to bond with their children.
What Are the Symptoms of Depression? A woman who is depressed feels sad or “blue” and has other symptoms that last for two weeks or longer. The other symptoms include the following:
Trouble sleeping
Sleeping too much
Lack of interest
Feelings of guilt
Loss of energy
Difficulty concentrating
Changes in appetite
Restlessness, agitation or slowed movement
Thoughts or ideas about suicide
Things other than depression can cause some of these symptoms. For instance, changes in appetite and trouble sleeping are common in pregnancy. Some medical conditions, such as anemia and hypothyroidism, can cause a pregnant woman to lack energy.
If you have any of these symptoms, talk to your health care provider. He or she will check to see what might be causing your symptoms. You need to be checked for depression if symptoms continue and interfere with your daily life and if your provider rules out other medical conditions.
TreatmentsDepression can be treated in several ways. Support groups may help. Some women go to therapy or counseling with a mental health professional (such as a social worker psychotherapist or psychiatrist).
Some people suffer from a type of depression that comes on during the fall or winter, when there is less sunlight. This is called seasonal affective disorder (SAD). This condition is treated with light therapy. In her home, the patient looks into a box with special light bulbs. To avoid injury to her eyes, she looks at the lights indirectly. Typically, the patient does this from 15 minutes to two hours every day. The health provider may recommend a different number of minutes over time.
Mental health professionals often talk with women about the risks and benefits of antidepressants.
Two Groups of AntidepressantsMost antidepressants can be categorized into one of two groups.
Group 1: Selective serotonin uptake inhibitors (SSRIs). This group of drugs includes:
Prozac (fluoxetine)
Lexapro (escitalopram)
Zoloft (sertraline)
Celexa (citalopram)
Effexor (venlafaxine)
Paxil (paroxetine)
Cymbalta (duloxetine)
Group 2: Tricyclic antidepressants (TCAs). This group of drugs includes:
Elavil (amitriptyline)
Tofranil (imipramine)
Pamelor (Aventyl, nortriptyline)
Like many drugs, antidepressants can have side effects. SSRIs usually have fewer side effects than TCAs. Women differ in the type and seriousness of the side effects that they have.
What Research Tells Us About AntidepressantsIt's challenging to study and understand the risks of any drug given to pregnant women. During pregnancy, two patients—the mother and the fetus—are exposed to the drug. Medications that are safe for a woman are sometimes risky for a fetus. Because of this, researchers have not studied many drugs during pregnancy.
Medical experts get most of their information about antidepressants during pregnancy by:
Drawing on research about drugs that have been approved for women who aren't pregnant
Conducting studies on animals
Studying women who took antidepressants before they knew they were pregnant
Several drugs have been used for many years without any obvious signs of serious risk to the baby. But some researchers have reported that some antidepressants may have increased risks. SSRIs are a newer group of drugs than TCAs. Researchers are continuing to study them.
Research has clearly shown that women who are not pregnant and are depressed are very likely to become ill again if they stop taking their medications. But we have less information about whether this is also true for pregnant women.
Here are some other things that research has told us.
One study in 2006 found that pregnant women with major depression are very likely to become ill again during their pregnancy if they stop taking their medication. A depressed woman may have trouble taking care of herself during pregnancy. This could threaten the health of the fetus.
Many studies have found no link between antidepressants and serious malformations in newborns. But in 2005, the U.S. Food and Drug Administration (FDA) issued a warning about Paxil (paroxetine) based on several studies. The warning said that taking the drug during the first three months of pregnancy may increase the risk of birth defects, particularly heart defects. Scientists do not yet know enough to draw a firm conclusion. The American College of Obstetricians and Gynecologists recommends that pregnant women or women planning to become pregnant avoid Paxil, if possible. Other types of treatment for depression may be a better choice.
Some babies born to mothers who are taking SSRI antidepressants show signs of “withdrawal.” For instance, they may have breathing or feeding problems. Their movements may be jerky. Some have seizures. Health providers who care for newborn babies are aware of these risks and can provide treatment. It's important for the baby's provider to know ahead of time that the mother has taken antidepressants during pregnancy.
Babies exposed to SSRIs in late pregnancy (after 20 weeks) may be more likely to have persistent pulmonary hypertension (PPHN). This rare, but serious, condition affects the lungs and blood vessels. Not enough studies have been done to know for certain if SSRIs cause the disorder. More research is needed.
Some researchers have studied children whose mothers took antidepressants. They have found no link to serious problems with language, behavior or intelligence.
Some studies have shown a link between antidepressants and premature delivery.
Choosing an AntidepressantThis decision is difficult because we don't know all the answers. No drug is entirely safe. A woman and her health care team must look at her case and carefully weigh:
The risks and benefits of various drugs
The risks and benefits of other types of treatment
The risk of untreated depression for the woman and her baby
St. John's Wort and Other Herbal RemediesSt. John's wort is an herb that some people use to treat depression. According to the National Center for Complementary and Alternative Medicine some research has shown that St. John's wort is useful for treating mild to moderate depression. Other studies have shown that it is does not help one type of major depression.Herbal products, such as St. John's wort, vary in strength and quality from product to product. We need more research to help us know whether St. John's wort is useful and safe for treating depression in pregnant women. IMPORTANT: We know very little about the effect of St. John's wort on the fetus. Do no take this herb or other herbal remedies without first speaking to your health provider. ResourcesThe Organization of Teratology Information Services (OTIS), (866) 626-6847. Provides fact sheets on pregnancy and specific antidepressants, including Prozac and Zoloft. Depression During and After Pregnancy, a resource for women, their families and friends, provided by the U.S. Department of Health and Human ServicesDepression During and After Pregnancy, provided by the Maternal and Child Health LibraryJuly 2007
Tuesday, April 14, 2009
Monday, April 13, 2009
Great Article on Postpartum and medication
I do like this article as it discusses many different aspects of ppd. However I do disagree on some points when it talks about how it effects the child. I suffered ppd, but I did not suffer it that I did not want to be around my baby. I held him and took care of him because I knew that he needed me and I was the only one there to take care of him. I held him because I knew that I needed him to help me get through this. He was my security. This is how I feel that postpartum effects everyone differently. It is not just depression and you do not want to be around your baby. It can be a variety of symptoms. Again, see your doctor if you do not know if you are suffering and need help!
Postpartum Depression
Author: Ruta M Nonacs, MD, PhD, Associate Director of the Perinatal Psychiatry Clinical Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical SchoolContributor Information and Disclosures
Updated: Dec 4, 2007
Background
During the postpartum period, up to 85% of women experience some type of mood disturbance. For most women, symptoms are transient and relatively mild (ie, postpartum blues); however, 10-15% of women experience a more disabling and persistent form of mood disturbance (eg, postpartum depression, postpartum psychosis).
Postpartum psychiatric illness was initially conceptualized as a group of disorders specifically linked to pregnancy and childbirth and thus was considered diagnostically distinct from other types of psychiatric illness. More recent evidence suggests that postpartum psychiatric illness is virtually indistinguishable from psychiatric disorders that occur at other times during a woman's life.
Although effective nonpharmacologic and pharmacologic treatments are available, both patients and their caregivers frequently overlook postpartum depression. Untreated postpartum affective illness places both the mother and infant at risk and is associated with significant long-term effects on child development and behavior; therefore, prompt recognition and treatment of postpartum depression are essential for both maternal and infant well-being.
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Postpartum Blues
Up to 85% of women experience postpartum affective instability.
Rapidly fluctuating mood, tearfulness, irritability, and anxiety are common symptoms.
Symptoms peak on the fourth or fifth day after delivery and last for several days, but they are generally time-limited and spontaneously remit within the first 2 postpartum weeks.
Symptoms do not interfere with a mother's ability to function and to care for her child.
Women with more severe symptoms or symptoms persisting longer than 2 weeks should be screened for postpartum depression.
Postpartum Psychosis
Postpartum psychosis is the most severe form of postpartum psychiatric illness.
The condition is rare and occurs in approximately 1-2 per 1000 women after childbirth.
At highest risk are women with a personal history of bipolar disorder or a previous episode of postpartum psychosis.
Postpartum psychosis has a dramatic onset, emerging as early as the first 48-72 hours after delivery. In most women, symptoms develop within the first 2 postpartum weeks.
The condition resembles a rapidly evolving manic or mixed episode with symptoms such as restlessness and insomnia, irritability, rapidly shifting depressed or elated mood, and disorganized behavior.
The mother may have delusional beliefs that relate to the infant (eg, baby is defective or dying, infant is Satan or God), or she may have auditory hallucinations that instruct her to harm herself or her infant.
Risks for infanticide and suicide are high among women with untreated postpartum psychosis.
Screening for Postpartum Mood Disorders
Despite multiple contacts with medical professionals during the postpartum period, patients and their caregivers often overlook postpartum affective illness. Too often, postpartum depression is dismissed as a normal or natural consequence of childbirth.
Women commonly report the persistence of depressive symptoms for many months before the initiation of treatment. Although symptoms of depression may remit spontaneously, many women are still depressed one year after childbirth.
Predicting who is at risk for postpartum psychiatric illness is difficult. Individuals at greatest risk often have a prior history of postpartum depression or psychosis, personal or family history of mood disorder, or depression during the current pregnancy. Other risk factors include inadequate social supports, marital dissatisfaction or discord, and recent negative life events such as a death in the family, financial difficulties, or loss of employment.
Screening of all mothers during the postpartum period is indicated.
Screening women for depressive symptoms during pregnancy may also help to identify those women at higher risk for postpartum depression.
The Edinburgh Postnatal Depression Scales1 is a 10-item self-rated questionnaire used extensively for detection of postpartum depression. A score of 12 or more on EPDS or an affirmative answer on question 10 (presence of suicidal thoughts) requires more thorough evaluation. The EPDS may be included in routine well-baby and pediatric visits.
Treatment
Postpartum blues
Postpartum blues is typically mild in severity and resolves spontaneously.
No specific treatment is required, other than support and reassurance.
Further evaluation is necessary if symptoms persist more than 2 weeks.
Postpartum depression
Postpartum depression manifests along a continuum; some patients may experience relatively mild or moderate symptoms, or they may present with a more severe form of depression, characterized by prominent neurovegetative symptoms and marked impairment of functioning.
Exclude medical causes for mood disturbance (eg, thyroid dysfunction, anemia). Initial evaluation includes a thorough medical history, physical examination, and routine laboratory tests.
The severity of illness should guide treatment.
Nonpharmacologic treatment strategies are useful for women with mild-to-moderate depressive symptoms. Individual or group psychotherapy (cognitive-behavioral and interpersonal therapy) are effective. Psychoeducational or support groups may also be helpful. These modalities may be especially attractive to mothers who are nursing and who wish to avoid taking medications.
Pharmacologic strategies are indicated for moderate-to-severe depressive symptoms or when a woman does not respond to nonpharmacologic treatment. Medication may also be used in conjunction with nonpharmacologic therapies.
Selective serotonin reuptake inhibitors (SSRIs) are first-line agents and are effective in women with postpartum depression. Use standard antidepressant dosages, eg, fluoxetine (Prozac) 10-60 mg/d, sertraline (Zoloft) 50-200 mg/d, paroxetine (Paxil) 20-60 mg/d, citalopram (Celexa) 20-60 mg/d, or escitalopram (Lexapro) 10-20 mg/d. Adverse effects of this drug category include insomnia, jitteriness, nausea, appetite suppression, headache, and sexual dysfunction.
Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor) 75-300 mg/d or duloxetine (Cymbalta) 40-60 mg/d, are also highly effective for depression and anxiety.
Tricyclic antidepressants (eg, nortriptyline 50-150 mg/d) may be useful for women with sleep disturbance, although some studies suggest that women respond better to the SSRI drug category. Adverse effects of the tricyclic antidepressants include sedation, weight gain, dry mouth, constipation, and sexual dysfunction.
Typically, symptoms start to diminish in 2-4 weeks. A full remission may take several months. In partial responders, increasing the dosage may be helpful.
Anxiolytic agents such as lorazepam and clonazepam may be useful as adjunctive treatment in patients with anxiety and sleep disturbance.
Preliminary data suggest that estrogen, alone or in combination with an antidepressant, may be beneficial; however, antidepressants remain the first line of treatment.
If this is the first episode of depression, 6-12 months of treatment is recommended. For women with recurrent major depression, long-term maintenance treatment with an antidepressant is indicated.
Inadequate treatment increases the risk of morbidity in both mother and infant.
Earlier initiation of treatment is associated with better prognosis.
Inpatient hospitalization may be necessary for severe postpartum depression.
Electroconvulsive therapy (ECT) is rapid, safe, and effective for women with severe postpartum depression, especially those with active suicidal ideation.
Puerperal psychosis
Puerperal psychosis is a psychiatric emergency that typically requires inpatient treatment.
Most patients with postpartum psychosis have bipolar disorder. Acute treatment includes a mood stabilizer (eg, lithium, valproic acid, carbamazepine) in combination with antipsychotic medications and benzodiazepines.
ECT (often bilateral) is well tolerated and rapidly effective.
Risk of suicide is significant in this population.
Rates of infanticide associated with untreated puerperal psychosis are as high as 4%.
Special Concerns
Breastfeeding and psychotropic medications
Women who plan to breastfeed must be informed that all psychotropic medications, including antidepressants, are secreted into breast milk. Concentrations in breast milk vary widely.
Data on the use of tricyclic antidepressants, fluoxetine, sertraline, and paroxetine during breastfeeding are encouraging, and serum antidepressant levels in the breastfed infant are either low or undetectable. Reports of toxicity in breastfed infants are rare, although the long-term effects of exposure to trace amounts of medication are not known.
Infant serum blood levels of antidepressants are not typically obtained unless the question of toxicity in the infant arises.
Women treated with valproic acid and carbamazepine should avoid breastfeeding because these agents have been associated with hepatotoxicity in the infant.
Breastfeeding in women treated with lithium should be pursued with caution because lithium is secreted at high levels in breast milk and may cause significant toxicity in the nursing infant. If the breastfed infant is exposed to lithium in the breast milk, periodic monitoring of lithium levels and thyroid function is indicated.
Avoid breastfeeding in premature infants or in those with hepatic insufficiency who may have difficulty metabolizing medications present in breast milk.
Prevention of postpartum psychiatric illness
Women at high risk for postpartum illness should be identified prior to delivery. This includes women with a prior episode of postpartum illness and women with histories of either unipolar or bipolar depression. Women who experience depression during pregnancy should also be considered at high risk for postpartum illness.
In addition to monitoring, women with a history of recurrent depression or a history of postpartum depression may benefit from prophylactic treatment with an antidepressant medication. If antidepressants are not used during pregnancy, they may be initiated shortly before or immediately after delivery to reduce the risk of recurrent illness.
Women with bipolar disorder or a history of postpartum psychosis may benefit from prophylactic treatment with lithium, initiated either prior to or within 24 hours of delivery.
The prophylactic efficacy of nonpharmacologic interventions in this setting has not been fully assessed, although one study reported lower rates of postpartum depression in a group of women receiving interpersonal therapy for depression during pregnancy.
Impact of postpartum depression on child development
A large body of literature suggests that a mother's attitude and behavior toward her infant significantly affect mother-infant bonding and infant well-being and development. Postpartum depression may negatively affect these mother-infant interactions.
Mothers with postpartum depression are more likely to express negative attitudes about their infant and to view their infant as more demanding or difficult. Depressed mothers exhibit difficulties engaging the infant, either being more withdrawn or inappropriately intrusive, and more commonly exhibit negative facial interactions. These early disruptions in mother-infant bonding may have a profound impact on child development.
Children of mothers with postpartum depression are more likely than children of nondepressed mothers to exhibit behavioral problems (eg, sleep and eating difficulties, temper tantrums, hyperactivity), delays in cognitive development, emotional and social dysregulation, and early onset of depressive illness.
Pathophysiology
Hormonal factors
Levels of estrogen, progesterone, and cortisol fall dramatically within 48 hours after delivery.
Women with postpartum depression do not differ significantly from nondepressed women with regard to levels of estrogen, progesterone, prolactin, and cortisol or in the degree to which these hormone levels change; however, affected individuals may be abnormally sensitive to changes in the hormonal milieu and may develop depressive symptoms when treated with exogenous estrogen or progesterone.
Psychosocial factors
Women who report inadequate social supports, marital discord or dissatisfaction, or recent negative life events are more likely to experience postpartum depression.
No consistent association between obstetric factors and risk for postpartum depression is apparent.
Biologic vulnerability
Women with prior history of depression or family history of a mood disorder are at increased risk for postpartum depression.
Women with a prior history of postpartum depression or psychosis have up to 90% risk of recurrence.
Conclusion
Postpartum psychiatric illness consists of a highly prevalent group of disorders that affect women during the childbearing years. While postpartum blues is typically benign and self-limited, postpartum depression and postpartum psychosis cause significant distress and dysfunction. Despite multiple contacts with medical professionals during the postpartum period, puerperal mood disorders are frequently missed, and many women go without treatment.
Untreated mood disorders place the mother at risk for recurrent disease. Furthermore, maternal depression is associated with long-term cognitive, emotional, and behavioral problems in the child. One of the most important objectives is to increase awareness across the spectrum of health care professionals who care for women during pregnancy and the puerperium so that postpartum mood disorders may be identified early and treated appropriately. Effective pharmacologic and nonpharmacologic therapies are available.
For excellent patient education resources, visit eMedicine's Depression Center. Also, see eMedicine's patient education articles Depression and Postpartum Depression.
Postpartum Depression
Author: Ruta M Nonacs, MD, PhD, Associate Director of the Perinatal Psychiatry Clinical Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical SchoolContributor Information and Disclosures
Updated: Dec 4, 2007
Background
During the postpartum period, up to 85% of women experience some type of mood disturbance. For most women, symptoms are transient and relatively mild (ie, postpartum blues); however, 10-15% of women experience a more disabling and persistent form of mood disturbance (eg, postpartum depression, postpartum psychosis).
Postpartum psychiatric illness was initially conceptualized as a group of disorders specifically linked to pregnancy and childbirth and thus was considered diagnostically distinct from other types of psychiatric illness. More recent evidence suggests that postpartum psychiatric illness is virtually indistinguishable from psychiatric disorders that occur at other times during a woman's life.
Although effective nonpharmacologic and pharmacologic treatments are available, both patients and their caregivers frequently overlook postpartum depression. Untreated postpartum affective illness places both the mother and infant at risk and is associated with significant long-term effects on child development and behavior; therefore, prompt recognition and treatment of postpartum depression are essential for both maternal and infant well-being.
document.write('')
document.write('')
Postpartum Blues
Up to 85% of women experience postpartum affective instability.
Rapidly fluctuating mood, tearfulness, irritability, and anxiety are common symptoms.
Symptoms peak on the fourth or fifth day after delivery and last for several days, but they are generally time-limited and spontaneously remit within the first 2 postpartum weeks.
Symptoms do not interfere with a mother's ability to function and to care for her child.
Women with more severe symptoms or symptoms persisting longer than 2 weeks should be screened for postpartum depression.
Postpartum Psychosis
Postpartum psychosis is the most severe form of postpartum psychiatric illness.
The condition is rare and occurs in approximately 1-2 per 1000 women after childbirth.
At highest risk are women with a personal history of bipolar disorder or a previous episode of postpartum psychosis.
Postpartum psychosis has a dramatic onset, emerging as early as the first 48-72 hours after delivery. In most women, symptoms develop within the first 2 postpartum weeks.
The condition resembles a rapidly evolving manic or mixed episode with symptoms such as restlessness and insomnia, irritability, rapidly shifting depressed or elated mood, and disorganized behavior.
The mother may have delusional beliefs that relate to the infant (eg, baby is defective or dying, infant is Satan or God), or she may have auditory hallucinations that instruct her to harm herself or her infant.
Risks for infanticide and suicide are high among women with untreated postpartum psychosis.
Screening for Postpartum Mood Disorders
Despite multiple contacts with medical professionals during the postpartum period, patients and their caregivers often overlook postpartum affective illness. Too often, postpartum depression is dismissed as a normal or natural consequence of childbirth.
Women commonly report the persistence of depressive symptoms for many months before the initiation of treatment. Although symptoms of depression may remit spontaneously, many women are still depressed one year after childbirth.
Predicting who is at risk for postpartum psychiatric illness is difficult. Individuals at greatest risk often have a prior history of postpartum depression or psychosis, personal or family history of mood disorder, or depression during the current pregnancy. Other risk factors include inadequate social supports, marital dissatisfaction or discord, and recent negative life events such as a death in the family, financial difficulties, or loss of employment.
Screening of all mothers during the postpartum period is indicated.
Screening women for depressive symptoms during pregnancy may also help to identify those women at higher risk for postpartum depression.
The Edinburgh Postnatal Depression Scales1 is a 10-item self-rated questionnaire used extensively for detection of postpartum depression. A score of 12 or more on EPDS or an affirmative answer on question 10 (presence of suicidal thoughts) requires more thorough evaluation. The EPDS may be included in routine well-baby and pediatric visits.
Treatment
Postpartum blues
Postpartum blues is typically mild in severity and resolves spontaneously.
No specific treatment is required, other than support and reassurance.
Further evaluation is necessary if symptoms persist more than 2 weeks.
Postpartum depression
Postpartum depression manifests along a continuum; some patients may experience relatively mild or moderate symptoms, or they may present with a more severe form of depression, characterized by prominent neurovegetative symptoms and marked impairment of functioning.
Exclude medical causes for mood disturbance (eg, thyroid dysfunction, anemia). Initial evaluation includes a thorough medical history, physical examination, and routine laboratory tests.
The severity of illness should guide treatment.
Nonpharmacologic treatment strategies are useful for women with mild-to-moderate depressive symptoms. Individual or group psychotherapy (cognitive-behavioral and interpersonal therapy) are effective. Psychoeducational or support groups may also be helpful. These modalities may be especially attractive to mothers who are nursing and who wish to avoid taking medications.
Pharmacologic strategies are indicated for moderate-to-severe depressive symptoms or when a woman does not respond to nonpharmacologic treatment. Medication may also be used in conjunction with nonpharmacologic therapies.
Selective serotonin reuptake inhibitors (SSRIs) are first-line agents and are effective in women with postpartum depression. Use standard antidepressant dosages, eg, fluoxetine (Prozac) 10-60 mg/d, sertraline (Zoloft) 50-200 mg/d, paroxetine (Paxil) 20-60 mg/d, citalopram (Celexa) 20-60 mg/d, or escitalopram (Lexapro) 10-20 mg/d. Adverse effects of this drug category include insomnia, jitteriness, nausea, appetite suppression, headache, and sexual dysfunction.
Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor) 75-300 mg/d or duloxetine (Cymbalta) 40-60 mg/d, are also highly effective for depression and anxiety.
Tricyclic antidepressants (eg, nortriptyline 50-150 mg/d) may be useful for women with sleep disturbance, although some studies suggest that women respond better to the SSRI drug category. Adverse effects of the tricyclic antidepressants include sedation, weight gain, dry mouth, constipation, and sexual dysfunction.
Typically, symptoms start to diminish in 2-4 weeks. A full remission may take several months. In partial responders, increasing the dosage may be helpful.
Anxiolytic agents such as lorazepam and clonazepam may be useful as adjunctive treatment in patients with anxiety and sleep disturbance.
Preliminary data suggest that estrogen, alone or in combination with an antidepressant, may be beneficial; however, antidepressants remain the first line of treatment.
If this is the first episode of depression, 6-12 months of treatment is recommended. For women with recurrent major depression, long-term maintenance treatment with an antidepressant is indicated.
Inadequate treatment increases the risk of morbidity in both mother and infant.
Earlier initiation of treatment is associated with better prognosis.
Inpatient hospitalization may be necessary for severe postpartum depression.
Electroconvulsive therapy (ECT) is rapid, safe, and effective for women with severe postpartum depression, especially those with active suicidal ideation.
Puerperal psychosis
Puerperal psychosis is a psychiatric emergency that typically requires inpatient treatment.
Most patients with postpartum psychosis have bipolar disorder. Acute treatment includes a mood stabilizer (eg, lithium, valproic acid, carbamazepine) in combination with antipsychotic medications and benzodiazepines.
ECT (often bilateral) is well tolerated and rapidly effective.
Risk of suicide is significant in this population.
Rates of infanticide associated with untreated puerperal psychosis are as high as 4%.
Special Concerns
Breastfeeding and psychotropic medications
Women who plan to breastfeed must be informed that all psychotropic medications, including antidepressants, are secreted into breast milk. Concentrations in breast milk vary widely.
Data on the use of tricyclic antidepressants, fluoxetine, sertraline, and paroxetine during breastfeeding are encouraging, and serum antidepressant levels in the breastfed infant are either low or undetectable. Reports of toxicity in breastfed infants are rare, although the long-term effects of exposure to trace amounts of medication are not known.
Infant serum blood levels of antidepressants are not typically obtained unless the question of toxicity in the infant arises.
Women treated with valproic acid and carbamazepine should avoid breastfeeding because these agents have been associated with hepatotoxicity in the infant.
Breastfeeding in women treated with lithium should be pursued with caution because lithium is secreted at high levels in breast milk and may cause significant toxicity in the nursing infant. If the breastfed infant is exposed to lithium in the breast milk, periodic monitoring of lithium levels and thyroid function is indicated.
Avoid breastfeeding in premature infants or in those with hepatic insufficiency who may have difficulty metabolizing medications present in breast milk.
Prevention of postpartum psychiatric illness
Women at high risk for postpartum illness should be identified prior to delivery. This includes women with a prior episode of postpartum illness and women with histories of either unipolar or bipolar depression. Women who experience depression during pregnancy should also be considered at high risk for postpartum illness.
In addition to monitoring, women with a history of recurrent depression or a history of postpartum depression may benefit from prophylactic treatment with an antidepressant medication. If antidepressants are not used during pregnancy, they may be initiated shortly before or immediately after delivery to reduce the risk of recurrent illness.
Women with bipolar disorder or a history of postpartum psychosis may benefit from prophylactic treatment with lithium, initiated either prior to or within 24 hours of delivery.
The prophylactic efficacy of nonpharmacologic interventions in this setting has not been fully assessed, although one study reported lower rates of postpartum depression in a group of women receiving interpersonal therapy for depression during pregnancy.
Impact of postpartum depression on child development
A large body of literature suggests that a mother's attitude and behavior toward her infant significantly affect mother-infant bonding and infant well-being and development. Postpartum depression may negatively affect these mother-infant interactions.
Mothers with postpartum depression are more likely to express negative attitudes about their infant and to view their infant as more demanding or difficult. Depressed mothers exhibit difficulties engaging the infant, either being more withdrawn or inappropriately intrusive, and more commonly exhibit negative facial interactions. These early disruptions in mother-infant bonding may have a profound impact on child development.
Children of mothers with postpartum depression are more likely than children of nondepressed mothers to exhibit behavioral problems (eg, sleep and eating difficulties, temper tantrums, hyperactivity), delays in cognitive development, emotional and social dysregulation, and early onset of depressive illness.
Pathophysiology
Hormonal factors
Levels of estrogen, progesterone, and cortisol fall dramatically within 48 hours after delivery.
Women with postpartum depression do not differ significantly from nondepressed women with regard to levels of estrogen, progesterone, prolactin, and cortisol or in the degree to which these hormone levels change; however, affected individuals may be abnormally sensitive to changes in the hormonal milieu and may develop depressive symptoms when treated with exogenous estrogen or progesterone.
Psychosocial factors
Women who report inadequate social supports, marital discord or dissatisfaction, or recent negative life events are more likely to experience postpartum depression.
No consistent association between obstetric factors and risk for postpartum depression is apparent.
Biologic vulnerability
Women with prior history of depression or family history of a mood disorder are at increased risk for postpartum depression.
Women with a prior history of postpartum depression or psychosis have up to 90% risk of recurrence.
Conclusion
Postpartum psychiatric illness consists of a highly prevalent group of disorders that affect women during the childbearing years. While postpartum blues is typically benign and self-limited, postpartum depression and postpartum psychosis cause significant distress and dysfunction. Despite multiple contacts with medical professionals during the postpartum period, puerperal mood disorders are frequently missed, and many women go without treatment.
Untreated mood disorders place the mother at risk for recurrent disease. Furthermore, maternal depression is associated with long-term cognitive, emotional, and behavioral problems in the child. One of the most important objectives is to increase awareness across the spectrum of health care professionals who care for women during pregnancy and the puerperium so that postpartum mood disorders may be identified early and treated appropriately. Effective pharmacologic and nonpharmacologic therapies are available.
For excellent patient education resources, visit eMedicine's Depression Center. Also, see eMedicine's patient education articles Depression and Postpartum Depression.
Sunday, April 12, 2009
Postpartum Depression for Men website
After yesterday's article I decided to post a website for men who may be suffering from postpartum. http://www.postpartummen.com/ Again, women or men, please consult a doctor if you have any signs in any article posted.
Helping Men Beat the Baby Blues and Overcome Depression
PostpartumMen is a place for men with concerns about depression, anxiety or other problems with mood after the birth of a child. It promotes self-help, provides important information for fathers – including a self-assessment for postpartum depression, hosts an online forum for dads to talk to each other, offers resources, gathers new information about men’s experiences postpartum, and – most importantly – helps fathers to beat the baby blues.
Yes, men do get postpartum depression. It’s a fact that most people – and even many health professionals – don’t know. As a result, most men with postpartum depression suffer in isolation. With PostpartumMen, these dads are no longer alone.
What Is Men’s Postpartum Depression or PPND?
Remember seeing your baby for the first time? You were probably filled with pride and excitement. That’s what you always heard it was like having a child – pure joy. Baby bliss.
Then, reality sets in. Sleepless nights. A screaming infant needing nearly constant care. Fights with your partner. Going to work exhausted.
Then, over time, you’ve noticed things have gotten worse.
Now, you’ve lost your sense of humor, and there’s not much to look forward to. You’ve started getting more anxious or panicky. You’ve had trouble sleeping. And you’re miserable a lot of the time.
Or perhaps you’ve been irritable. You’re getting more stressed at work and getting angry with your wife. Maybe you’ve noticed you’re drinking more – or withdrawing from people.
These are all signs of men’s depression. You may think you should just “get over it” – and that you must be the only guy who can’t. But you’re not the only one.
You’re Not Alone – Not By A Long Shot
Every day, over 1,000 new dads in the United States become depressed. And according to some studies, that number is as high as 2,700. That’s 1 in 10 to as many as 1 in 4 new dads who have postpartum depression. Whatever the exact number, we know that a lot of fathers are suffering from this painful condition.
The truth is, depression, anxiety and other mood disorders are common. In fact, they’re just as common – and just as real – as physical problems, like heart disease and diabetes. They can also be as crippling.
Now, contrary to what you might think, admitting you’re depressed isn’t admitting defeat. It’s admitting there’s hope. And it’s taking charge of your life.
There Is Hope
Postpartum depression in dads – or PPND (for Paternal Postnatal Depression) – is a very serious condition. Without effective treatment, it can result in damaging, long-term consequences for a man, his child, and his entire family. But with proper treatment and support, men can fully recover from PPND.
Depression isn’t something a guy can simply “get over.” It’s a health condition that needs to be treated – just like a bad heart or injured knee. PostpartumMen is a place for you to find the strength and courage you need to get your life back on track
Helping Men Beat the Baby Blues and Overcome Depression
PostpartumMen is a place for men with concerns about depression, anxiety or other problems with mood after the birth of a child. It promotes self-help, provides important information for fathers – including a self-assessment for postpartum depression, hosts an online forum for dads to talk to each other, offers resources, gathers new information about men’s experiences postpartum, and – most importantly – helps fathers to beat the baby blues.
Yes, men do get postpartum depression. It’s a fact that most people – and even many health professionals – don’t know. As a result, most men with postpartum depression suffer in isolation. With PostpartumMen, these dads are no longer alone.
What Is Men’s Postpartum Depression or PPND?
Remember seeing your baby for the first time? You were probably filled with pride and excitement. That’s what you always heard it was like having a child – pure joy. Baby bliss.
Then, reality sets in. Sleepless nights. A screaming infant needing nearly constant care. Fights with your partner. Going to work exhausted.
Then, over time, you’ve noticed things have gotten worse.
Now, you’ve lost your sense of humor, and there’s not much to look forward to. You’ve started getting more anxious or panicky. You’ve had trouble sleeping. And you’re miserable a lot of the time.
Or perhaps you’ve been irritable. You’re getting more stressed at work and getting angry with your wife. Maybe you’ve noticed you’re drinking more – or withdrawing from people.
These are all signs of men’s depression. You may think you should just “get over it” – and that you must be the only guy who can’t. But you’re not the only one.
You’re Not Alone – Not By A Long Shot
Every day, over 1,000 new dads in the United States become depressed. And according to some studies, that number is as high as 2,700. That’s 1 in 10 to as many as 1 in 4 new dads who have postpartum depression. Whatever the exact number, we know that a lot of fathers are suffering from this painful condition.
The truth is, depression, anxiety and other mood disorders are common. In fact, they’re just as common – and just as real – as physical problems, like heart disease and diabetes. They can also be as crippling.
Now, contrary to what you might think, admitting you’re depressed isn’t admitting defeat. It’s admitting there’s hope. And it’s taking charge of your life.
There Is Hope
Postpartum depression in dads – or PPND (for Paternal Postnatal Depression) – is a very serious condition. Without effective treatment, it can result in damaging, long-term consequences for a man, his child, and his entire family. But with proper treatment and support, men can fully recover from PPND.
Depression isn’t something a guy can simply “get over.” It’s a health condition that needs to be treated – just like a bad heart or injured knee. PostpartumMen is a place for you to find the strength and courage you need to get your life back on track
Saturday, April 11, 2009
Can men suffer baby blues?
Article taken from babycenter.com
Can men get the baby blues?
I had a baby a few weeks ago, and since then my husband has been very down in the dumps and moody. He's just not himself. Can men get the baby blues?
Expert Answers
Karen Kleiman, therapist
Yes, fathers are vulnerable to similar emotions. Many years ago, the National Institute of Child Health and Human Development found that 62 percent of fathers felt blue some time during the first four months following the birth of their baby. That's one of the reasons we know that the baby blues aren't exclusively caused by hormonal changes.Many factors can contribute to these feelings. The most common are: fear of fatherhood or worries related to new responsibilities and loss of freedom, financial concerns or stress over added expenses and worries about whether his current salary will be sufficient, and role anxieties such as asking, "Will I be a good father? Will I father like my father did?"What compounds the stress is that men are encouraged not to share their fears. Instead, they're often told to "take it like a man" and just deal with it. Unfortunately, keeping silent about your emotions can actually increase stress. Men should be encouraged to talk to their partner or to a professional about what's worrying them. By expressing their anxieties, new dads are more likely to get a clearer perspective and the support they need to feel better.Occasionally, some men will develop depression that goes beyond what we would refer to as the "blues" or common worries. In fact, a study published in the August 2006 edition of Pediatrics found that ten percent of new dads — compared with 14 percent of new moms — showed signs of moderate or severe postpartum depression.Clinical depression needs to be taken seriously, and it's very treatable. Typically, a dad who's depressed feels fatigued and anxious, is preoccupied with finances, begins to withdraw from the family, is irritable, sleeps poorly or too much, or becomes very angry. If any of these symptoms persist beyond a couple of weeks, he should seek professional help from a therapist or psychiatrist. Men who are depressed may also turn to short-term fixes, which can turn into long-term problems if things get out of control. For example, some men may throw themselves into their work, extending their hours and leaving little room for down time. Others may rely on alcohol or other substances for relaxation or escape.Like new moms, new dads need support, encouragement, reassurance, and a safe place to vent their concerns. Talk about the changes in your lives with your partner. Support each other. Remember that dads, too, need some extra TLC and attention during this transition — they just may not be good at asking for it.
Can men get the baby blues?
I had a baby a few weeks ago, and since then my husband has been very down in the dumps and moody. He's just not himself. Can men get the baby blues?
Expert Answers
Karen Kleiman, therapist
Yes, fathers are vulnerable to similar emotions. Many years ago, the National Institute of Child Health and Human Development found that 62 percent of fathers felt blue some time during the first four months following the birth of their baby. That's one of the reasons we know that the baby blues aren't exclusively caused by hormonal changes.Many factors can contribute to these feelings. The most common are: fear of fatherhood or worries related to new responsibilities and loss of freedom, financial concerns or stress over added expenses and worries about whether his current salary will be sufficient, and role anxieties such as asking, "Will I be a good father? Will I father like my father did?"What compounds the stress is that men are encouraged not to share their fears. Instead, they're often told to "take it like a man" and just deal with it. Unfortunately, keeping silent about your emotions can actually increase stress. Men should be encouraged to talk to their partner or to a professional about what's worrying them. By expressing their anxieties, new dads are more likely to get a clearer perspective and the support they need to feel better.Occasionally, some men will develop depression that goes beyond what we would refer to as the "blues" or common worries. In fact, a study published in the August 2006 edition of Pediatrics found that ten percent of new dads — compared with 14 percent of new moms — showed signs of moderate or severe postpartum depression.Clinical depression needs to be taken seriously, and it's very treatable. Typically, a dad who's depressed feels fatigued and anxious, is preoccupied with finances, begins to withdraw from the family, is irritable, sleeps poorly or too much, or becomes very angry. If any of these symptoms persist beyond a couple of weeks, he should seek professional help from a therapist or psychiatrist. Men who are depressed may also turn to short-term fixes, which can turn into long-term problems if things get out of control. For example, some men may throw themselves into their work, extending their hours and leaving little room for down time. Others may rely on alcohol or other substances for relaxation or escape.Like new moms, new dads need support, encouragement, reassurance, and a safe place to vent their concerns. Talk about the changes in your lives with your partner. Support each other. Remember that dads, too, need some extra TLC and attention during this transition — they just may not be good at asking for it.
Friday, April 10, 2009
What to do if your daughter has postpartum depression.
Note from Beth: I know without my mom's understanding I never would have gotten through this. She was always there to talk to; she came over when I needed her; she let me come over whenever I was in a panic. Please do not judge and be supportive. Whether you are near or far, just being there is what matters.
Part II: Is It Baby Blues, Postpartum Depression or Something Else?
What to Do if Your Daughter or Daughter-in-Law Has Postpartum Depression
By Susan Adcox, About.com
See More About:
postpartum depression
baby blues
therapy
anti-depressant
emotional health
zSB(3,3)
Sponsored Links
Postpartum DepressionFind answers and help for those dealing with postpartum depression.www.jennyslight.org
Mother-In-Law QuizDo You Like Your Mother-In-Law? Discover The Truth With This Quiz!www.LifeScript.com/Quiz
Mother's RingsMother's Day Is May 10th - Order By May 4 For Mother's Day Deliverywww.Kranichs.com
zob();if(zs
Grandparents Ads
Grants for Single Mother Adopt a Newborn Post Birth Depression Severe Depression Help Grandparent Poems
What happens after you have analyzed the symptoms that your daughter or daughter-in-law is experiencing and have decided that postpartum depression (PPD) is a definite possibility?
Doing nothing is not an option. The mother with PPD is suffering, and her baby could be suffering also. If the depression is severe, the baby may not be getting the level of care and attention that he or she needs. Less severe depression can still cause a lack of bonding between parent and child. In one or two cases per thousand, the mother actually develops postpartum psychosis. For the sake of both mother and child, you must take action.
Starting the Conversation
If you have a good relationship with your daughter or daughter-in-law, you may want to approach her yourself. If you are the grandmother, you can take a woman-to-woman approach.
Simone* Says:
My mom was the greatest help to me even though she lives on the other side of the Atlantic. She went through the same thing after she had my younger sister. My grandmother ended up taking me, my mom and my sister in and looking after us for about a year. We talked on the phone a lot, and it helped so much to hear my mom, who did such a good job raising us, talk about having feelings exactly the same as mine.
If the direct approach does not seem advisable or does not work, the father can be tapped to encourage the mother to seek help. This works, of course, only if the marital relationship is relatively sound.
A third approach can be to utilize some other person. The mother’s ob/gyn or midwife is a natural choice. A pastor or other spiritual advisor may be able to help.
Margo Says:
Among the people who helped the most were my pediatrician and my ob/gyn. I had a c-section, so I was still seeing my ob/gyn for that. He was a family friend--I babysat for his children when I was a teenager--so I felt closer to him than you might normally feel.
What Grandparents Can Do
Mothers with PPD may need therapy and/or medication. Other strategies, however, may help by relieving some of the more stressful situations in the mother’s life. As the grandparent, you are in a good position to enable some of these strategies.
Offer to help with the baby so the new mother can sleep. Sleep deprivation is huge in many episodes of PPD. Often the mother has difficulty sleeping, so having the opportunity to sleep doesn’t always work, but it is a simple solution that is worth a try.
Offer to keep the baby so that the baby’s parents can go out. It’s good to have this happen as soon as possible, so that the parents know that they and the baby can survive a few hours of separation.
Bring up the topic of the mother’s feelings. Mothers often feel guilty that they have any feelings other than unmitigated joy. Let the mother know that it is okay to feel tired, resentful, overwhelmed and neglected.
Get the new mother out of the house. Take the mother and baby out for lunch, or for a stroll. If there is a problem, such as the baby crying, the mother does not have to deal with it alone.
Reassure the mother. Many mothers with PPD feel inadequate, and as the grandparent, you are uniquely positioned to allay those fears. Don’t be gushy, and don’t lie. But do focus on those things that the mother does well and reassure her that she can do things for her child that no one else can do. If you are the mother-in-law, you have special power, as most young women want to make a good impression on their in-laws. Approval and validation from you will be especially powerful.
Serious Help for PPD
Sometimes just talking about the situation and taking some common-sense steps will help. If not, PPD must be treated much like any other type of depression, with therapy and/or medication. Breast-feeding mothers will want to avoid medication if at all possible. If the depression does not abate with therapy, however, it may be best for the mother to take one of the medications that is considered safe for breastfeeding, or even to stop breastfeeding. These are decisions that will need to be made with the help of a professional.
Therapy does not have to be the traditional one-on-one mode. Group therapy can be especially effective since mothers with PPD may feel isolated.
Simone Says:
I joined a support group that met once a week to talk about all kinds of issues, and it really helped to meet other mothers who had gone or were going through it too. The group also helped me to realize that no mother is perfect. We all have problems, and we all need support. I also met other moms for playdates, outside a support group, and going out to the park. Even when my son was too small to go on the swings, getting out and getting fresh air and doing something fun instead of sitting in the house with a newborn was a lifesaver. It was hard to find the energy to even go to the park, but I'm so glad I did. I've made some wonderful friends, for me and my son.
Awareness and Self-Help Strategies
In some cases, merely being aware that one's emotional health is a bit precarious can avert an episode.
Laurie Says:
By the time my third child arrived, my husband and I both were a little more savvy about the baby blues. Erik was home from the hospital for a week or so when my husband made some kind of joke that really touched a nerve with me. I don't remember exactly what it was, but I remember very loudly telling him this was NOT a good time to say that. He promptly fell all over himself apologizing, because we both knew exactly what was going on, and a crisis was averted.
Simone Says:
I realized that the only one who could actually get me out of the depression was me. Support from others helped, but I was the only one who could actually change it. Taking it day by day, getting out of the house, and trying to incorporate non-Mom activities in my life--reading, painting my toenails, small things like that--all helped.
With time and some support, most episodes of PPD can be resolved without lasting effects on the mother or baby. As the grandparent, however, you shouldn’t trust to chance. If you are kind, caring and never, ever judgmental, your daughter’s or daughter-in-law’s bout with postpartum depression can prove to be a positive relation-building episode.
*Not her real name
More About Postpartum Depression
Postpartum: Does It Have to be a Bumpy Ride?Postpartum PsychosisPPD and Postpartum Thyroid Disease
Related Articles
Postpartum Depression - How to Know If Your Daughter or Daughter-in-Law Has...
Antidepressants and Pregnancy
The Good News about Postpartum Depression
Postpartum Depression (PPD) in Moms of Twins/Multiples
Signs of Postpartum Depression (PPD)
Part II: Is It Baby Blues, Postpartum Depression or Something Else?
What to Do if Your Daughter or Daughter-in-Law Has Postpartum Depression
By Susan Adcox, About.com
See More About:
postpartum depression
baby blues
therapy
anti-depressant
emotional health
zSB(3,3)
Sponsored Links
Postpartum DepressionFind answers and help for those dealing with postpartum depression.www.jennyslight.org
Mother-In-Law QuizDo You Like Your Mother-In-Law? Discover The Truth With This Quiz!www.LifeScript.com/Quiz
Mother's RingsMother's Day Is May 10th - Order By May 4 For Mother's Day Deliverywww.Kranichs.com
zob();if(zs
Grandparents Ads
Grants for Single Mother Adopt a Newborn Post Birth Depression Severe Depression Help Grandparent Poems
What happens after you have analyzed the symptoms that your daughter or daughter-in-law is experiencing and have decided that postpartum depression (PPD) is a definite possibility?
Doing nothing is not an option. The mother with PPD is suffering, and her baby could be suffering also. If the depression is severe, the baby may not be getting the level of care and attention that he or she needs. Less severe depression can still cause a lack of bonding between parent and child. In one or two cases per thousand, the mother actually develops postpartum psychosis. For the sake of both mother and child, you must take action.
Starting the Conversation
If you have a good relationship with your daughter or daughter-in-law, you may want to approach her yourself. If you are the grandmother, you can take a woman-to-woman approach.
Simone* Says:
My mom was the greatest help to me even though she lives on the other side of the Atlantic. She went through the same thing after she had my younger sister. My grandmother ended up taking me, my mom and my sister in and looking after us for about a year. We talked on the phone a lot, and it helped so much to hear my mom, who did such a good job raising us, talk about having feelings exactly the same as mine.
If the direct approach does not seem advisable or does not work, the father can be tapped to encourage the mother to seek help. This works, of course, only if the marital relationship is relatively sound.
A third approach can be to utilize some other person. The mother’s ob/gyn or midwife is a natural choice. A pastor or other spiritual advisor may be able to help.
Margo Says:
Among the people who helped the most were my pediatrician and my ob/gyn. I had a c-section, so I was still seeing my ob/gyn for that. He was a family friend--I babysat for his children when I was a teenager--so I felt closer to him than you might normally feel.
What Grandparents Can Do
Mothers with PPD may need therapy and/or medication. Other strategies, however, may help by relieving some of the more stressful situations in the mother’s life. As the grandparent, you are in a good position to enable some of these strategies.
Offer to help with the baby so the new mother can sleep. Sleep deprivation is huge in many episodes of PPD. Often the mother has difficulty sleeping, so having the opportunity to sleep doesn’t always work, but it is a simple solution that is worth a try.
Offer to keep the baby so that the baby’s parents can go out. It’s good to have this happen as soon as possible, so that the parents know that they and the baby can survive a few hours of separation.
Bring up the topic of the mother’s feelings. Mothers often feel guilty that they have any feelings other than unmitigated joy. Let the mother know that it is okay to feel tired, resentful, overwhelmed and neglected.
Get the new mother out of the house. Take the mother and baby out for lunch, or for a stroll. If there is a problem, such as the baby crying, the mother does not have to deal with it alone.
Reassure the mother. Many mothers with PPD feel inadequate, and as the grandparent, you are uniquely positioned to allay those fears. Don’t be gushy, and don’t lie. But do focus on those things that the mother does well and reassure her that she can do things for her child that no one else can do. If you are the mother-in-law, you have special power, as most young women want to make a good impression on their in-laws. Approval and validation from you will be especially powerful.
Serious Help for PPD
Sometimes just talking about the situation and taking some common-sense steps will help. If not, PPD must be treated much like any other type of depression, with therapy and/or medication. Breast-feeding mothers will want to avoid medication if at all possible. If the depression does not abate with therapy, however, it may be best for the mother to take one of the medications that is considered safe for breastfeeding, or even to stop breastfeeding. These are decisions that will need to be made with the help of a professional.
Therapy does not have to be the traditional one-on-one mode. Group therapy can be especially effective since mothers with PPD may feel isolated.
Simone Says:
I joined a support group that met once a week to talk about all kinds of issues, and it really helped to meet other mothers who had gone or were going through it too. The group also helped me to realize that no mother is perfect. We all have problems, and we all need support. I also met other moms for playdates, outside a support group, and going out to the park. Even when my son was too small to go on the swings, getting out and getting fresh air and doing something fun instead of sitting in the house with a newborn was a lifesaver. It was hard to find the energy to even go to the park, but I'm so glad I did. I've made some wonderful friends, for me and my son.
Awareness and Self-Help Strategies
In some cases, merely being aware that one's emotional health is a bit precarious can avert an episode.
Laurie Says:
By the time my third child arrived, my husband and I both were a little more savvy about the baby blues. Erik was home from the hospital for a week or so when my husband made some kind of joke that really touched a nerve with me. I don't remember exactly what it was, but I remember very loudly telling him this was NOT a good time to say that. He promptly fell all over himself apologizing, because we both knew exactly what was going on, and a crisis was averted.
Simone Says:
I realized that the only one who could actually get me out of the depression was me. Support from others helped, but I was the only one who could actually change it. Taking it day by day, getting out of the house, and trying to incorporate non-Mom activities in my life--reading, painting my toenails, small things like that--all helped.
With time and some support, most episodes of PPD can be resolved without lasting effects on the mother or baby. As the grandparent, however, you shouldn’t trust to chance. If you are kind, caring and never, ever judgmental, your daughter’s or daughter-in-law’s bout with postpartum depression can prove to be a positive relation-building episode.
*Not her real name
More About Postpartum Depression
Postpartum: Does It Have to be a Bumpy Ride?Postpartum PsychosisPPD and Postpartum Thyroid Disease
Related Articles
Postpartum Depression - How to Know If Your Daughter or Daughter-in-Law Has...
Antidepressants and Pregnancy
The Good News about Postpartum Depression
Postpartum Depression (PPD) in Moms of Twins/Multiples
Signs of Postpartum Depression (PPD)
Thursday, April 9, 2009
Could there be a test for PPD?
Blood Test May Predict Postpartum Depression
Measuring hormone could find three-fourths of women at risk, study claims
Posted February 2, 2009
By Steven ReinbergHealthDay Reporter
MONDAY, Feb. 2 (HealthDay News) -- Measuring the levels of a hormone produced by the placenta during pregnancy might predict whether a woman is likely to develop postpartum depression, a new study suggests.
Approximately 13 percent of women will experience postpartum depression, a condition that holds significant consequences not only for women but for their infants and families as well, experts say. Once a woman has had postpartum depression, she is more likely to have future bouts of depression, and that puts infants and children at risk for cognitive, behavioral and social problems.
"If we know early on that a woman is at high risk to develop postpartum depression, then we can implement interventions before symptoms actually occur," said lead researcher Ilona S. Yim, an assistant professor of psychology at the University of California, Irvine.
"By means of a simple blood draw, we could correctly identify 75 percent of women who would later develop postpartum depression," she said.
The report is published in the February issue of Archives of General Psychiatry.
For the study, Yim's group looked for a link between placental corticotropin-releasing hormone (pCRH) and postpartum depression. The researchers took blood samples from 100 pregnant women at various stages during their pregnancy and tested for levels of pCRH.
They also assessed the women for signs of depression
during pregnancy and about eight weeks, on average, after delivery.
In all, 16 women developed postpartum depression. In each case, the women had had high levels of pCRH at 25 weeks into their pregnancies, the study found.
The blood test, which was found to have a high degree of both specificity and sensitivity, could identify about 75 percent of women who would develop postpartum depression, Yim's team found. The test misclassified about 25 percent of the women.
When the blood test was combined with assessing symptoms of depression during pregnancy, Yim noted, it was even more predictive of postpartum depression.
If the findings can be replicated, then testing the level of this hormone might become standard care, Yim said.
"Postpartum depression affects so many women that it would be great to have something that would help to identify being at risk early on, and perhaps develop strategies to prevent it," she said.
Women who know they are at risk for postpartum depression can take steps to reduce stress that might ward off the condition, Yim said. "They could take yoga classes and avoid severe stressors," she said.
Postpartum depression generally begins within four to six weeks after delivery. Risk factors include a history of depression, stressful life events, a lack of social support, low self-esteem and depression, anxiety or stress during pregnancy.
Postpartum depression expert Jeanelle Sheeder, a clinical sciences senior instructor of obstetrics and gynecology and pediatrics at the University of Colorado Medical Center in Denver, said she was not sure that the blood test would add more than what can be gleaned from screening women for signs of depression before and during their pregnancies.
"It is encouraging to have a prenatal biologic measure that predicts postpartum depression," Sheeder said. "However, I am not sure about the practicality of using pCRH as a screening tool. It has been shown that prenatal depression is predictive of postpartum depression, and it is easier and cheaper to do that type of screening than pCRH in most clinical settings."
More information
The National Women's Health Information Center has more on depression and pregnancy.
Measuring hormone could find three-fourths of women at risk, study claims
Posted February 2, 2009
By Steven ReinbergHealthDay Reporter
MONDAY, Feb. 2 (HealthDay News) -- Measuring the levels of a hormone produced by the placenta during pregnancy might predict whether a woman is likely to develop postpartum depression, a new study suggests.
Approximately 13 percent of women will experience postpartum depression, a condition that holds significant consequences not only for women but for their infants and families as well, experts say. Once a woman has had postpartum depression, she is more likely to have future bouts of depression, and that puts infants and children at risk for cognitive, behavioral and social problems.
"If we know early on that a woman is at high risk to develop postpartum depression, then we can implement interventions before symptoms actually occur," said lead researcher Ilona S. Yim, an assistant professor of psychology at the University of California, Irvine.
"By means of a simple blood draw, we could correctly identify 75 percent of women who would later develop postpartum depression," she said.
The report is published in the February issue of Archives of General Psychiatry.
For the study, Yim's group looked for a link between placental corticotropin-releasing hormone (pCRH) and postpartum depression. The researchers took blood samples from 100 pregnant women at various stages during their pregnancy and tested for levels of pCRH.
They also assessed the women for signs of depression
during pregnancy and about eight weeks, on average, after delivery.
In all, 16 women developed postpartum depression. In each case, the women had had high levels of pCRH at 25 weeks into their pregnancies, the study found.
The blood test, which was found to have a high degree of both specificity and sensitivity, could identify about 75 percent of women who would develop postpartum depression, Yim's team found. The test misclassified about 25 percent of the women.
When the blood test was combined with assessing symptoms of depression during pregnancy, Yim noted, it was even more predictive of postpartum depression.
If the findings can be replicated, then testing the level of this hormone might become standard care, Yim said.
"Postpartum depression affects so many women that it would be great to have something that would help to identify being at risk early on, and perhaps develop strategies to prevent it," she said.
Women who know they are at risk for postpartum depression can take steps to reduce stress that might ward off the condition, Yim said. "They could take yoga classes and avoid severe stressors," she said.
Postpartum depression generally begins within four to six weeks after delivery. Risk factors include a history of depression, stressful life events, a lack of social support, low self-esteem and depression, anxiety or stress during pregnancy.
Postpartum depression expert Jeanelle Sheeder, a clinical sciences senior instructor of obstetrics and gynecology and pediatrics at the University of Colorado Medical Center in Denver, said she was not sure that the blood test would add more than what can be gleaned from screening women for signs of depression before and during their pregnancies.
"It is encouraging to have a prenatal biologic measure that predicts postpartum depression," Sheeder said. "However, I am not sure about the practicality of using pCRH as a screening tool. It has been shown that prenatal depression is predictive of postpartum depression, and it is easier and cheaper to do that type of screening than pCRH in most clinical settings."
More information
The National Women's Health Information Center has more on depression and pregnancy.
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