Coping with postpartum mood disorders.

"While our mothers may have taught us that misery and suffering is part of mothering an infant, it is simply untrue," says Elizabeth Tortes, Psy.D., a psychologist who leads support groups for women experiencing postpartum depression (PPD). PPD affects up to 20% of new mothers, but it can be effectively treated. Torres says, "The best treatment is some combination of cognitive-behavioral therapy (CBT), which emphasizes here and now tools to get the woman back on her feet, and anti-depressants.

Research demonstrates the effectiveness of CBT. It's perfect for new mothers. Therapy at this time isn't about examining history and doing deep emotional work. It's about coping strategies, self-care, and managing energy for the job at hand." Kathleen Kendall, Health Psychologist, IBCLC, and author of Depression in New Mothers says that additionally "exercise, Omega 3s, and St. John's Wort can be effective."

It's important for women to know "many anti-depressants are compatible with breastfeeding and may help a depressed woman to continue breastfeeding," says Karen Gromada, MSN, RN, IBCLC. "Researchers found breastfeeding may lower the risk of PPD."

Teresa Twomey of Farmville, Virginia, experienced PPD, postpartum psychosis, and postpartum obsessive-compulsive disorder after her daughter's birth. Her experience led her to become a Postpartum Support International (PSI) coordinator. She describes herself postpartum as "angry, irritable, and utterly alone. I felt I was a bad mother and not bonding with my baby. I wanted to run away. I wondered where the "real me' had gone and whether she would ever return. I was desperate, hopeless, and miserable." Twomey finally sought help because she felt that would be best for her family. Medication and learning about her condition were helpful. Now she offers the Universal Message of PSI to other women:

   You are not alone.
   You are not to blame.
   You will be well.
   Your experience is real and there is help.

Up to 80% of women experience the baby blues postpartum. But they will usually begin having more good days than bad ones by the time their babies are two weeks old. Women who are depressed longer should seek help from their obstetrician or midwife. Twomey says, "You may have to be your own advocate. Many doctors are under-informed about this. If you don't feel you are getting adequate help, ask your doctor to use a formal screening tool for depression or see another doctor. If you don't know where to turn, ask your pediatrician." PPD is a pediatric issue since the health of the mother influences the well-being of her child.

"Unresolved PPD is associated with depression, behavioral disturbances, avoidant attachment, and cognitive impairments for children of affected women. Research indicates PPD is associated with early weaning, although women who continue to breastfeed through PPD have more positive mother-baby interactions," reports Gromada.Symptoms of postpartum depression include: "sadness, anhedonia (inability to experience pleasure), sleep disturbances, emotional sensitivity. and appetite disturbances," says Kendall. Depression occurs during pregnancy at similar rates and should be treated as well. A medical screening is important to rule out other conditions that cause depression, including thyroid disorders.

"A family member might notice the new mother has feelings of sorrow, a lack of joy, difficulty connecting with her baby, taking care of herself, and/or sleeping," explains Kendall. He or she can help by expressing concern, providing physical support, asking her if she feels depressed, learning more about postpartum depression, and helping her to seek services and support.

Postpartum anxiety disorders are also common. Torres says, "Women can be obsessive in their thinking, irritable, compulsive about baby care or housework, and have physical symptoms such as stomach aches, muscle tension/spasms, headaches and fatigue. They probably wouldn't consider themselves depressed and might not seek help. Women who have OCD have disturbing, intrusive thoughts of harming their children or that they have harmed them in some way. These women are upset by their thoughts and would not act on them. They often secondarily become depressed."

Women with a history of depression or anxiety, or a history of mood disorders in their biological families are most at risk. Poverty, an unwanted pregnancy, a difficult birth or baby, and a lack of social support may also be risk factors. But "PPD affects women regardless of ethnicity, religious background, marital status, educational level or social or economic status, says Margaret Howard, Ph.D., Director of the Postpartum Depression Day Hospital at Women & Infants' Hospital in Providence, RI. "No one is immune. It's the most common complication of childbirth."

Having physical help caring for the baby can offset that risk. Torres says, "Women often plan to have help for two weeks or less. That's inadequate for most women. Our culture gives women an impossible vision of motherhood to live up to. Being around other new mothers is a huge buffer; it can dispel the isolation and pain around learning this new role."

Resources

Depression After Delivery www.Depressionaflerdelivery.com

Postpartum Support International (PSI) www.postpartum.net; 805-967-7636

www.wellmother.com--resources for emotional challenges related to the reproductive cycle including prenatal depression and PPD from Dr. Shaila Misri, author of Shouldn't I Be Happy?

The Edinburgh Postnatal Depression Scale is a concise and valid screening tool for depression and can be found at: www.dbpeds.org/media/edinburghscale.pdf

Julie Brill is a certified childbirth educator and home-schooling mother of two daughters. She trains childbirth educators for CAPPA. teaches perinatal classes, and works as a freelance writer. Her website is www.wellpregnancy.com.