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Doctor's corner Is it more than the baby blues? Understanding postpartum depression and related conditions

Portsmouth Herald - 7/23/2017

The birth of a child is a wonderful event, and triggers many emotions. Most women, especially first-time mothers, experience some anxiety about caring for an infant and the responsibility a baby brings. But for some women, giving birth sends their emotions into a darker place, causing depression.

Postpartum depression is more than just the "baby blues" - those mood swings and crying spells caused by hormonal changes. Those quickly fade but postpartum depression lingers, and usually requires professional help to be resolved. Let's take a closer look at the difference between postpartum depression and the "baby blues," and other issues that may be involved.

How is postpartum depression different from the baby blues?

The baby blues usually last only a few days or weeks; these symptoms include mood swings, anxiety, sadness, irritability, crying, decreased concentration and trouble sleeping. The symptoms for postpartum depression can be similar to the baby blues, but usually are more intense and last longer. They can also interfere with the mother's ability to care for her baby or cope with daily life. Symptoms of postpartum depression include:

n Loss of appetite.

n Insomnia.

n Overwhelming fatigue.

n Loss of interest in sex.

n Taking no pleasure in life.

n Feelings of shame, guilt or inadequacy.

n Severe mood swings.

n Difficulty bonding with the baby.

n Feeling confused and scared over what's happening.

n Difficulty concentrating.

n Withdrawal from friends, family and social contact; some women speak of feeling disconnected, like they are apart from everyone else and the rest of the world.

* Thoughts of harming herself or the baby.

Signs of postpartum depression usually develop within four weeks of giving birth. Untreated, postpartum depression can last a year or more.

How does postpartum depression affect the new mother and her family?

Postpartum depression affects the entire family. Left untreated, it can interfere with long-term mother-child bonding and cause future family problems. Children of depressed mothers cans have behavioral problems such as difficulty sleeping and eating, frequent tantrums and hyperactivity. Delays in language development can occur.

Postpartum depression can erode the bond between couples and dissolve relationships.

Sometimes postpartum depression can lead to a chronic depressive disorder. Even with treatment, postpartum depression can increase a woman's risk for depression in the future. However, your doctor can help you identify possible triggers and signs to watch for so that such an occurrence can possibly be avoided, minimized or treated as soon as possible if it does happen.

What are some common causes of postpartum depression?

Postpartum depression can be caused by a number of physical, emotional and lifestyle issues. Here are some examples:

Physical: After childbirth, your body experiences a dramatic drop in hormones, particularly estrogen and progesterone. This drop can contribute to postpartum depression. Your thyroid hormones can also dip significantly, leaving you tired and depressed. Changes in your immune system, metabolism, blood volume and blood pressure can also contribute to fatigue and mood swings.

Emotional: If you are tired, it is easy to feel overwhelmed. Even minor problems can seem too much to cope with. As a new mother, you may be worried about caring for a new baby. You may not feel ready to be a mother or you may be concerned about your appearance. Many women worry about getting back to their pre-baby weight and regaining their abdominal muscle tone; some feel less attractive post-pregnancy. Some women feel that they no longer have control over their own lives - they feel like everything now and for years to come revolves around the child. These kinds of feelings can lead to postpartum depression.

Lifestyle: A new baby changes everyone's schedule. These changes can be exhausting initially - even more so, if there are other children in the family who also need attention. Some women have difficulty breast-feeding, which creates stress. Others may feel that their partners are not providing enough help with care of the baby, household, or other children. And some families are burdened with financial worries. All of these items can trigger postpartum depression.

How do you tell if you are at risk for postpartum depression?

Postpartum depression can develop after the birth of any child, not just the first one. You may be at risk if you have these factors:

n You have a history of depression, either during pregnancy or at other times.

n You had postpartum depression after a previous pregnancy.

n You have experienced stressful events during the past year - such as illness, loss of job, or pregnancy complications.

n You are having problems in your relationship with your spouse or significant other.

n You don't have a strong support system to help you.

n You have financial problems.

n The pregnancy was unwanted or unplanned.

The risk of postpartum depression is also higher for women with bipolar disorder.

What about postpartum post-traumatic stress disorder?

In addition to being at risk for regular depression, new mothers can also be at risk for postpartum post-traumatic stress disorder, depending on the circumstances surrounding their delivery. Postpartum PTSD occurs as the result of trauma - or perceived trauma - during the baby's delivery, while typical postpartum depression can be the result of the possible contributing factors previously described. In some cases, the two conditions are connected, and certainly one can aggravate the other.

Postpartum PTSD can occur with new moms who gave birth prematurely and now are dealing with infants in the NICU - sometimes for a prolonged period. Studies have shown that 24 percent of mothers who gave birth to premature at-risk infants suffered from PTSD and were still experiencing symptoms six months after the birth date.

Postpartum PTSD can also occur with mothers who suffered a prolapsed cord, had an unplanned Caesarean section, had a difficult birth, had their babies delivered via forceps or a vacuum extractor, or who experienced feelings of powerlessness or lack of support or reassurance during delivery.

Symptoms of postpartum PTSD include flashbacks or nightmares about the experience, re-experiencing of the event, avoidance of anything or anyone who reminds them of the event, persistent and increased irritability, hypervigilance and difficulty sleeping. Moms with PTSD may also experience anxiety, feelings of unreality and detachment and are easily startled.

On the positive side, postpartum PTSD is temporary and it is treatable. The most important thing is to identify PTSD early on and get professional help before the postpartum PTSD morphs into other more persistent mental disorders, such as an eating disorder, addiction, persistent depression, or panic disorders.

What about postpartum anxiety and postpartum OCD?

These symptoms can also appear any time within 12 months of having a baby. With postpartum anxiety, women may feel like their thoughts are racing and they cannot relax. They feel like they must be doing something to care for the baby or around the house at every minute. They feel extremely worried about everything all the time. They may also have disturbing thoughts - thoughts that scare them, about things they have never thought about before and would never do, but these thoughts pop into their head. These are all symptoms of postpartum anxiety.

With postpartum OCD, or obsessive-compulsive disorder, women find themselves checking and rechecking things, whether it's the baby, the stove, is the door locked? They need constant reassurance that everything is at it should be. They may constantly wash their hands or be obsessive about having the baby's items clean. Disturbing intrusive thoughts can occur with postpartum OCD as well.

Women who have postpartum depression may also have anxiety and OCD. They may also experience physical symptoms such as nausea, shakiness, cramps, headaches or panic attacks.

Why do some women avoid reaching out for treatment for any of these disorders?

Some women feel like they should "snap out of it" on their own. They feel that if they take their vitamins, eat healthy, exercise and otherwise do everything right, they should just get over it. They may know something is wrong, but they are in denial or afraid to seek treatment. Some women fear that they are going crazy, that they will always feel this way, and instead of seeing treatment as a way to help them feel better, fear that it will just confirm that they are mentally ill with no hope for improvement. Many new moms also worry that if they reach out for help, someone will take their baby away. These fears are troubling because the only way to feel better, and to be able to take good care of your baby is to get help.

What are some of the treatments for postpartum depression?

If you have symptoms of postpartum depression, or anxiety, OCD or PTSD, call your doctor - do not let shame or anxiety stop you. Postpartum depression is common - it is not your fault, but do get treatment as soon as possible.

Your doctor may suggest a referral to a psychiatrist and/or therapist to help you find better ways to cope with your feelings, solve problems and set realistic goals. Sometimes, having your spouse or family members attend such sessions with you can be helpful, too.

Medication may also be prescribed. Antidepressants are a proven treatment for postpartum depression, although if you are breast feeding you need to be aware that any medication you take will enter your breast milk. However, some antidepressants can be used during breast feeding with little risk of side effects for your baby. Your doctor can advise you.

Getting adequate sleep is essential. Insomnia increases the risk for depression, as well as worsening depression. Perhaps you can arrange for your partner, or a supportive relative, to assist with nighttime bottle feedings. If you are breastfeeding, a stored bottle of breast milk can be used by your support person so you can get more sleep.

Often, a combination of counseling, medication and lifestyle changes is recommended. With appropriate treatment, postpartum depression can wane within a few months. However, it is important to continue treatment even after you feel better. Stopping treatment too early can lead to a relapse.

What can new mothers do to help ease postpartum depression?

Postpartum depression does require professional treatment, but there are some things new mothers can do that can help enhance the healing process.

n Make physical activity part of your daily routine - a walk, going to the gym - anything that gets you moving. Physical activity releases endorphins, the "feel good" hormones, and reduces stress.

n Eat healthy foods and avoid alcohol.

n Lower your expectations - don't expect to run the perfect household at this time. Don't put pressure on yourself to accomplish an unrealistic list of tasks. Do what you can and don't worry about the rest.

n Don't be afraid to ask for help - with errands, child care, getting meals - whatever needs doing.

n Make time for yourself. Take a break to do something you enjoy; be sure to keep connected socially. Make time for your partner.

n Avoid being alone too much. Talk with your family and friends about how you are feeling and encourage visits. Also make sure you get dressed and go out. Talk with other mothers about their experiences. Your doctor may be able to recommend support groups for postpartum mothers or new mothers.

With proper treatment, you, too can be enjoying this special time in your life as you welcome your new baby.

-Dr. David Schopick is a psychiatrist in private practice in Portsmouth. He is board certified by the American Board of Psychiatry and Neurology in adult, adolescent and child psychiatry and has been serving patients in the Greater Seacoast area and beyond for more than 25 years. For information, call 431-5411 or visit www.schopickpsychiatry.com.