The Complete Guide To Postpartum Depression
You have just had a baby, and this is supposed to be a happy time, yet all you feel is intense sadness. Why is this? Postpartum depression is the culprit. Symptoms can vary from mild to severe, and are often referred to as the ‘baby blues.’ Postpartum depression and the ‘baby blues’ are to an extent a natural part of motherhood, but they can be managed and overcome.
What causes postpartum depression?
While there is no one cause of the ‘baby blues,’ there are three factors1 that are involved:
- Hormonal fluctuations
Immediately after you have given birth, there is a sharp decrease in estrogen and progesterone, and a possible decrease in thyroid hormones. Remember how the interplay of hormones sometimes caused you to feel weepy and edgy during your menstrual period? Postpartum depression can feel even worse.
- Physical issues
A feeling of fatigue and an extreme lack of energy is not uncommon during the period immediately after childbirth, especially in women who have given birth via cesarean section. It often takes a few weeks for women to regain their strength and energy after giving birth. Fatigue from sleep that is interrupted by a hungry baby contributes to postpartum depression.
- Emotional concerns
A newborn baby often takes a while to adjust to a sleep pattern that allows its parents to get a good night’s sleep. Studies have shown that the part of the brain that deals with emotional issues (amygdala) is over-reactive by 60% when one is sleep deprived.2
There are other emotional concerns that often plague women who have just given birth. If you are a first time mother, you may be concerned about your ability to parent a child. This concern comes to the forefront once you are confronted with your newborn. A wide array of self-doubts and concerns about attractiveness are other concerns you might have.
All of these emotional issues are heightened by the effects of the hormonal decreases, and often lead to varying degrees of postpartum depression.
If you are subject to depression, if it runs in your family, or if you are dealing with major emotional issues, you will be more prone to having postpartum depression.
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How do you know you have postpartum depression?
Symptoms of depression from any cause may include any of the following, and can be present in varying degrees in all levels of postpartum depression: 3
- Trouble focusing and remembering
- Moodiness, sadness, crying episodes, and hopelessness
- Eating disturbances such as overeating or anorexia
- Sleep disturbances
- Self-doubt and self-recrimination
- Withdrawal from social interactions and loss of interest in life
Some authorities on postpartum depression4 categorize the condition in three levels of severity:
1. Baby blues is the name given to the slight depressive feelings some women have after giving birth. These feelings resolve in a few days to a week after childbirth. ‘Baby blues’ symptoms include:
- Mood swings accompanied by crying spells
- A loss of appetite and sleep disruption
- Feelings of intense sadness, inability to cope, and anxiety.
The ‘baby blues’ do not require any medical intervention.
2. Postpartum depression can be triggered at birth or any time during the first year of your child’s life. It includes the above symptoms plus:
- A loss of interest in your child
- Thoughts of causing harm to either your baby or yourself.
See your doctor for help in resolving postpartum depression. A therapist can also help you deal with any emotional issues that are the underlying cause of postpartum depression.
3. Postpartum psychosis is a very rare problem, occurring in only a few women. It generally only affects women who are bipolar or who have schizoaffective disorder. Symptoms of postpartum psychosis include many of the above symptoms as well as:
- Frequent mood swings
- Attempts to hurt your baby and/or yourself.
What happens when postpartum depression remains untreated?
The symptoms of postpartum depression affect not only the person suffering from it but they fan out in a ripple effect, touching everyone around the sufferer.
Effects of postpartum depression on relationships with spouses and friends:5
- The withdrawal that accompanies depression distances the depressed person from her spouse and her friends. This distance adds to the depression, causing even more distance to occur, until the depressed person feels like she is stranded on an island in the middle of the ocean, with no one able to reach her or help her.
- Communication is affected by the withdrawal and the emotionally charged state the depressed mother is in, making it difficult to work out problems, since solutions to difficulties, and express and receive love and affection.
- Loss of interest in physical intimacy pushes couples further apart as does the loss of interest in joint enjoyable activities.
- Depression can also cause a person to be angry and inflexible. Many women are more prone to withdrawal than to outbursts of anger and intolerance.
Effects of postpartum depression on the babies of depressed mothers:
While postpartum depression interferes with a mother’s ability to effectively care for her baby, is also interferes with some very important functional development for the baby.
Israeli researchers6 found that babies of depressed mothers had a low level of social engagement. They were also much less able to adapt to new situations, greeting them with fussing and crying behaviors. In addition, they showed a much higher level of physical stress.
Studies have also shown that untreated postpartum depressed mothers:
- Pay less attention to the infant’s needs for nourishment, including refusing to breastfeed
- Do not instigate healthy sleep routines for the child
- Touch their babies less often, and when they do touch the babies, it is in a more negative way with roughness
- Interact with more negative than positive verbal utterances to their children
- Take fewer safety precautions with their babies such as using car seats, electric outlet covers, and cabinet latches
- Do not always take the child to important periodic medical checkups, and for vaccinations.7
Children of untreated postpartum depressed mothers are more apt to be much slower at developing motor skills such as turning over, lifting up their heads, and learning to sit up, crawl, and walk. They also show developmental delays in cognitive skills. As they grow, studies have shown the these children have lower IQs, more behavioral problems, and problems in school.8
How to treat postpartum depression
Postpartum depression goes away faster when you recognize it and treat it. Even the ‘baby blues’ disappear faster with assistance.
Non-medical suggestions for treating the postpartum blues:
- Getting as much sleep as you can is very important. If your baby does not yet sleep through the night, power naps can sometimes bridge the gap between barely functioning and being able to cope. Although they do not make up for lost sleep, naps can help. A 20-30 minute nap while your baby is sleeping can offset sleep deprivation, make you more alert, and increase your motor skills.9
- After childbirth, when you are not at your best and you are learning new skills is not the time to worry about doing everything perfectly. Just do the best you can and accept that it will be okay.
- Learning to ask for help from family and friends when you need it – a tough thing for many of us to do – is a necessary skill to adopt.
- Support groups for new mothers are wonderful places to give and receive support. Something you do to cope may help someone else and vice versa.
- It is important to avoid major life changes during your early motherhood, as they require adaptive measures you may not be able to handle right now.
- Getting plenty of exercise every day helps combat postpartum depression. Even mild exercise such as gardening can help reduce depression. In a study at the Cooper Research Institute, Dr. Andrea Dunn learned that walking for 35 minutes daily for 6 days a week caused persons suffering from depression to have a reduction of 47 percent in their depression.10
- Relaxation exercises, like meditation, are another way to reduce depression because they rearrange the brain’s energy patterns.
- Taking care of your health by eating a healthy, nutritional diet, preferable organic if you are breastfeeding helps you function better. Your body needs nutrients to assist your brain with combating depression.
- Every new mother needs to get some ‘you time’ often. With someone watching your baby, you can take time to do something pleasurable for yourself.
- Spending time with other adults so that you are not constantly alone with your depression is very helpful also.
- Spending time with your pet can also make a difference. In addition to the unconditional love our pets give us, many of them also love to entertain us. Fluffy and Fido may even be feeling a little left out with this new little stranger in the house who is garnering all the attention, and your attention can help them cope with all the changes.
Medical intervention for postpartum depression:
With proper treatment, new mothers with postpartum depression can move beyond it. Postpartum depression, when treated, is just a temporary interruption in life that can be corrected.
The two basic treatments most doctors recommend for treating postpartum depression are antidepressants and therapy.
Many breastfeeding mothers are skeptical about using antidepressants because some of the antidepressant goes through their breast milk into their baby. However, recent studies have shown that while a baby’s cytochrome P-450 enzyme system (the liver’s main detoxification pathway) is less active for the first two months, it soon speeds up to be able to metabolize drugs two to three times faster than its’ mother can.
SSRI’s (selective serotonin reuptake inhibitors) are a class of antidepressants that have been used quite successfully (with the exception of Prozac) with postpartum depressive mothers with no appreciable side effects on their babies.11
There are several different types of therapy that have been successfully used with mothers suffering from postpartum depression. Oftentimes there are issues that predate the mother’s pregnancy which surface or become important to deal with after her child is born. Finding a supportive, qualified therapist can be key to not only alleviating depression, but can also facilitate personal growth.
Some of the therapeutic modalities include:
1. Interpersonal psychotherapy limited to 12-16 weeks teaches communication skills and relationship skills, and is very effective at helping postpartum depression.12
2. Cognitive behavioral therapy has been demonstrated to be effective in postpartum depression by assisting mothers with changing their thinking patterns and developing healthier coping strategies.13
3. Dialectical Behavioral Therapy, once only used with treating Borderline Personality Disorder, is used in postpartum depression to teach thought management, stress endurance, emotional control and relationship skills.14
4. Psychodynamic psychotherapy focuses on bringing traumatic past events lodged in the subconscious to the forefront and resolving them.15
5. Eye Movement Desensitization and Reprocessing involves bilaterally stimulating the brain to rephrase beliefs and feelings in the processing of memories.
Other therapies that are useful for alleviating postpartum depression include couples therapy to help both parents cope with and understand postpartum depression, and group therapy.
Nutritional intervention with postpartum depression:
A good diet during pregnancy goes a long way toward avoiding some of the problems with nutritional deficiencies that many mothers experience after birth. But cravings during pregnancy have a way of forcing even the best diet off its tracks, and the unborn baby claims the choicest of nutrients ingested by the mother.
This leaves the mother’s body depleted of the nutrients needed for her to function optimally at a time when her hormones are dropping dramatically and other bodily changes are rapidly occurring.
After her child is born, the mother needs to have her nutrient levels tested by her doctor to find out what her deficiencies are. Bodnan and Wisner reviewed the studies dealing with the nutritional deficiencies in women of child-bearing age and found that deficiencies of folate, omega-3 fatty acids, Vitamin B12, iron, zinc, and selenium are common among depressed women. They also concluded that pregnancy and lactation are major nutrient depleting agents for mothers.16
Proper intake of proteins and carbohydrates is also important in the prevention and treatment of postpartum depression. Proteins are the basis of the brain’s neurotransmitters. When the neurotransmitters cannot successfully send messages between the brain’s neurons, depression can and does occur.17
Minerals are also important in relieving postpartum depression. In addition to the previously mentioned minerals, the following are necessary for alleviating depression: calcium, chromium, iodine and lithium.17
Testing for nutritional deficiencies is of paramount importance, though, as almost as much harm can be done by taking certain supplements as good. Some supplements like B vitamins are not harmful. Whatever the body does not need is excreted in the urine. Other supplements, however, can accumulate in the body and cause problems. A Nutritionist can be a great help in structuring a supplementation program.
- Frequently asked questions. Labor, delivery, and postpartum care FAQ091. Postpartum depression. American College of Obstetricians and Gynecologists. Found at http://www.acog.org/-/media/For-Patients/faq091.pdf?dmc=1&ts=20150716T1631486138. Accessed October 26, 2015.
- Warner, J. Sleep Deprivation Stirs UP Emotions, Study Explains Why Lack of Sleep May Lead to Irrational Behavior. Oct 22, 2007. Found at http://www.webmd.com/sleep-disorders/news/20071022/sleep-deprivation-stirs-up-emotions, accessed October 26, 2015.
- Depression during and after pregnancy fact sheet. WomensHealth.gov. http://www.womenshealth.gov/publications/our-publications/fact-sheet/depression-pregnancy.html. Accessed October 26, 2015.
- Postpartum Psychiatric Disorders. Massachusetts General Hospital Center for Women’s Mental Health. Found at https://womensmentalhealth.org/specialty-clinics/postpartum-psychiatric-disorders/. Accessed October 27, 2015.
- Kiefer D. Depression and Relationships. March 29, 2012. Found at http://www.healthline.com/health/depression/relationships. Accessed October 27, 2015.
- Nauert R. Postpartum Depression’s Effect on the Baby. Found at http://psychcentral.com/news/2009/08/21/postpartum-depressions-effect-on-the-baby/7899.html. Accessed October 27, 2015.
- Field T. Postpartum Depression Effects on Early Interactions, Parenting, and Safety Practices: A Review. Infant Behav Dev. 2010 Feb; 33(1): 1. US National Library of Medicine. Found at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2819576/. Accessed October 287, 2015
- Parenting and PPMD. PBS: This Emotional Life. Found at http://www.pbs.org/thisemotionallife/topic/postpartum/parenting-ppmd. Accessed October 27, 2015.
- Soong, J. The Secret (and Surprising) Power of Naps. Found at http://www.webmd.com/balance/features/the-secret-and-surprising-power-of-naps. Accessed October 26, 2015.
- Dunn A, Trivedi MH, Kampert JB, Clark CG, Chambliss HO. Exercise Treatment for Depression. American Journal of Preventive Medicine. January 2005, Volume 28, Issue 1, Pages 1–8. Found at http://www.ajpmonline.org/article/S0749-3797%2804%2900241-7/abstract. Accessed October 26, 2015.
- The Carlat Psychiatry Report. Breast-feeding and Antidepressants: An Update. Found at http://pro.psychcentral.com/breast-feeding-and-antidepressants-an-update/001306.html#. Accessed October 27, 2015.
- O'Hara MW, Stuart S, Gorman L, Wenzel A. Efficacy of Interpersonal Psychotherapy for Postpartum Depression. JAMA Psychiatry. 2000. Found at http://archpsyc.jamanetwork.com/article.aspx?articleid=481669. Accessed October 27, 2015.
- Mehta A, Sheth S. Postpartum Depression: How to Recognize and Treat This Common Condition. April 24, 2006. Medscape, Found at http://www.medscape.com/viewarticle/529390_5. Accessed October 27, 2015.
- Stone S. Empowering PPD Recovery with Dialectical Behavior Therapy. New Jeersey Psychological Association. Volume 56, Number 3, Summer 2006. Found at http://www.perinatalpro.com/pmadbooksandarticles/dbtandppd.html. Accessed October 27, 2015.
- Blum MD. Psychodynamics of Postpartum Depression. Psychoanalytic Psychology. 2007, Vol. 24, No. 1, 45–6. Found at https://www.psychologytoday.com/sites/default/files/attachments/58717/postpartumdepression-pp-2007.pdf. Accessed October 27, 2015.
- Bodnan LM, Wisner KL. Nutrition and Depression: Implications for Improving Mental Health Among Childbearing-Aged Women. Biological Psychiatry. Jul 27, 2005. Found at http://www.biologicalpsychiatryjournal.com/article/S0006-3223%2805%2900585-8/abstract?cc=y=. Accessed October 26, 2015.
- Sathyanarayana Rao TS, Asha MR, Ramesh, BN, Jagannatha Rao KS. Understanding nutrition, depression, and mental illnesses. Indian Journal of Psychiatry. 2008 Apr-Jun; 50(2): 77–82. Found at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738337/. Accessed October 26, 2015