“I started to experience a sick sensation in my stomach; it was as if a vise were tightening around my chest. Instead of this nervous anxiety that often accompanies panic, a feeling of devastation overcame me. I hardly moved…I wasn’t simply emotional or weepy…This was something quite different. This was sadness of a shockingly different magnitude. It felt as if it would never go away”
~ Brooke Shields, Down came the Rain: My Journey Through Postpartum Depression
I clutched my pillow and attempted to hide my ugly cry from my baby. I allowed the pillow to muffle my noise and soak up the tears. I kept the lights off.
“This must be normal,” I thought. “This must be that ‘heavy love’ – the ‘it’s so good it hurts’ sort of love – maybe it’s just hormones…”
My husband peeked his head in on his lunch break. “How ya doing sweetie? Let’s plan to see friends tonight. This is what community is for!”
“No, thank you,” I responded.
I didn’t care if my close friends saw my tears. I just did not want to leave the house. I didn’t want anyone else to have to deal with my baby screaming. It was a feeling of devastation. Of disappointment. Of confusion. Of conflicting thoughts. I knew I should allow someone to take my baby off my hands. I didn’t want to be away from her, but I also did not want to be near her. It was utter hell.
What is PPD and how is it different from regular depression?
Postpartum Depression (PPD) is an illness a mother may experience after the birth of a baby. It can present in a number of ways. PPD is typically an agitated depression with symptoms of both depression and anxiety.
While PPD is technically depression with a postpartum onset, it is also incredibly different from the standard diagnosis of depression we see in the DSM. This is because of the simultaneous experience of life’s greatest gift (a baby) and one of life’s hardest illnesses (depression).
I most appreciate the analogy of this difference as it is presented in the book, This Isn’t what I Expected:
“Imagine two women going in for operations, one to have a kidney removed, one to have a breast removed. In both cases, the women will experience many similar things; they will both will undergo anxiety, surgery, pain, recovery, and the loss of a body part. But in addition, the woman who loses her breast will experience feelings and changes related to sexuality, self-esteem and identity.”
How Prevalent is PPD in the United States?
Every year, more than 400,000 infants are born to mothers who are depressed, which makes perinatal depression the most under diagnosed obstetric complication in America.
At least 1 in 7 women suffer from postpartum depression or anxiety.
Postpartum depression is considered the number one complication of childbirth.
Suicide accounts for up to 20% of postpartum deaths and is the second leading cause of mortality in postpartum women.
In Colorado, self-harm is the #1 cause of death in new mothers.
Is this just an American Epidemic?
No.
Based on research conducted worldwide, even the cultures with healthy, holistic, mother-baby-centered postpartum practices reflect levels of perinatal mood disorders.
According to the World Health Organization, about 10% of pregnant women and 13% of postpartum women experience a mental disorder globally. In developing countries, this statistic is higher: nearly 16% during pregnancy and 20% of women during the postpartum period.
A snapshot of prevalence of PPD in other countries:
(Country: % of birthing women suffering from PPD)
Pakistan: 30%
India: 23% (16% in rural south India)
Chile: 50%
Brazil: 20%
To consult a more thorough list of statistics per country, please visit this website
Snapshot data from (http://www.postpartumprogress.com/is-postpartum-depression-non-existent-in-other-cultures-the-facts)
WHO thorough report: (http://apps.who.int/iris/bitstream/10665/43846/1/9789241563567_eng.pdf)
Are perinatal mood disorders a new phenomenon?
No.
Perinatal mood disorders were first studied by Hippocrates in 460BC. Later, Louis Victor Marcé, a French psychiatrist, wrote about postpartum health in 1858.
Between 1858 and the 1900s, research seems to have dropped off.
James A. Hamilton, MD, PhD, became the Father of Postpartum Psychiatric Illness and was the forerunner of resurgence and support for perinatal mental health.
DSM-4 (Diagnostic Statistic Manual) included a specifier for the illness starting in 1994.
How does one develop a perinatal mood disorder?
All women are at risk for mental disorders during pregnancy and throughout the postpartum period, including when she weans her baby, even if that is over a year after delivery. The causes are multifaceted.
Poverty, stress, having multiples, exposure to violence, high conflict environments, natural disasters, having a baby with a difficult temperament or health condition, and low social support generally increase risk for these disorders.
Other contributors to developing PPD include psychological challenges associated with attachment, feeding, loss of freedom and control, birth trauma, physical healing from labor/delivery, insecurities about parenting, identity changes, social adjustments, body image issues, and financial pressures.
Nine personality traits have been linked to predictors of PPD, as well. These nine traits include neuroticism, high worry and low self-confidence, mistrust, high introversion/low extraversion, perfectionism, harm avoidance, interpersonal sensitivity, body image dissatisfaction, high trait anger and personal distress empathy.
PPD has a strong biological component and individuals who have a personal or family history of depression or mental illness are more likely to experience PPD.
Research indicates a strong connection between these disorders and biochemical changes during pregnancy and following delivery. The sudden shift of hormones within a woman during this period of time can have physical and mental ramifications.
The washing of these hormones over the brain during this time can result in a bit of re-shaping of various cerebral components anatomically. The results can manifest in a mood disorder.
Research shows that sleep deprivation can, indeed, trigger disorders that were laying dormant, particularly Bipolar I and depression.
Suicide:
Suicide is the second leading cause of death among postpartum women.
Not all women with PPD are suicidal, but many do suffer from thoughts of harming themselves or their babies.
Women who are most likely to successfully commit suicide are those who are high achieving and successful individuals and typically have a strong “helping,” personality.
Is Postpartum Depression Preventable?
The studies are mixed.
The most effective methods of prevention include:
~Sleep: The most critical method of prevention and intervention is sleep, however she can acquire it. Many doctors and psychiatrists recommend a sleep aid to help her get the rest she needs in order for therapeutic interventions to be effective. Mothers may opt for natural sleep aids using dietary changes, supplements, and aromatherapy rather than medication. Regardless of the remedy she chooses, it must result in her sleeping.
~ Medication: it is advised if mothers were diagnosed with PPD in one pregnancy, they are put on an anti-depressant during subsequent pregnancies. The dose is sometimes increased during the third trimester and always increased immediately after birth to offset hormonal shifts.
~ Psychotherapy: Preventative cognitive behavioral therapy and a sort of prenatal survival skills support group or class is recommended. Not just a birthing class, but a course that offers practical skills to offset challenges of new parenthood.
~ Nutrition: She must be eating a well-rounded, healthy diet. This is not necessarily paleo or carb-free. There have been some studies that indicate a connection between a low carbohydrate diet and increased occurrences of depression. Ultimately, she needs to eat healthy foods that her body digests well.
~ Social Support
*There is currently no scientific studies that can demonstrate a connection between placenta consumption and PPD prevention. There are a couple studies currently open, but none have been conclusive.
Typical Pregnancy vs. Prenatal Depression Symptoms:
It is important to note that about 33% of the time, episodes of depression actually begin during pregnancy. So, we must begin opening up this dialogue well before the postpartum period with mamas.
How do we tell the difference between typical pregnancy hormones and prenatal depression?
Typical Pregnancy symptoms:
- Changing mood
- Normal self esteem
- Sleep disruptions due to bladder or heartburn – but ultimately can sleep
- Tired, but rest restores energy
- Joy and anticipation of baby with appropriate levels of worry
- Appetite increases
Prenatal Depression symptoms:
- Unchanging feeling of gloom or emotional heaviness
- Low self esteem and feelings of guilt
- Inability to sleep with early A.M. awakenings (not due to bladder or heartburn)
- Suicidal thoughts, plans or intentions
- Tired and rest does not restore energy
- Inability to feel pleasure
- Lack of appetite
If you or a loved one identifies more with Prenatal Depression, talk with your OBGYN or a licensed counselor about intervention early on! Early detection and intervention can help prevent or curb PPD.
Baby Blues vs. PPD Signs and Symptoms:
60-80% of new moms experience baby blues.
Baby blues is a 2 day to 2 week span of feeling sort of depressed due to hormone fluctuations after birth. These feelings often peek 2 to 5 days after delivery and are unrelated to stress or psychiatric history.
In my opinion, the idea of Baby Blues can overshadow the diagnoses of PPD. Given the statistics, we often allow PPD to go untreated or ignored because we assume ladies are experiencing Baby Blues.
Baby Blues Symptoms:
- Tearful
- Feeling overwhelmed with new role as mama
- Feeling uncertain
- Changing mood
- Predominant mood is happiness, though she may experience bouts of sadness or anxiety
- Fatigue and inability to sleep (usually due to baby)
- Lasts no longer than 2 weeks post delivery
Postpartum Depression Symptoms:
- Tearful
- Unexplained physical complaints
- Suicidal thoughts
- Appetite changes
- Sleep disturbances (key indicator of PPD: unable to sleep when baby sleeps)
- Poor concentration/focus
- Irritable and angry
- Feelings of hopelessness, helplessness, guilt and shame
- Lack of feelings toward baby
- Inability to take care of self or family
- Loss of interest in pleasurable and joyful activities
- Anxious and overwhelmed
- Most commonly peaks 3 months after birth – though symptomatic before and later. Standard diagnosis states these symptoms occur within 12 months of delivery.
If Baby Blues feels like running to your mailbox through thick mud, PPD feels like running a marathon through wet cement. with a broken ankle.
I experienced textbook PPD and was utterly blind to the fact that I was in the midst of it until it was almost too late. Oddly, the closet incident was not when I realized I had PPD. I realized I had PPD while talking to a friend and bouncing my crying baby at a Mexican restaurant.
“How are you really doing?” This emotionally intuitive mommy friend asked me.
“Well,” I replied and laughed a little, “I’m good, I guess. Actually, I like hearing her cry now. It’s like this subtle reminder that there’s nothing I can do to make this better.”
Do you hear the lack of logic in my reply? At the time Summer was 3 or 4 months old.
It was in that moment that I had a bit of an out-of-body experience. I heard myself say those words. I thought about how I sounded a little crazy. I had a flashback of 10 minutes from grad school when I glossed over this diagnosis of PPD, and I began wrestling with the thought that I may actually have this condition.
I still waited. I set a timeline. “If this does not get better by Mother’s Day, maybe I’ll get help.”
Mother’s Day was almost too late.
You see, even mamas educated on perinatal mood disorders are usually living in a complete blur in the midst of PPD. Many times these ladies are in utter denial, or they are frightened to admit their thoughts and feelings due to shame, guilt and embarrassment.
Many times these mamas do not wear their condition outwardly.
Often they do their best to put on make-up, take care of their home, and force a smile, feeling a moral, relational and spiritual obligation to do so. Sometimes cleaning their home is a form of coping.
Surrounded by platitudes of, “this too shall pass,” – “it gets better” – “just sleep when the baby is sleeping” – “you have a happy, healthy baby and that’s what matters” – “you’re just tired” – “what a beautiful blessing your baby is!”- “It’s normal to worry as a new parent”…mamas feel buried under the overt expectations of society that they should be glowing or, at the very least, thankful.
Mamas with PPD are unwilling and unable to admit they feel contrary to what society says they should feel. In fact, these platitudes often cause their anger and depression to manifest in the quiet spaces of their mind. In isolation: the most dangerous place for these mamas.
This means the key players in detecting and supporting those who are suffering are actually friends and family. I will write more specifics on supporting your loved later in the series.
Screening:
If you are a mama of a new baby, please consult this screening tool to see if you may have PPD. Consult your midwife or OBGYN if you have any concerns at all!
It is important to note that screening tools screen and do not diagnose. They simply help to inform us if a potential diagnosis exists. One must consult a mental health professional or doctor/midwife for an official diagnosis and to discuss intervention.
Intervention:
Common intervention for PPD includes therapy and medication. There are medications that mamas can safely consume while pregnant and breastfeeding!
There are some alternative and complementary interventions including: relaxation and imagery, herbal medicine/homeopathy, dietary supplements, acupuncture, aromatherapy, light therapy, and Omega 3s. Many of these treatments, though empirically based and effective, take longer to work.
For more severe cases of PPD, a prescribed medication is often required.
Resources:
If you are having thoughts of harming yourself or your baby, arrangements can be made (if safe) that include you remaining with your newborn and/or pumping regularly to maintain a breastfeeding relationship, if that is important to you. Do not remain silent for fear of being hospitalized, separated from your baby, stigmatized, or requiring medication.
At this point, there are only 3 hospital inpatient units I could find that specialize in perinatal mental health and allow mother and baby to be together:
UNC’s Center for Women’s Mood Disorders
New York’s Northwell Health Perinatal Psychiatry Service
California’s Community Hospital Long Beach Inpatient Program
There are a growing number of reputable outpatient programs in operation throughout the U.S, too.
It actually doesn’t have to be miserable. Even with the sleep deprivation and transitions, happiness is possible. It can be better.
PSI’s Helpline: 800-944-4773 ~ A line where mamas, their partners, and their family can call and ask questions. They will be connected with resources, including therapists. Every first Monday, fathers can call this line to be part of a conversation regarding how to support mamas with PPD.
PSI’S Text line: 503-894-9453 ~ Sometimes you just want to cry through the conversation and not talk. This line is available to struggling mamas for support and help.
General Resources Page: http://www.postpartum.net/
If you are from a region not mentioned above, feel free to contact me or call the helpline to find resources in your area. PSI has contacts in every state and more than 40 countries!
If you are having thoughts of harming yourself or your baby, go to your nearest Emergency Room immediately.
Suicide hotline: 1-800-273-8255.
You can also contact someone for a live online chat at this Suicide Prevention Live Chat link
Living Uncovered 