20 Aug When the Blues Turn Black: Who Suffers from Postpartum Depression and What You Can do About It – Part II
In my previous blog I discussed the common and benign phenomenon of Postpartum Blues, which affects up to 80% of new mothers and does not require any special intervention other than some TLC. But what if low mood, weepiness, irritability, being overwhelmed and feeling lack of joy or hopelessness persists?
Postpartum Depression: A serious, debilitating disorder
Nathalie was very much in love with her 3 months old baby, Emma. Emma was a beautiful baby with very a round face, rosy lips and a giggle that put everyone around her in a good mood. But Emma was a poor sleeper. She woke up several times every night and took a long time to settle back down. She was also not napping a lot during the day, so Nathalie did not have a chance to catch up on her sleep. Nathalie’s common-law partner, Sam, was travelling a lot for work. When he was home he did his best to share baby-care with Nathalie as much as possible, but he was simply not there a lot of the time. As the months went by, Nathalie’s exhaustion deepened and her mood got worse and worse. She found it hard to get out of bed in the morning and she was crying a lot, sometimes for hours, feeling like there was no hope for better, easier times. One morning as Sam was getting ready to go to work Nathalie broke down in tears and told him she could not do it anymore. When he asked her what the problem was she yelled at him and accused him for not being there for her and for not understanding. She then collapsed on the bed and was crying uncontrollably. “I want to sleep,” she murmured, “I want to sleep and not wake up.”
Up to 15% of new mothers will develop what is called Postpartum Depression (PPD) in the first year following the birth of their baby. These numbers are even higher in disadvantaged populations and when the mother is isolated and experiences lack of support or is coping with relationship issues, financial worries, or health problems.
Signs and Symptoms of PPD
Postpartum depression is quite similar to general clinical depression except some of the symptom content might have to do with the baby and motherhood. Symptoms are often physical, emotional, cognitive (thoughts) and often lead to behavior changes. Here is a list of the most common symptoms of PPD.
- Depressed/sad mood
- Crying spells
- A sense of hopelessness
- Lack of joy
- Inability to enjoy activities which previously were enjoyable
- Lack of motivation
- Lack of energy
- Changes in sleep and appetite (usually decreased appetite and poor sleep but sometimes over-eating and over-sleeping
- Aches and pains
- Poor concentration
- Difficulty making decisions, even simple ones
- Anxiety (while anxiety is a disorder in and by itself, it can also be a part of depression)
- Social withdrawal, self-isolation
- Thoughts of self-harm
If only 5 of the symptoms are present, PPD is suspected. However, a bad day or even a bad week does not mean that a woman has developed PPD. Rather, symptoms have to have been present for at least two weeks in order for it to be considered as fully blown depression.
It is sometimes surprising or even shocking to the mother or her family and friends that she would suffer from depression following giving birth. After all, the birth of a baby is considered a joyous event, if not the happiest event in a family’s life cycle. Why, then, do so many women suffer from Postpartum Depression?
Vulnerability to PPD
Extensive research over the past few decades have focused on the question what makes a woman vulnerable to Postpartum Depression? Of the dozens of factors that have been researched, a few stand out.
Family history of mental illness
A woman is more likely to suffer from Postpartum Depression if one or more of her biological family members have struggled with mental illness (not necessarily PPD).
Personal Mental Health Issues
When a woman has been struggling with mental health issues such as Depression, Anxiety, Bi-polar disorder, Obsessive-Compulsive Disorder Personality Disorder, she is at a higher risk for developing PPD. Women who struggle with mental health issues should seek professional help early in pregnancy and into the postpartum period to make sure they are well-treated should they develop postpartum depression.
Women who experience lack of support, isolation or loneliness may be at a higher risk for developing PPD. As humans, we are meant to live in communities and raise our children with help from others. Never in older times did women raise children on their own. We used to live in extended families and tight knit communities and raising a child was regarded as a family endeavour. You are probably familiar with the saying “it takes a village to raise a child” and yet, in our society, mothers are often the main if not sole care takers of babies and children, with some being helped by fathers but not much more than that.
Difficult labor and birth
Women who have had difficult or traumatic birth experience and who may experience physical or emotional injury from it may be at a higher risk of developing PPD. These women can benefit from a combination of good medical care to insure a full physical recovery and, at the same time, emotional and psychological help from a licensed therapist or psychologist.
A few personality traits have been found to be related to PPD. Among them are perfectionism and rigidity of thought and behavior. While most people understand that nobody is perfect, some people stick with a perfectionistic outlook on life, their partner, themselves or their baby. Women who have been able in the past to have a sense of control over their world and their emotions fairly well, often find themselves at a loss when they have a baby. This is simply because babies are not perfect and, no matter how much you try, you cannot be a perfect mother. A woman who realizes she sometimes doesn’t have the right answer for a restless, crying baby who won’t nap regularly or not feed as they “should” can find herself losing her bearings and she may be disappointed in herself, her baby or motherhood in general.
Poor relationship with partner
The transition to parenthood can present significant challenges to both mothers and fathers. A solid couple’s relationship has been found to be a buffer against PPD and, in cases where the mother does suffer from it, the relationship with her partner can help with recovery. However, women who have a difficult relationship with their partner may be at an increased risk for developing PPD.
Lack of sleep
That is a tough one because most mothers and sometimes father suffer from disrupted sleep but only some new moms get depressed. Wouldn’t all parents who suffer from lack of adequate sleep bound to become depressed? It turns out that some people are more sensitive than others to lack of sleep and are likely to do poorly when sleep deprivation continues over time. In a very interesting study that was conducted in a Toronto maternal hospital, women were kept at the hospital for 5 days postpartum while their babies were taken to the nursery at night, allowing them adequate sleep. These women were later followed up and it was found that Postpartum Depression was much more prevalent in the study population of new mothers compared to the general population. It is extremely important for mothers and fathers to catch on sleep as much as possible.
What to do if you or someone close to you may have PPD?
If you suspect you have developed PPD or are at risk for PPD or, if you know a new mother who seems to be struggling a lot, it is very important to get professional help sooner than later. It is important to seek help from a professional who is both knowledgeable and experienced in the area of PPD. A family physician may be able to perform an assessment of your mood and may refer you to a psychologist in your community. Sometimes anti-depressant medication can be helpful while other times, especially in cases of mild or moderate depression, a course of Cognitive-Behavioral Therapy, Interpersonal Psychotherapy, Group Therapy or Marital Therapy (especially in case where the couple’s relationship is poor) can be extremely helpful. The important thing is to get help and stop suffering in silence. Excellent help is available out there and a woman would do well for herself and her family if she seeks help.