Hello Jim1946,
Postpartum depression, is different from the ?Baby Blues? that
affect up to 70% of women who have delivered a baby. Baby blues are
temporary and do not affect normal functioning. Postpartum depression
affects about 1 in 10 women, and appears anytime from a few days after
childbirth to a year. Symptoms include fatigue, confusion,
uncontrollable crying, and lack of interest in the baby.
?Postpartum mood episodes with psychotic features appear to occur in
from 1 in 500 to 1 in 1,000 deliveries.
Postpartum depression can evolve into psychosis following a dramatic
or traumatic event.?
http://healthyminds.org/postpartumdepression.cfm
?"I haven't been myself since the baby was born. What's wrong with me?"
The once-taboo topic has recently gained national attention with a
book by Brooke Shields and a public clash between the actress and Tom
Cruise over Shields' use of antidepressants to cope with her own
struggle after the birth of her first child.
Now, New York state's Department of Health is working to provide
information about the subject with a public-awareness campaign it
launched in and around Albany. The department's ads are plastered on
bus shelters and benches, and TV and radio spots have been running on
local stations.
The movement, which the Health Department hopes to expand statewide,
reflects a national drive to raise awareness about a condition health
care professionals say often goes untreated.?
http://www.newsday.com/news/local/wire/newyork/ny-bc-ny--postpartumdepress1001oct01,0,3741536.story?coll=ny-region-apnewyork
?Depression after pregnancy is called postpartum depression or
peripartum depression. After pregnancy, hormonal changes in a woman's
body may trigger symptoms of depression. During pregnancy, the amount
of two female hormones, estrogen and progesterone, in a woman's body
increases greatly. In the first 24 hours after childbirth, the amount
of these hormones rapidly drops back down to their normal non-pregnant
levels. Researchers think the fast change in hormone levels may lead
to depression, just as smaller changes in hormones can affect a
woman's moods before she gets her menstrual period.
Occasionally, levels of thyroid hormones may also drop after giving
birth. The thyroid is a small gland in the neck that helps to regulate
your metabolism (how your body uses and stores energy from food). Low
thyroid levels can cause symptoms of depression including depressed
mood, decreased interest in things, irritability, fatigue, difficulty
concentrating, sleep problems, and weight gain. A simple blood test
can tell if this condition is causing a woman's depression. If so,
thyroid medicine can be prescribed by a doctor.?
http://womenshealth.gov/faq/postpartum.htm#3
· Postpartum depression occurs in 10-15% of women in the general population.
· Women at highest risk are those with a personal history of
depression, previous episode of postpartum depression, or depression
during pregnancy.
· Typically, postpartum depression develops insidiously over the
first 3 postpartum months, although the disorder may have a more acute
onset. Postpartum depression is more persistent and debilitating than
postpartum blues.
· Signs and symptoms are clinically indistinguishable from major
depression that occurs in women at other times. Symptoms may include
depressed mood, tearfulness, anhedonia, insomnia, fatigue, appetite
disturbance, suicidal thoughts, and recurrent thoughts of death.
· Anxiety is prominent, including worries or obsessions about the
infant's health and well-being.
· The mother may have ambivalent or negative feelings toward the
infant. She may also have intrusive and unpleasant fears or thoughts
about harming the infant.
· Postpartum depression often interferes with the mother's ability to
care for herself or her child.?
Impact of postpartum depression on child development
· A large body of literature suggests that a mother's attitude and
behavior toward her infant significantly affect mother-infant bonding
and infant well-being and development. Postpartum depression may
negatively affect these mother-infant interactions.
· Mothers with postpartum depression are more likely to express
negative attitudes about their infant and to view their infant as more
demanding or difficult. Depressed mothers exhibit difficulties
engaging the infant, either being more withdrawn or inappropriately
intrusive, and more commonly exhibit negative facial interactions.
These early disruptions in mother-infant bonding may have a profound
impact on child development.
· Children of mothers with postpartum depression are more likely than
children of nondepressed mothers to exhibit behavioral problems (eg,
sleep and eating difficulties, temper tantrums, hyperactivity), delays
in cognitive development, emotional and social dysregulation, and
early onset of depressive illness.
· Psychosocial factors
· Women who report inadequate social supports, marital discord or
dissatisfaction, or recent negative life events are more likely to
experience postpartum depression.
· No consistent association between obstetric factors and risk for
postpartum depression is apparent.
· Biologic vulnerability
· Women with prior history of depression or family history of a mood
disorder are at increased risk for postpartum depression.
· Women with a prior history of postpartum depression or psychosis
have up to 90% risk of recurrence.
http://www.emedicine.com/med/topic3408.htm
What can I do to help myself?
If you have given birth recently and are feeling sad, blue, anxious,
irritable, tired or have any of the other symptoms mentioned here,
remember that many other women have had the same experience. You're
not "losing your mind" or "going crazy" and you shouldn't feel that
you just have to suffer. Here are some things you can do that other
mothers with postpartum depression have found helpful:
· Find someone to talk to--and tell that person about your feelings.
· Get in touch with people who can help you with child care, household
chores and errands. This social support network will help you find
time for yourself so you can rest.
· Find time to do something for yourself, even if it's only 15 minutes
a day. Try reading, exercising (walking is good for you and easy to
do), taking a bath or meditating.
· Keep a diary: every day, write down your emotions and feelings as a
way of "letting it all out." Once you begin to feel better, you can go
back and reread your diary--this will help you see how much better you
are.
· Even if you can only get one thing done in any given day, this is a
step in the right direction. There may be days when you can't get
anything done. Try not to get angry with yourself when this happens.
· It's OK to feel overwhelmed. Childbirth brings many changes, and
parenting may be a new role. When you're not feeling like yourself,
these changes can seem like too much to cope with.
· You're not expected to be a "supermom." Be honest about how much you
can do, and ask other people to help you.
· Find a support group in your area or contact one of the
organizations listed below. They can put you in touch with people near
you who have experience with postpartum depression.
http://www.aafp.org/afp/990415ap/990415e.html
?Can PPD lead to other problems?
When a new mother has severe depression, the vital mother-child
relationship may become strained. She may be less able to respond to
her child?s needs. Several studies have shown that the more depressed
a new mother is, the greater the delay in the infant?s development. A
new mother?s attention to her newborn is particularly important
immediately following birth because the first year of life is a
critical time in cognitive development.
Is PPD preventable?
In most cases PPD is preventable; early identification can lead to
early treatment. A major part of prevention is being informed about
the risk factors and the medical community can play a key role in
identifying and treating PPD. Women should be screened by their
physician to determine their risk for acquiring PPD. Because social
support is also a vital factor in prevention, early identification of
mothers who are at risk can enable a woman to seek support from
physicians, partners, friends, and coworkers.?
http://www.nmha.org/infoctr/factsheets/postpartum.cfm
?Postpartum depression is caused by changes in hormones and can run in
families. Women with severe premenstrual syndrome are more likely to
suffer from postpartum depression. Mild or moderate depression, either
postpartum or otherwise, can be treated with medication or with
psychotherapy, or, particularly for women with severe cases, a
combination of the two. Women who have postpartum depression love
their children but may be convinced that they're not able to be good
mothers.
Postpartum depression is distinguished from the baby blues both by its
duration and the debilitating effects of indifference the mother has
about herself and her children.?
http://healthyminds.org/postpartumdepression.cfm
· Postnatal depression is treatable using antidepressants and
psychotherapy, but more effective screening and additional research
assessing treatment and prevention methods are essential. [3]
· Women with postpartum depression often display more anxiety than
women with other types of depression, take longer to respond to
medication and require more than one antidepressant. [4]
· Postpartum depression and its severity may vary depending on social
or cultural settings. One study of 296 women in eight countries
revealed varying postpartum depression rates six months after
delivery, ranging from 2.1 percent to 31.6 percent. [5]
· Postpartum depression should not be confused with the more serious
postpartum psychosis, occurring in less than 0.2 percent of mothers
and characterized by hallucinations and delusions. Such women may be
threats to themselves or to their babies, and require immediate
hospitalization. [8]
· Interpersonal therapy, focusing on the patient?s relationships with
other people, appears effective in reducing postpartum depression.
This and other types of psychotherapy may be appropriate for
breastfeeding women concerned about taking antidepressant medications.
[6]
· A trial testing several kinds of counseling or therapy against
routine primary care found short-term benefits to mothers and children
but no effects on children?s cognitive development or on their
emotional and behavioral problems at age 5. [9]
· Exposure to some antidepressant drugs in utero does not appear to
adversely affect thinking, language development or the temperament of
preschool and early-school children. In contrast, a mother?s
depression is associated with reduced cognitive and language
achievement by their children. [7]
· Whether nursing women should use antidepressant medications is open
to debate. In women with severe postpartum depression, ?the benefits
of taking an antidepressant will probably outweigh the risks of infant
psychotropic exposure.? The ultimate decision on using medication
should follow a discussion among the woman, her doctor and her
husband/partner regarding potential risks and benefits. [13]
http://www.cfah.org/factsoflife/vol9no11.cfm
?The findings from the meta-analyses of over 14,000 subjects, and
subsequent studies of nearly 10,000 additional subjects found that the
following factors were the strongest predictors of postpartum
depression: depression during pregnancy, anxiety during pregnancy,
experiencing stressful life events during pregnancy or the early
puerperium, low levels of social support and having a previous history
of depression. Moderate predictors were high levels of childcare
stress, low self esteem, neuroticism and infant temperament. Small
predictors were obstetric and pregnancy complications, negative
cognitive attributions, quality of relationship with partner, and
socioeconomic status. Ethnicity, maternal age, level of education,
parity and gender of child (in Western societies) were not predictors
of postpartum depression.?
?Untreated postpartum depression can have adverse long-term effects.
For the mother, the episode can be the precursor of chronic recurrent
depression. For her children, a mother?s ongoing depression can
contribute to emotional, behavioral, cognitive and interpersonal
problems in later life (Jacobsen, 1999).
If postpartum depression is to be prevented by clinical or public
health intervention, its risk factors need to be reliably identified,
however, numerous studies have produced inconsistent results (Appleby
et al.,1994; Cooper et al., 1988; Hannah et al.,1992; Warner et al.,
1996). This chapter will provide a synthesis of the recent literature
pertaining to risk factors associated with developing this condition.?
http://www.toronto.ca/health/pdf/ppd_e_chap1.pdf
?And postpartum depression also appears linked to omega-3 levels. A
study of women in 23 countries showed that women who ate less seafood
and had lower rates of DHA in their breast milk were more likely to
suffer postpartum depression. Pilot studies by Dr. Marlene Freeman
[cq], director of the Women?s Mental Health Program at the University
of Arizona, suggest taking DHA and EPA can reduce post-partum
depression by 50 percent.?
http://www.myhealthsense.com/F050308_omega3fa.html
Societal Factors
================
?Postpartum Psychosis sufferers sometimes experience an altered
reality, actually believing they hear voices commanding them to kill
their children or themselves.
Sometimes a woman with PPD's symptoms can worsen if they go untreated
and she may experience psychotic symptoms that can escalate to the
degree that she becomes a threat to herself and her child.
It is possible that this was the case with Dr. Killinger-Johnson. But
how could this have happened to a woman who was a therapist and a
doctor?
Why did she not seek help before things got so bad? To ask this
question is to underestimate the shame that accompanies Postpartum
Depression.
Perhaps, like me, she was afraid of losing professional credibility.
Perhaps, like me, she was afraid of disappointing her friends and
family who expected her to be so good at motherhood.?
http://www.cwhn.ca/network-reseau/4-1/4-1pg3.html
?As a society, we tend to romanticize motherhood, creating a disparity
between a woman's expectations and the reality that she will
experience. "Society reinforces the myth of the perfect baby in the
arms of the perfect mother, with all her maternal instincts intact,"
says Kleiman. "When there is a significant discrepancy between what a
woman anticipates and what she actually experiences, guilt, confusion
and great unhappiness can result."
In addition to societal pressures, personal adversities such as loss
of a loved one, marital conflict or lack of financial security, can
put some women at greater risk, according to PSI. Lifestyle and role
changes also create internal conflict and stress: A new mother may
lose the independence, spontaneity, personal time, sleep and physical
shape that she once had, along with her role as an attention-drawing
pregnant woman or as a career woman. Finally, she may simply miss
adult company in general. "Women with PPD will find adapting to these
losses especially difficult," Kleiman notes, "because of their
increased vulnerability."
http://www.findarticles.com/p/articles/mi_m1175/is_6_35/ai_92849365/pg_2
Risk Assessment During Pregnancy
http://www.postpartumstress.com/ppd_risk_assessment_during.html
?Modern health-care practitioners normally screen their patients for a
history of premenstrual syndrome, previous personal psychiatric
history, and family psychiatric history. They also subjectively
evaluate and discuss prenatal and PPD, anxiety, and stressful life
events. However, they do not use a standardized questionnaire to
identify these factors. This lack of a formal, systematic process
increases the potential for poor intervention, treatment, and
follow-up care by appropriate mental-health experts. They do refer to
psychiatrists, psychologists, counselors, and support groups, which
suggests that there is an interdisciplinary, professional team
approach in operation.
Any woman who has been identified as high risk requires the support of
her partner, according to the research literature. There appears to be
a general willingness among physicians to include the partner in
developing a treatment plan, judging by the number of physician
respondents to my research survey. These respondents said they
regularly ask about their patients' level of support from their
partners and social support systems.?
http://www.childbirthsolutions.com/articles/postpartum/psi/index.php
General Postpartum Information
==============================
http://www.thelaboroflove.com/forum/karena/
http://en.wikipedia.org/wiki/Postpartum_depression
http://www.emedicinehealth.com/articles/10311-1.asp
http://www.4woman.gov/faq/postpartum.htm
http://www.postpartumstress.com/things_you_can_do.html
http://www.nubella.com/content/blogsection/20/157/10/30/
http://www.nmha.org/children/ppd.pdf
http://www.deccanherald.com/deccanherald/jul22005/panorama16516200571.asp
http://www.drdonnica.com/display.asp?article=154
http://www.lalecheleague.org/llleaderweb/LV/LVJulAug93p53.html
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10831472&dopt=Citation
http://www.apa.org/monitor/oct02/postpartum.html
http://www.beyondblue.org.au/postnataldepression/
http://www.mhanys.org/factsheets/fspostpartum.htm
http://www.gentlebirth.org/archives/ppdepres.html
http://www.10news.com/health/3512760/detail.html
Treatment
=========
The Drugging of Postpartum Depression
http://www.cchr.org/publications/Post_Partum.pdf
Treatment of PPD
http://www.womensmentalhealth.org/topics/PDF/Newport_Tx_PPDep&Infant_Exp.pdf?cmd=Retrieve&db=PubMed&list_uids=11995777&dopt=Abstract
?Current conventional treatment of postpartum depression has three
components: psychopharmacology, psychotherapy, and psychosocial
care.[12] The first line of treatment for postpartum depression
consists primarily of antidepressant medication in addition to
psychotherapy with a mental health practitioner who has experience in
treating women with postpartum depression.[12] The third component of
treatment is psychosocial care. Sichel and Driscoll[13] developed an
acronym to guide supportive measures given to a woman with postpartum
depression: "NURSE." The components of the acronym are nutrition and
needs, understanding, rest and relaxation, spirituality, and
exercise.?
http://www.medscape.com/viewarticle/471895
?Pregnant or nursing women may be able to reduce their chances of
developing postpartum depression and improve the neurological
development of their babies by increasing their consumption of the
essential fatty acid DHA, according to David Kyle, Ph.D., the U.S.
director of the Mother and Child Foundation. DHA (docosahexaenoic
acid) is an omega-3 fatty acid mostly found in fish like tuna and
salmon and in algae.
Approximately 15-20 percent of women who give birth in the United
States develop postpartum depression, according to Kyle, who spoke
today at the 223rd national meeting of the American Chemical Society,
the world's largest scientific society. "We believe that the high
incidence of postpartum depression in the United States may be
triggered by a low dietary intake of DHA," he said.?
http://www.intelihealth.com/IH/ihtIH/WSIHW000/333/343/348368.html
?Decisions about treatment for postpartum mood disorders vary
according to the severity of symptoms. Professional opinion, however,
often supports the use of antidepressant medications in combination
with psychotherapy from a qualified family therapist. Family and
couples therapy is also effective, allowing the family and/or partner
to better understand the depression and be a source of support for the
mother. A marriage and family therapist may work with the couple to
explore the history of each person's feelings, and will focus on
solutions that the family can implement right away.
Group psychotherapy, involving the participation of other women
who are experiencing a postpartum mood disorder, has also been found
to improve depression by reducing the feelings of isolation that many
women feel in the early months after childbirth. It is important to
know that if you are breastfeeding, it may not be necessary to stop
while taking antidepressants. Be sure to consult with your doctor
about medication options that are appropriate for your particular
circumstances.?
http://www.aamft.org/families/Consumer_Updates/Postpartum_Depression.asp
Yoga
http://www.yogajournal.com/parenting/1653.cfm
?Determining how much time has elapsed since delivery helps the
physician to distinguish PMD from subclinical mood fluctuations, which
occur with such frequency during the first two weeks after delivery
that they are considered part of the normal postpartum experience.
Many women (range: 26 to 85 percent) experience the "baby blues,"
which are characterized by mild depressive symptoms, tearfulness
(often for no discernible reason), anxiety, irritability, mood
lability, increased sensitivity and fatigue.15,19 The blues typically
peak four to five days after delivery, may last hours to days and
resolve by the 10th postnatal day.
Although for most women the blues are short-lived, evidence suggests
that women who experience them have an increased risk for PMD later in
the postpartum period, especially if the blues symptoms were severe.20
Of women who met criteria for PMD six weeks after delivery, two thirds
were found to have had the baby blues.21 Similarly, the 10 percent of
childbearing women who experience the "highs" (mild euphoria,
increased energy) within the first few days of delivery are more
likely to be depressed several months later.22 Therefore, subclinical
mood swings in either direction after delivery are an indication for
more intensive follow-up later in the postpartum period.?
?Although it is arguable that all women with PMD should seek some type
of counseling, a woman whose depression is persistent or so severe
that she is having difficulty taking care of herself or functioning as
a mother, or is having thoughts of harming herself or her child should
be evaluated for antidepressant treatment. Frequently, PMD is
accompanied by severe anxiety, agitation, or both. Although
benzodiazepines may be used to treat anxiety, it is important to
consider them as an adjunct to antidepressants because they are not
effective in alleviating the core symptoms of depression.?
http://www.aafp.org/afp/990415ap/2247.html
Antidepressants + Breastfeeding
?All postpartum patients should be screened for depression both in the
hospital and at the six-week examination. Pediatricians seeing infants
for well-child checks should use this opportunity to identify mothers
who are depressed. Simply remembering to ask the mother about her mood
is the most important step. The usual DSM-IV criteria for depressive
disorders apply to postpartum women, but the picture may be confused
by symptoms that normally occur in postpartum women such as fatigue
and sleep disturbance. Furthermore, women who fail to meet the
criteria for a major depressive episode may still benefit from
treatment if significant functional impairment is present. The
Edinburgh Postnatal Depression Scale (EPDS) is a validated 10-item
screening questionnaire specifically designed to screen for postpartum
depression and has been used worldwide. A score of 9-12 indicates
possible depression, while a score >12 indicates likely depression.
Abnormal scores should be followed up with an appropriate clinical
assessment.?
http://www.vh.org/adult/provider/familymedicine/postpartumdepression/
Worldwide
=========
Statistics Worldwide of PPD
http://www.wrongdiagnosis.com/p/postpartum_depression/stats-country.htm
Low Income Countries + Mental Health
http://bmj.bmjjournals.com/cgi/content/full/329/7475/1138
?In a study of 277 pregnant women, researchers in the Netherlands
found that those who were highly introverted and highly neurotic were
at increased risk of developing postpartum depression in the year
after giving birth.
These women were nearly seven times more likely than their more
outgoing and laid-back peers to be depressed when their babies were 12
months old.
Researchers led by Dr. Gerda J.M. Verkerk of Tilburg University used
standard questionnaires to gauge introversion and neuroticism among
women late in pregnancy. The women were also screened for depression
at this time and again 3, 6 and 12 months after giving birth.
People who are highly introverted prefer to keep to themselves and
tend to avoid social situations; they also generally keep their
feelings to themselves. Highly neurotic individuals are generally
anxious and sensitive, and tend to be "moody" or easily stressed out.?
http://www.medicinenet.com/script/main/art.asp?articlekey=53027
?This paper describes a British-based longitudinal qualitative study
of postpartum depression over the transition to motherhood.
Twenty-four women were interviewed during pregnancy and one, three and
six months after the birth. The data were transcribed verbatim and
analyzed from a symbolic interactionist perspective to identify themes
surrounding the meaning of motherhood and experiences of depression
during this time.
The findings presented here demonstrate an important paradox in
women's experiences: they are happy to be mothers to their children,
while unhappy at the losses that early motherhood inflicts upon their
lives - losses of autonomy and time, appearance, femininity and
sexuality, and occupational identity. It is argued that if these
losses were taken seriously and the women encouraged to grieve that
postpartum depression would be seen by the women and their partners,
family and friends as a potentially healthy process towards
psychological re-integration and personal growth rather than as a
pathological response to a "happy event."
http://www.findarticles.com/p/articles/mi_qa3711/is_199905/ai_n8844183
Additional Information
======================
There is a great deal of information on PPD on this page. (Warning,
this is a very slow loading site, but well worth the wait)
http://www.rnao.org/bestpractices/completed_guidelines/BPG_Guide_C5_Post_Partum_Depression.asp
Individual Stories
http://postpartum.net/brief.html
One mother?s story
http://www.npr.org/programs/morning/features/2002/feb/postpartum/020218.postpartum.html
Terri Denton?s story
http://www.parenthood.com/articles.html?article_id=4046
New dads can suffer from depression too!
http://seattletimes.nwsource.com/html/health/2002529804_healthmalepartum02.html
Books:
http://www.enotalone.com/books/282839-4.html
http://www.beyondtheblues.com/
This should give you a good start on your paper! If any part of my
answer is unclear, please request an Answer Clarification. I will be
happy to assist you further on this question, if it is not rated
before I have a chance to respond.
Good Luck!
Sincerely, Crabcakes
Search Terms
============
postpartum depression
postpartum depression worldwide
postpartum depression + globally
postpartum depression + societal effects |
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