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Postpartum depression is defined by the DSM-IV as
the onset of depressive symptoms within 4 weeks of childbirth. Symptoms
are very similar to major depression, and can also include fluctuations
in mood, preoccupation with infant well-being, as well as at times
just the opposite, complete disinterest in the infant which, if
prolonged, may result in failure to thrive syndrome. Although the
DSM-IV suggests rigid guidelines in terms of time periods where
this diagnosis should or should not be made, it is imperative to
note that in medicine, as well as psychiatry and psychology, there
is leeway. Subsequently, at 4 weeks and 2 days, if the mother comes
down with depressive symptoms, this diagnosis still should be made.
Infantcide, where children are killed by their mother, is most
often associated with postpartum psychotic episodes that are usually
characterized by hallucinations. These are usually auditory command
hallucinations directing the mother to kill the infant. There can
be delusions that the child may be possessed. Statistics for psychotic
breaches with postpartum depression range anywhere from 1 in 500
to 1 in 1,000, as per the DSM-IV.
Once a woman has had a postpartum episode, the risk of occurrence
for future deliveries is approximately a 30-50% increase.
Other symptomatology may include anxiety attacks, panic attacks,
fear of being alone with the infant, and complete disinterest. This
is not to be confused with the “baby blues,” which does
affect up to approximately 70% of women during the first 10-14 days
postpartum. This is transient, and usually does not impair functioning.
It is not uncommon for the healthiest of mother to experience fear
and anxiety with the birth of a child. Common fears that are not
often voiced may relate to ability to raise a child successfully,
questioning whether she will do a “better job or worse job”
than her own mother, fears regarding possible health issues that
could develop in her child, and ability to care for a child in the
event that occurs, fear regarding ability to maintain her relationship
with her significant other (“Will I still be a good wife?).
All of these feelings and questions are normal, and only become
“abnormal” when they impact daily routines and/or involve
risky caretaker behavior.
Good communication is crucial. It is extremely helpful to talk
about these feelings with other mothers, or a spouse.
Any time there is a major life event such as giving birth to another
human being, a barrage of feelings are to be expected. There may
even be feelings of regret, which many women stifle, and never share,
feeling very guilty having these feelings, which can cause transient
depression. “I didn’t want the baby” is also a
common feeling. This does not mean that the mother is not a loving
mother. This does not mean that the mother cannot take care of her
child. These are common, transient type feelings that do occur.
It is imperative that we understand the dark side contained in
each of us. When we begin to understand our dark sides, admit to
those feelings, we are better able to address them and move on with
less anxiety and less stress in a variety of interactions.
Postpartum Depression Symptoms
As with all illnesses, there are symptom gradations. Postpartum
depression symptoms may be mild, moderate or severe in nature. Symptoms
usually affect the entire family network. Postpartum depression
can also be associated with anxiety. Please see Anxiety Disorders
on Peace and Healing.com. Symptoms of postpartum depression may
include insomnia, fluctuations of anger, sudden outbursts of crying,
feelings of isolation, wanting to leave the baby and/or family network,
fear of not being a good caretaker. As with most depression, there
may be decreased personal hygiene, and although somewhat uncommon,
eating disturbances. There are also physiological symptoms associated
with this disorder including weight fluctuations. Breastfeeding
issues are also common. The baby rejecting breastfeeding can cause
an exacerbation of depression. Other symptoms: Headaches, feeling
decreased support from the husband, especially if he doesn’t
understand what his wife is experiencing and not being emotionally
supportive.
Treatment of Postpartum Depression
The most important part of treating any depression is recognition
of the problem and getting the individual into treatment. Traditional
treatment includes a combination of anti-depressants and psychotherapy.
Family support, especially spousal, is very important. Individuals
often feel like they are losing their minds. Much encouragement
is needed. However, bear in mind that postpartum depression is not
a normal process. Additional spousal help and support may alleviate
many symptoms. It is important for the mother to try to rest/sleep
at the same time as her baby. Subsequently, house chores should
not be a priority. If the individual has a good family support network,
asking for help with the chores or errands is essential, and in
fact is key. Nowadays, in our society, we “want to do it on
our own.” We have been taught not to ask for help as we don’t
want to appear dependent on others. As Dr. Hammerschlag points out
most eloquently, it is much easier to paddle a canoe across the
lake with two individuals paddling, than one. If you have ever paddled
a canoe by yourself, you realize how difficult it is. If you have
two individuals paddling, it is much easier. This analogy applies
to sufferers of postpartum depression. There has to be a team in
place, and the husband plays a vital role.
Try to get away; even it is only for a cup of coffee for half hour.
Try to spend time in the outdoors, go shopping or to a movie. Seeing
a movie is the epitome of self-hypnosis, as you are engrossed in
the film and therefore momentarily distracted.
Anti-depressants can be extremely helpful in treating postpartum
depression. There are many anti-depressants than can be used even
if the mother is breastfeeding. Examples include Zoloft, Anafranil,
and Norpramin. Paxil is questionable. Anti-depressant usage doesn’t
need to be the first line of treatment; however, this would clearly
dependent on the severity of the depression and how debilitating
the symptoms are. If the symptoms were severe enough that child
care is impacted, clearly this would be a first line treatment option.
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