Effective, empathic therapy to support recovery from perinatal or postpartum mood disorders
Postpartum Depression: Common Questions often asked by mothers who may be suffering and those who love them.
Here are some questions I frequently hear from clients, their family members and friends. If you have a question, email it to me and I'll do my best to get a response online ASAP. To subscribe to Perinatal Pro's weekly blog,click here.
How long after giving birth does postpartum depression typically appear?
This question has a range of responses. While many women are not diagnosed with postpartum depression until 4 - 6 months after the baby's birth, this doesn't mean there were not symptoms before then...it means this is the time frame in which the mother or her loved ones finally sought help for the illness.
Sometimes, postpartum depression occurs immediately after birth and is identified prior to discharge due to symptom severity; at other times, its presentation may be more gradual as the intensity of the symptoms increases and the mother realizes that what she is feeling is more the baby blues.
What are the baby blues and how do I tell the difference between that and postpartum depression?
The baby blues frequently occurs anywhere from immediately to two weeks after delivery and resolves on its own within two to four weeks. Symptoms are tearfulness, mood swings, transient feelings of insecurity, self-doubt and sometimes trauma.
Postpartum mood disorders on the other hand, present with more persistent and heightened symptoms such as inability to relax, rumination, overwhelming sadness, feelings of inadequacy, excessive guilt, feelings of not being able to bond with the baby, insomnia, isolation, estrangement from family and friends, dissociation, wishing the baby were not here, thoughts of harming self or the baby. Watch a video of the symptom description here.
I have heard that postpartum depression can start during pregnancy, how do I know it's not just "hormones"?
Up to 12% of women will experience antenatal depression, that is, depression during pregnancy. While some mood swings are normal during pregnancy, intense sadness, anxiety, lethary, self-doubt, insomnia, ruminating about the baby's health to an extreme and isolation are not normal. Whe symptoms intefere with daily functioning and rob a pregnant woman of all joy, it's time to get an assessment.
I didn't cry or stay in bed all day after my baby was born, but I just felt nothing inside. I couldn't get back to myself. Is this postpartum depression?
It is unfortunate that postpartum depression has been mostly associated with tearfulness, withdrawal, loss of pleasure and lethary. Actually, depression in the postpartum commonly occurs with anxiety and agitation. The symptoms may include insomnia, restlessness, feelings of going crazy, irritability, anger, and feeling "hyper". Vigilance and constant checking the baby can be part of this agitation, but may also signal another disorder which may initially present in the postpartum called Obsessive Compulsive Disorder.
No one in my family has ever had depression or anxiety, but I developed postpartum depression; how is this possible?
While a family history of depression,anxiety or other mental illness can increase the risk of developing postpartum depression, absence of such history is not protective. Sometimes, the person's own biological response to hormonal changes, or a high number of psychosocial stressors can exacerbate the illness.
What do you mean by psychosocial stressors?
Psychosocial stressors refers to events, situations in your immediate environment which cause you anxiety or stress. Some of these include, financial difficulties, poor access to healthcare, poor partner relationship, health problems, the loss or death of a close friend or family member, moving to a new location, changing jobs or a recent marriage. We tend to think of stress associated with negative life events, but in fact, any change in our world brings a certain level of stress, even positive changes.
How long does postpartum depression last? Will it go away on its own?
While some depressive illness will remit without intervention, more serious presentations need rapid and effective intervention to bring recovery. Some women manage to tough it out, but often recall this experience as one of their lives worst, and wish they had gotten help or someone had helped them. Others have no choice but to seek help as their symptoms represent a true emergency requiring immediate intervention. If postpartum depression is not treated, it can last well into the following year.
How do you know if you have to go to the Emergency Room. When do these illnesses become life-threatening?
Any expression of suicide presents a psychiatric emergency and requires IMMEDIATE intervention. DO NOT WAIT. Go to your nearest hospital emergency room without delay. Do not make the mistake of these thoughts are out of character and the urge will pass. Any expression of harming the baby, strange behavior, thoughts, hallucinations (including hearing things, or someone telling you to harm yourself or the baby) present a true medical emergency and require IMMEDIATE hospitalization.
How long will it take me to recover?
This depends on symptom management and symptom severity. The sooner you get treatment, the sooner you will begin to recover. As each woman's illness is uniquely representational of her individual biological, psychological and social causative factors, no two treatment plans or recovery periods will be similar. It is damaging to attempt comparisons to others you have known who recovered in a week or a month. For most women relief from the most difficult symptoms can be expendiently achieved, but full recovery can take several weeks or months.
I don't want to take medication, but my doctor says I won't recover without it. Isn't there something else I can do?
There are many non pharmacological interventions that can support the road to recovery. Exercise is very helpful in mild to moderate depression and can also help reduce symptom severity in severe depression. Diet, nutritional supplements, light therapy, acupuncture, massage and extending the support circle can be of great assistance.
Social support groups and supportive psychotherapy are important adjunct treatments which can greatly enhance the recovery process. Be sure your selected therapist has had specialized training in treating pregnancy related mood disorders so she is up to date on the latest research and treatments.
Sometimes, ECT can be greatly relieving of symptoms if a woman is medication resistant. It has come a long way from the past's negative associations and can be offered on an outpatient basis.
For severe antenatal or postpartum depression, anxiety, bipoloar disorders or postpartum psychosis however, medication may be necessary and life-saving. This is a decision that is made on an individual basis between the client and her psychiatrist.
NO WOMAN SHOULD BE SHAMED INTO FEELING SHE SHOULD "GET OVER IT" ON HER OWN OR THAT THE NEED FOR MEDICATION OR ANY OTHER FORM OF TREATMENT INDICATES WEAKNESS!!!
These are medical illnesses. Would you expect a diabetic to recover without insulin? Would you consider a cancer patient "weak" if he needed chemotherapy to survive?
The recovery prescription will be different for each woman and nothing should be taken off the table to achieve full recovery as quickly as possible.
Does being diagnosed with one of these disorders mean I will always be at risk for a relapse?
Having a diagnosable mood disorder is a medical illness. We all have vulnerabilities to different environmental antagonists be they biological, psychological or social. When these stressors are especially high, we are more vulnerable to the development or re-emergence of symptoms/ illness. This applies to all forms of medical illness including mood disorders.
Consistent management of any medical illness is the best way to prevent reoccurences. Some women may never suffer another episode of a mood disorders while for others, especially those who do not seek treatment, the illness may become chronic or subject to relapse.
How can I prevent this from happening in the first place?
If you plan to become pregnant, you are pregnant or you have recently given birth, talk to your doctor about what your risk factors may be including family history, financial stress, interpersonal difficulties, marital problems, drug or alcohol abuse, smoking cessation,other medical health issues, expectations of pregnancy and delivery, isolation, being a member of an immigrant or socially or legally vulnerable population or isolation from support.
In addition if there have been recent losses, if you are carrying multiple fetuses, sought fertility interventions, experienced past miscarriages, stillbirths, or have a history of physical or sexual abuse, review of the possible effects of such situations is worthy of discussion.
A poor relationship with your partner is considered to be a major risk factor.
However, none of these factors in of themselves are predictive of developing a pregnancy related mood disorder. There are biological systems associated with pregnancy which are not yet completely understood in terms of their implication in such illnesses.
Finally, there are screening tests to help you and your doctor determine if you are at risk or have developed a postpartum mood disorder.
Remember, there is help and primary prevention is often possible! Do not suffer alone.
Who is qualified to treat myself or my loved one for postpartum depression or related disorders?
Clinical Social Workerswho carry the advanced license (LCSW, licensed clinical social worker which is only offered at the Master's level of completed education) deliver most of the individual mental health services sought by consumers today. The advanced license is conferred only after after rigorous exams and thousands of supervisory hours of clinical practice. The license is maintained through additional annual educational requirements and continuing training in their chosen area of specialty.
Clinical social workers maintain group or independent private practices, are accepted by insurance companies, do not need a physicians oversight to determine diagnosis and treatment, but do not prescribe medication. They are among the most respected mental health practitioners for women, families and children with a special appreciation for the biopsychosocial perspective.
Clinical Psychologistsmust have a PhD and a state license in order to practice or offer mental health services independently outside an agency or hospital setting. Today, many psychologists are employed for their specialized skills in testing and evaluation. They also provide individual therapy, but are not able to prescribe medication.
Nurse Practitioners - Are licensed to assessed, treat and in some cases prescribe medication for the clients they see. A rapidly developing field of private practice, nurse practitioners are highly trained clinicians whose medical background and experience gives them great professional understanding of the perinatal period.
Psychiatrist - Is an MD who has chosen to use his dedicate his practice to the field of psychiatry. Psychiatrists assess, evaluate and treat clients and may prescribe medication or admit clients to an inpatient program where they may remain under their care. Psychiatrists may offer therapy themselves or make therapy referrals to social workers, nurse practitioners or psychologists.
Always ask what specific training your provider has had in perinatal mood disorders to ensure the best possible match between your needs and his/her professional expertise. A mental health provider with this specialty should be able to see you within 48 hours of referral, sooner if there is an emergency.