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- What is postpartum depression?
- Can it affect me before
I have the baby (during pregnancy)?
- What are the symptoms
of a major depression?
- Doesn't postpartum
depression just go away? Isn't it just the "baby blues"?
- How many women suffer
from PPD?
- What causes PPD?
- What are the PPD risk
factors?
- Is PPD treatable?
- Won’t the drugs
harm my baby during pregnancy or during breast-feeding?
- What if I’m not
sure whether I have PPD?
- How do I find the
help I need?
- If I have PPD, won’t
my obstetrician pick up on it when I go in for my six-week checkup?
- What can I do to
take better care of myself if I get postpartum depression?
- What will happen
if PPD goes untreated?
1. What is postpartum depression?
Postpartum depression (PPD) is a
major depression that affects hundreds of thousands of women each
year in the United States.
Women who suffer from this disorder often plunge into despair, feeling
extremely sad and lonely. They lose interest in just about everything,
including their families. They may have difficulty eating and sleeping
properly. They cry too much and laugh too little. In severe cases,
they may even have thoughts of suicide.
The good news is that PPD is curable. With the right treatment,
most women bounce back and go on to enjoy their babies and live
healthy, happy lives.
If you believe you may be a victim of PPD, we invite you to take
a simple screening test by clicking the orange box below. If the
test implies that you may have PPD we urge you to contact your health
professional and tell him or her exactly how you feel. We will put
you in contact with peer support groups who understand what you
are going through and health care professionals who can get you
the help you need.
Yes. Doctors call this prenatal or antenatal
depression. The symptoms and the consequences are the same as those
of postpartum depression (PPD). The fact is that 40% of
women who develop postpartum depression are depressed during their
pregnancy.
3. What are the symptoms of a major
depression?
People
with major depression no longer enjoy life. They feel very sad and
lose interest in just about everything, including their families.
Their self-esteem plummets. They may have difficulties eating or
sleeping.
They may lose interest in sex. They may lack energy and become unable
to concentrate. They may not be able to get out of bed. In severe
cases, many women may have suicidal thoughts. These can take a passive
form of wishing they would die as well as an active form of considering
how to kill themselves.
4. Doesn't postpartum
depression just go away? Isn't it just the "baby blues"?
No! Most women experience feelings
of sadness, irritability, anxiety and big mood swings when they
first bring their babies home. They have trouble sleeping and eating.
This is due to hormonal changes in women and the tremendous stress
that a new baby can cause in a household, especially those with
other small children.
In most cases these feelings go away after a couple weeks. If the
condition persists longer than two weeks it is probably postpartum
depression. 50% of untreated women will still be depressed after
a year. For many women this is the beginning of a lifelong depression,
which may worsen with each subsequent pregnancy. While some women
are able to recover on their own, those that don't have increasingly
severe symptoms over time which may include fantasies about harming their
baby or suicide.
5. How many women suffer from PPD?
It
is the most common serious complication of pregnancy. Twenty percent of new mothers suffer from it. In high stress environments, like the inner city, the rate can reach 40%. Given four million births
in the U.S. each year, there are between 400,000 and 800,000 new
cases of PPD in the U.S. each year. The rates are different in different
populations. This is a disease that is fueled by stress. Some populations
may have rates as high as 30%.
Many women are surprised by how common the disease is. Intense feelings
of shame and fear of stigma make such women extremely reluctant
to talk about it, even with other members of their families, their
closest friends, and most of all their health care professionals.
Some have learned to cover up their symptoms when in public, even
in their doctors' offices. This tendency has led some to label PPD
as "the smiling depression".
While the common term for this illness is postpartum depression
many women actually suffer from severe anxiety disorders such as
panic disorder and obsessive-compulsive disorder (OCD).
To emcompass all of these, we PPD to represent Perinatal Psychiatric Disorders. The symptoms of depression take a back seat, but these same women
are often very suicidal.
No one knows for sure. No single
cause has been identified. No researcher has found the gene or a
germ that pitches women into despair before and after having a baby.
PPD is probably caused by several factors that converge to create
the perfect emotional storm.
One important factor is sensitivity to hormonal changes. For some
women changes in hormones which occur during puberty, the menstrual
cycle, birth and menopause, result in severe mood changes and depressions.
Women who suffer from PMS or PMDD (a depressive illness that
lasts for one week per month) are tremendously more likely to
develop PPD.
Intense disillusionment is a frequent component of PPD. Women are
overwhelmed by the difference between the way they imagined childbirth
and the reality, often shattering their fantasy that this will be the most glorious day
of their life and they will be the star of the show with a serene
happy baby.
Difficult labors and C-sections seem to be important factors for
some mothers.
Many women lack emotional support. Some of it is due to being isolated,
not being understood or accepted by their spouse. Having other young
children, below the age of 3, to care for may be a factor.
Since doctors cannot run a test
for PPD as they do when they suspect pneumonia or other disease
with a known cause, they look for so-called risk factorsăconditions
common to women with PPD. This helps in identifying women who may
be susceptible and in making the diagnosis. They include:
Sensitivity to hormonal changes. Hormonal changes probably contribute
to PPD, but they are not the whole story. If they were, doctors
could make you feel better by giving you hormone replacements.
Prior history of depression. This seems obvious, but some women,
and perhaps even some doctors, still believe the myth that pregnancy
protects women from depression. It does not. On the contrary, if
you have been depressed before, you have a high risk of becoming
depressed again when you become pregnant.
Prior history of anxiety or mood disorders. These include panic
attacks, obsessive-compulsive disorder, phobias and post-traumatic
stress disorder. Untreated anxiety disorders may lead to depression
even without pregnancy.
Family history of depression. Depression and other mental illnesses
tend to run in families so it may be genetic-that is, you may simply
inherit it from your parents. Unfortunately, some of these illnesses
are kept secret so you may not know about them.
Lack of emotional, financial and social support. With the proper
support at home or in the community, pregnancy can be a joyful time.
Without it, it can be highly stressful. The greater the stress in
a woman's life, the more likely she is to suffer from PPD.
Stress comes from many sources-a baby who is too demanding or who
will not sleep, an unsupportive or absent father, financial difficulties
or troubles at work. Single or teenage mothers and those who struggle
with poverty or have drug or alcohol problems are 25% more likely
to fall ill.
Yes.
At present, less than 15% of PPD sufferers get any treatment at
all. Over 65% will get better with counseling or psychotherapy.
The same percentage will respond to antidepressant medication. It
is best treated with a new class of anti-depressants called SSRIs.
Together, they have proved effective in over 90% of the cases studied.
Women reclaim their lives and begin enjoying their families and
jobs again.
You have probably seen some of the SSRI anti-depressant medications
advertised on TV, like Prozac, Paxil, Zoloft and Celexa. They do
not provide instant relief. You may have to take the medication
for several weeks before feeling better. And different drugs work
for different people. So, you may have to try two or three before
finding one that is right for you.
Many women are fearful that these medicines will be "addicting".
What they mean is that they will get dependant on them. These medicines
replace substances hat are missing in the patient's body. This is
exactly the case in diabetes where insulin has to be given.
Medicines may be prescribed by your primary care doctor or obstetrician/gynecologist
when they make or confirm the PPD diagnosis. He or she can then
refer you to someone else for the talk therapy. It may a psychologist
(psychologists are experts on mental illness, but they are not
medical doctors and cannot prescribe drugs), a social worker
who has had experience with PPD, a professional counselor, or a
PPD peer-support group.
The important thing is that you talk to someone so that you can
fully understand PPD and how the medicines work and learn other
techniques for coping with the disease. Just being around other
people who understand what you are going through can be comforting
and help rebuild your self esteem.
Highly unlikely. We understand that you want to do everything you
can to protect your baby. But the chances that even the strongest
medicine will harm your baby are very small and they do not outweigh
the risk of your suffering through a major depression before or
after giving birth. A mother's untreated depression is very harmful
to newborns. The only time there is any risk at all is during the
first three weeks of gestation. Large population studies have shown
that there is no difference in fetal malformations between women
taking medicine or not.
Remember, if you are suffering emotionally, so is your baby. So
are the other members of your family. Again, SSRIs are very safe
during breastfeeding. There is no evidence of any serious harm done
to the baby by the tiny amount of medicine that gets into the milk.
Any minor reaction a baby has to medication will go away when the
mother stops taking it.
10. What if I'm not sure
whether I have PPD?
Make an appointment with your health care
provider as soon as possible. In the meantime, simply take our screening
test by clicking here. It will only take a few minutes. During the
test we recommend that you be as honest as you can. Your health
depends on it. Your baby's health depends on it.
11. How do I find the help I need?
Contact your health care provider and tell
him or her that you believe that you may be suffering from symptoms
of PPD. This may
be your primary care physician, nurse practitioner or nurse, your
child's pediatrician or your obstetrician/gynecologist. They can
start you back on the road to good health.
Whoever you see, make sure that they listen to you. As women are
fearful that if professionals knew the thoughts and feeling they
are having they would be put ion a mental hospital, jail or have
their baby taken away from them. If you are worried about this ask
your healthcare professional if they would communicate with anyone
else about your case under any circumstances.
Some doctors and nurses may be quick to give you quick assurances
that your feelings are not serious and that they will soon pass.
That is often not the case, especially if you have been feeling
bad for more than a couple of weeks.
If that fails, or if you just don't feel comfortable talking to
your regular health care provider, contact Postpartum Support International's help line: 1-800-944-4PPD. They will
put you in touch with other mothers who have survived PPD. They will
help you find the help you need. You don't even have to tell us
your name.
Postpartum Support International provides information about postpartum depression, including local resources in every state, via the Postpartum Depression Helpline or www.postpartum.net. If this is a medical emergency, contact your local emergency room or call
1-800-SUICIDE.
12. If I have PPD,
won't my obstetrician pick up on it when I go in for my six-week
checkup?
Not necessarily. In
fact, research shows that even the best obstetricians identify PPD
in only 40% of their patients. Obstetricians are primarily concerned
about your physical health. Many don’t see their jobs as monitoring
or treating your mental and emotional health. Many women describe
being in tears while their doctor seems only interested in problems
below the waist.
13. What can I do to take better care
of myself if I get postpartum depression?
The good news is that if you have PPD, there are things you can
do to take care of yourself.
- Get good, old-fashioned rest. Always try to nap when the baby
naps.
- Stop putting pressure on yourself to do everything. Do as
much as you can and leave the rest! Ask for help with household
chores and nighttime feedings.
- Talk to your husband, partner, family, and friends about how
you are feeling.
- Do not spend a lot of time alone. Get dressed and leave the
house. Run an errand or take a short walk.
- Spend time alone with your husband or partner.
- Talk to your health care provider about medical treatment.
Do not be shy about telling them your concerns. Not all health
care providers know how to tell if you have PPD. Ask for a referral
to a mental health professional that specializes in treating
depression.
- Talk with other mothers so you can learn from their experiences.
- Join a support group for women with PPD. Call a local hotline
or look in your telephone book for information and services.
14. What will happen if PPD goes untreated?
In half the cases, it will simply go away
within a year or so. But in the other half, it will persist and
continue to make the mother and her family miserable. Babies may
develop significant learning and behavioral problems, they may have
trouble forming attachments of their own and they are three times more likely
to become depressed as teenagers. Uncomprehending husbands may react
badly. Some believe that depression is the leading cause of divorce
and we know that domestic violence is highest around pregnancy and
childbirth. So if you feel you may have PPD, see a doctor. Don't
delay. The longer a depression goes untreated, the less responsive
it is to treatment.
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