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Friday, July 25, 2008

How Do I Know If I Have a Postpartum Mood Disorder and What Can I Do About It If I Do?

I’m so tired. Who has time for anything?

I love breastfeeding.

Breastfeeding is so challenging.

My husband is so calm with the baby.

My husband doesn’t have a clue.

I can’t remember where I put anything.

I can’t believe how much I love the baby. I never expected this feeling.

The baby cries all the time.

I never even get to take a shower.”

These are some of the things I’ve heard from new moms in my practice. You’ve probably heard them too, or even said them yourself. After having a baby everyone wants to know, “When will things get back to normal?”

Life will never return to exactly the way it was before you had children because your family structure and responsibilities have changed, so I call life post-children the “new normal.” For most of us, the intensity of the newborn period decreases and life gets easier after a few months, but for some women this time is complicated by Postpartum Mood Disorders (PPMD).

Postpartum Mood Disorders refers to a spectrum of disorders, which includes Baby Blues, Depression and/or Anxiety, Panic Disorder, Obsessive-Compulsive Disorder, and Psychosis. Symptoms may actually occur during pregnancy or begin during the first year after the birth of a baby (or later if weaning from breastfeeding occurs after one year) and may change in type and severity over the course of the illness. Postpartum Mood Disorders affect 20 – 30 % of postpartum women and occur in virtually all cultures and cut across racial, ethnic, class, and educational lines.

While there’s still a lot that’s not known about PPMD, there are probably multiple causes, including hormonal imbalance, stress, and isolation.

Some Risk Factors for PPMD may include:

  • Personal and/or family history of anxiety, depression, bipolar disorder, schizophrenia
  • History of PPMD in mother or other close female relative
  • Previous episode of PPMD (50 – 80 % chance of recurrence)
  • Complications of pregnancy and childbirth
  • History of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) and menstrual problems
  • Mood changes while taking birth control pills or fertility medication
  • Thyroid dysfunction
  • Abrupt weaning
  • History of trauma, physical/sexual abuse, personal and/or family substance abuse
  • Unresolved losses, including recent loss of a parent
  • Recent stressful life events
  • Ambivalence about pregnancy and/or maternal role
  • Unrealistic expectations
  • Social isolation and poor support

Remember, though, risk factors do not necessarily lead to or cause PPMD; they just make it more likely that a new mother will experience one. Some new moms with risk factors do not develop a PPMD; other new moms with few or no risk factors do develop a PPMD.

Here are some Symptoms of Postpartum Mood Disorders:

  • Sleep difficulties - often inability to sleep when the baby sleeps
  • Appetite changes – usually loss of appetite
  • Extreme fatigue
  • Difficulty concentrating and making decisions
  • Feeling overwhelmed
  • Irritability
  • Oversensitivity
  • Restlessness
  • Sadness
  • Weepiness
  • Anxiety
  • Excessive worry
  • Lack of feeling for your baby
  • Loss of normal interests and pleasure
  • Decreased interest in sex
  • Hopelessness
  • Comparing yourself unfavorably to other mothers
  • Panic attacks – shortness of breath, palpitations, dizziness
  • Intrusive thoughts – often fears of harming yourself or your baby
  • Repetitive behaviors – counting, checking, cleaning
  • Delusions and/or Hallucinations – these are considered a psychiatric emergency and the woman should receive immediate attention and treatment

A majority of new mothers will experience some of these symptoms of PPMD. In fact, Baby Blues is so common (up to 80% of new mothers) it is usually considered to be “normal,” not really a disorder. Its onset is within the first week postpartum, with symptoms that persist up to three weeks and decrease without treatment. Support and reassurance, from a postpartum doula, for example, can be invaluable in helping the new mom (and family) adjust to life with a baby and become more confident in her mothering.

When symptoms do not resolve within the first several weeks postpartum or begin after that time, you may be experiencing one or more of the other Postpartum Mood Disorders.

Treatment of Postpartum Mood Disorders

A mother who is experiencing symptoms of PPMD should have a physical exam to rule out other causes, such as a thyroid condition, as well as an evaluation by a mental health provider so she can begin appropriate treatment. Counseling or psychotherapy, support groups, and journaling are valuable treatment modalities. If necessary, psychotropic medications (such as antidepressants) can also be used, even during pregnancy and breastfeeding. It is important to see a psychiatrist who is familiar with treating PPMD, especially during breastfeeding if you are and want to continue to do so. Safe and effective alternatives (or adjuncts) to psychotropic medications that may be used include homeopathy, some herbal remedies (not all herbal remedies are safe during pregnancy and breastfeeding), acupuncture, massage, and light therapy. In addition, practical support and parenting education are always helpful.

Most importantly, if you’re wondering whether or not you’re suffering from a PPMD, you should talk to someone (your partner, health care provider, friend or family member) and get help. You can be treated and you can feel better!

Ellen Krug is a licensed clinical social worker, certified childbirth educator, and trained labor doula, who has been serving women and their families in Park Slope and the surrounding Brooklyn communities since 1984. Through Choiceful Birth and Parenting at www.choicefulbirth.com she offers counseling for pregnancy, postpartum, and parenting issues, as well as private childbirth classes tailored to individual needs. She’s the mom of a Park Slope-raised son and daughter who are now young adults.