Monday, November 24, 2014

Postpartum Depression and Mood Disorders



By Ella Clark

What is Postpartum Depression?

Anyone who has recently been pregnant, experienced miscarriage, stillbirth, recently adopted a child, or are the partner of someone who has recently been pregnant or adopted a child, can experience symptoms of postpartum depression (PPD).  While PPD is known to impact people of all backgrounds, many still experience symptoms without knowing what they are feeling has a name, and can be treated.  Still others may avoid seeking treatment because of negative stereotypes associated with mental health care.  Learning to recognize the symptoms before PPD sets in makes it easier to recognize the difference between the more normal stressors of new parenthood, and something more serious.  

Baby Blues v. PPD

As mentioned by Massachusetts General Hospital’s Center for Women’s Mental Health web page “about 85% of women experience some type of mood disturbance” after birth, including baby blues.   Though both baby blues, and PPD exhibit similar symptoms, PPD is generally considered more severe, and according to Postpartum Support International’s (PSI) website, only about 15% of those who have given birth develop PPD.  While baby blues generally only last for several days, if you notice symptoms that continue for two weeks or more you are likely experiencing PPD.  

Childbirth Connection’s website has provided a list of PPD symptoms to look for in new parents, and those who have recently been pregnant:
Crying easily
Sleep disturbances
Irritability
Anxiety
Lack of energy
Inability to focus
Sad mood
Loss of appetite
Inability to care for yourself
Obsessive or intrusive thoughts
Panic attacks
Thoughts of suicide
Thoughts of killing your baby

Because many of the symptoms of PPD interfere with daily life, and are in some cases potentially life threatening, it is important to seek help sooner rather than later.   

PPD Risk Factors

While anyone could develop PPD, PSI’s site reminds readers that some may be at a higher risk of developing symptoms, depending upon their personal, and family history.  A few of the known risk factors of PPD include:  
History of mental illnesses such as depression or anxiety in yourself, or family members
Lack of social support
Experiencing financial stress
Relationship stress
Difficult or traumatic pregnancy or postpartum period (could be related to difficulty breastfeeding, an unexpected c -section, an ill child, stillbirth, etc.)
Recent changes or major life events (marriage, moving, death of a loved one, change in employment, etc.)
Twin birth
Past difficulty with fertility or loss of a child
Illness in a parent
Post traumatic stress disorder
As described below, those who have survived any form of abuse, especially childhood sexual abuse (CSA), or have experienced and survived war are at an increased risk for developing PPD.  

PPD and Survivors of Childhood Sexual Abuse

Kathy Morelli explains in the Science and Sensibility article “Childhood Sexual Abuse as a Risk Factor for Postpartum Depression-- Part 1”  12-20% of women have experienced some form of childhood sexual abuse (CSA), which has been shown to increase a person’s risk of developing PPD.  Survivors of this form of abuse are known to have an increased rate of mental illnesses such as anxiety, and depression, as well as physical symptoms such as painful menstruation, pelvic pain, and pain during sex.  Morelli goes on to explain that experiencing long term stress, and fear during childhood can actually affect the makeup of the brain, especially portions of the brain associated with memories.  In part 2 of Morelli’s exploration of CSA and PPD “Childhood Sexual Abuse as a Risk Factor for Postpartum Depression-- Part 2: The Educator’s Role”, the author explains that physical, and emotional feelings of pregnancy, birth, and the extreme focus on the sex organs, may trigger memories of abuse in survivors.  These triggers, along with the increased stress of learning how to parent children, can create  an environment in which PPD is more likely to develop.  

PPD and War Veterans

According to Walker Karraa’s Science & Sensibility blog entry “Giving Birth after Battle: Increased Risk of Postpartum Depression for Women in Military” 16,000 active duty women give birth in the United States of America every year.  Throughout the article, Karraa references research published in the journal Medical Surveillance Monthly Report, which has shown that women who have served, and experience PPD are at greater risk for suicide compared to women who have served but do not develop PPD.  The Journal of Women’s Health, also noted by Karraa, reported that people who gave birth but have never been deployed, experienced PPD 10-11% of the time, while those who have given birth, have been deployed, and went through “combat-like experiences” develop PPD 16-17% of the time.  The risk factor for developing depression was even higher for those who deployed recently after giving birth.

Postpartum Psychosis

Another, more severe form of PPD, known as postpartum psychosis may also occur in some new parents. It’s important to remember that postpartum psychosis is very rare, and the symptoms that set in are both noticeable, and sudden.  Both Postpartum Progress and Massachusetts General Hospital Center for Women’s Mental Health  have listed symptoms related to Postpartum Psychosis:
Increased energy levels, feeling like you do not need sleep though you are tired
Feeling overly confident, that you’re mentally sharper, that you understand everything
Thinking that yourself or your child has special abilities
You are seeing or hearing things that others cannot
Voices may be telling you secrets or giving you orders
A loss of trust in others, or an extreme suspicion of those who you may have previously trusted
Trouble focusing, or remembering how to do things you used to enjoy
Loss of time, or an inability to track time
Strange physical sensations
A sharp increase in fighting with others
Feeling like someone or something is controlling your behavior
Feeling you have little to no control over your actions
Rapidly changing moods

Treatment and Prevention

It is vital for those working with pregnant, or otherwise expectant parents to focus some of their time on teaching clients, and patients to identify the symptoms of PPD.  Simply discussing PPD, and its effects, not only raise awareness about PPD, but also decreases some of the stigma associated with seeking treatment.  
Some with PPD have found comfort in meeting with, not only their doctors, but other parents who currently face similar difficulties.  Fortunately, the Lamaze Family Center of Ann Arbor offers several options for those seeking this type of support, with a monthly Pregnancy and Postpartum Support Group, weekly Mother’s Group, and monthly Miscarriage & Newborn Loss Support Group.  

Can You Prevent Postpartum Depression?

Though preventative exercises may help guard some people against experiencing PPD, there will still be some who will develop PPD, through no fault of their own, despite taking steps to prevent the development of PPD.  Listed below are some tips Kate Kripke has provided in the article “Can You Prevent Postpartum Depression?” on Postpartum Progress’s website, for those interested in trying to prevent this form of depression.
Take care of yourself through
proper nutrition
keeping hydrated
giving yourself down time every day
Practice good sleep hygiene
getting enough sleep
building a good sleep environment
creating a sleep schedule
Keep moving
Take time to build strong relationships with those around you
Become aware of your thoughts and feelings
Reduce stress through
meditation
mindfulness
deep breathing

Personal Accounts of PPD

While academic articles focusing on clinical descriptions of PPD offer valuable information on diagnosing this form of depression, there is no better way of learning what to look for than from those who have personally experienced PPD.  Below are a few links to blog entries, and interviews with people who have dealt with PPD.   
Lindsay Hunter  

Lebogang

Elizabeth R.

Addye

Rebecca Hawkes


Partners

Postpartum Depression PSI FAQ

Hotlines/Chatlines:

Safe House Sexual Assault Help Line
734-995-5444

Suicide Hotline
1-800-273-8255


Ozone House Crisis Line
734-662-2222
Military Vet Crisis and Family Crisis Line
1-800-273-8255 (1)

Active Military and Family Crisis Line
1-800-342-9647



Other Resources:









References

"Baby Blues or Postpartum Depression?" Childbirth Connection: Information for Women on Pregnancy & Childbirth. Web. 24 Sept. 2014. <http://www.childbirthconnection.org/article.asp?ck=10528>.

Hawkes, Rebecca. "The Day I Couldn't Get Out of Bed: Post-Adoption Depression." Sea Glass & Other Fragments. 1 May 2012. Web. 29 Sept. 2014. <http://www.rebeccahawkes.com/2012/05/day-i-couldnt-get-out-of-bed-post.html>.

Hawkes, Rebecca. "Five for Friday: Five Things I Did to Get Through Post-Adoption Depression." Sea Glass & Other Fragments. 4 May 2012. Web. 29 Sept. 2014. <http://www.rebeccahawkes.com/2012/05/five-for-friday-five-things-i-did-to.html>.

"Postpartum Psychiatric Disorders." Massachusetts Gnereal Hospital Center for Women's Mental Health. Web. 24 Sept. 2014. <http://womensmentalhealth.org/specialty-clinics/postpartum-psychiatric-disorders/>.

"Postpartum Support International." Web. 24 Sept. 2014. <http://postpartum.net/Default.aspx>.


Stone, Katherine. "Postpartum Psychosis Symptoms (in Plain Mama English)." Postpartum Progress. Web. 24 Sept. 2014. <http://www.postpartumprogress.com/the-symptoms-of-postpartum-psychosis-in-plain-mama-english>.

Morelli, Kathy. "Childhood Sexual Abuse as a Risk Factor for Postpartum Depression-- Part 2: The Educator's Role." Science & Sensibility: A Research Blog About Healthy Pregnancy, Birth & Beyond. 5 June 2014. Web. 24 Sept. 2014. <http://www.scienceandsensibility.org/?p=8374>.

Morelli, Kathy. "Childhood Sexual Abuse as a Risk Factor for Postpartum Depression – Part 1." Science & Sensibility: A Research Blog About Healthy Pregnancy, Birth & Beyond. 3 June 2014. Web. 24 Sept. 2014. <http://www.scienceandsensibility.org/?p=8370>.

Karraa, Walker. "Giving Birth after Battle: Increased Risk of Postpartum Depression for Women in Military." Science & Sensibility: A Research Blog About Healthy Pregnancy, Birth & Beyond. 11 Nov. 2013. Web. 24 Sept. 2014. <http://www.scienceandsensibility.org/?p=7555>.

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