Postpartum depression: When it's more than just the blues
Saturday, September 01, 2007
It took four maternal suicides in Chicago in 2002 and the case of Andrea Yates, who killed her children, to get people talking about postpartum depression.
"This topic gets its most exposure when there's a horrific event," says Diane Semprevivo of the Women's Behavioral Health Services Department of Advocate Good Samaritan Hospital in Downers Grove. "People didn't talk about this a lot at that time. Somehow these women fell through the cracks."
Each year, more than half of women who have recently given birth suffer from postpartum mood changes. Postpartum mood and anxiety disorders impair 15 to 20 percent of new mothers and postpartum psychosis strikes 1 or 2 in 1,000 women after birth.
"This is the most common OB complication," Semprevivo says.
Although Semprevivo acknowledges there's still a lot of work to do in treating PPD, new legislation introduced in Illinois and in the U.S. Senate may help more women get the treatment they need.
U.S. Sen. Dick Durbin (D-Ill.) introduced the Mom's Opportunity to Access Help, Education and Support for Postpartum Depression, or MOTHERS Act, to help new moms by providing education and screening on PPD that can lead to early identification and treatment. The legislation focuses on expanding research to improve and discover new treatments, diagnostic tools and educational materials for healthcare providers.
"I've been surprised in talking to women, how many women face this and many are without a helping hand," Durbin says.
Durbin's legislation focuses on educating healthcare providers outside the hospital about the signs and symptoms of PPD. "Many women don't see their own doctors for months after they leave the hospital, but they do see a pediatrician and it's obvious that we need to alert pediatricians about this," Durbin says.
Sen. Don Harmon (D-Oak Park) sponsored the Perinatal Mental Health Disorders and Treatment Act, which was signed into law in August. This act also focuses on educating healthcare providers about screening and treatment for PPD.
Signs of postpartum depression
Most women expect having a baby to be a wonderful, joyful experience. And for many women, it is. But others may find their new life to be nothing like what they expected. They may feel hopeless and sad. Some feel like they're babysitting-they don't bond with the baby.
"It's important to differentiate baby blues from postpartum depression. The huge difference is that the predominant mood in the blues is happiness," says Rebecca Christophersen, psychiatric mental health nurse practitioner at the University of Illinois at Chicago. "Postpartum depression women usually feel extremely sad, numb, despondent. They can't feel any joy. They feel inadequate and guilty."
Women with PPD may also have disturbing thoughts of wanting to hurt their baby. Although with PPD the majority of women never act on these thoughts, the new moms are often afraid to share this information for fear their child will be taken away from them, Christophersen says.
PPD can manifest itself any time within the first year after giving birth, as hormones shift due to childbirth and nursing. Up to 20 percent of women have suffered from some level of PPD by the time their child is 6 months old, Christophersen says. That's why early screening of women before they leave the safety net of the hospital is critical.
Some hospitals, including Advocate Good Samaritan in Downers Grove, have instituted a screening program for new moms. A short questionnaire allows medical staff to identify women who may be at risk for depression and refer them to appropriate care.
"You've got a critical time when they're in the hospital," Semprevivo says. Advocate Good Samaritan has educated the nursing staff and will ask Semprevivo to speak with the mom and her family if she is deemed at risk for PPD.
"I've had a pretty good response from the women. They're glad we have the (PPD support) group and that we screen and talk about it," Semprevivo says. "Look at the image of motherhood-I don't know too many who experience what we portray. So we have this woman who's crying, can't eat, can't sleep, they feel like why isn't it like this for me. So just the idea that somebody spoke about it and they have a number to call if something comes up, helps."
PPD affects whole family
Helping moms who are suffering from PPD can have long-range benefits for her whole family, says Linda Gilkerson, an early intervention specialist at The Erikson Institute in Chicago.
"Mothers who are depressed show more negative and sad facial expressions to their children and babies mirror this back," Gilkerson says. This can result in a fussy baby and a mom who feels even more at a loss when it comes to dealing with the child. Maternal depression can result in babies with feeding, sleeping or comforting issues, or children with behavioral problems.
Dads also need to be educated about PPD since they're often the ones in closest contact with the moms.
"Most dads don't usually see it," says Dr. Shannon Gritzenbach, medical director for women's behavioral health at Advocate Good Samaritan Hospital. "The majority of time, it's me calling the dad and saying 'Your wife's really sick and you need to step up to the plate.'
"There's a big stigma that women should be able to do this. I try to get around this with the husband by explaining that this is a medical illness-you need to treat this like diabetes," Gritzenbach says. "What a double whammy this is-mental illness and the stigma of a bad mother."
Treatment can vary
Treatment for PPD can include helping a woman build a support network around her and working with her to learn to ask for help, as well as cognitive behavioral therapy and medication.
"How it's treated is totally up to the woman. Unless she's suicidal or has plans to hurt the baby, she can't be forced into treatment against her will," Gritzenbach says. "Treatment generally depends on the severity and what's available. Medication may be a good option for women who don't have access to psychotherapy."
Women should be comfortable with the person treating them and find someone who specializes in women's mental health. "Listen to your intuition, call and screen the clinic ahead of time," Gritzenbach advises.
For women who are mildly to moderately depressed, psychotherapy can be worthwhile. It can be as simple as talking to the husband to get more support and to learn relaxation techniques, such as breathing skills. Sometimes a few sessions with a therapist is all a woman needs, Gritzenbach says.
For women with more severe depression, who may also be experiencing high anxiety or obsessive compulsive thoughts and behaviors, medication may be the best form of treatment. Antidepressant medications such as Zoloft or Prozac can provide relief to moms with PPD, while still allowing them to nurse their baby safely. It may take time for the benefits of the medication to kick in, and the first one doesn't always work, so women may have to work with the doctor to get the best treatment.
Reducing the stigma
But the most important part of treatment is diminishing the shame a woman feels about having PPD, Gritzenbach says. "This is a medical illness. It's not uncommon and you're not alone. They don't have to feel this way. There is help."
One way to decrease the shame and isolation women with PPD may feel is to talk about this illness and bring it out of the shadows.
"How do you change this? You have to educate and talk and talk about this," says Semprevivo. "Education has a lot of power. Women need to encourage their health care providers to discuss this with them-you should be screened prenatally and if you're not you have to be proactive and find out yourself.
"And we need to educate our patients and healthcare providers," Semprevivo says. "We have to call our congressmen and support this bill."