NYC psychotherapist Colette Dowling, author of the following article on postpartum depression, has written eight books on women's issues, including The Cinderella Complex: Women's Hidden Fear of Independence, and "You Mean I Don't Have to Feel This Way?": New Help for Depression, Anxiety and Addiction
Postpartum depression is surprisingly prevalent and too often goes untreated. At a time when a woman most needs her strength and sense of wellbeing in order to take care of a child, a dark mood can move in and take over, causing her to become depressed and even frightened.
I will talk about ways of treating--and sometimes even preventing--postpartum depression, but first, here's a glimpse of what it can look like.
A thirty-eight year old woman with her first baby described herself, within the first months following birth, as "losing it". She said, "I awake each day with dread. I can't face another day of feedings and diapers and small excursions to the neighborhood park. I feel myself getting unhinged. Each day is endless and like the day before. I feel I made a terrible mistake and I worry that I'm not taking good care of the baby."
Her husband is supportive and helpful. So are her mother and friends. Nothing makes a dent in the woman's low mood and anxious worry over her child. Perhaps BECAUSE she's a new mother people want to avoid the obvious: she's depressed.
The birth of a child, usually regarded as a joyous event, paradoxically brings an increased risk of emotional illness to the mother. One out of three women has an episode of at least mild clinical depression after childbirth. Experts in postpartum depression recognize three levels of the disorder. The so-called "maternity blues" is a brief depression affecting 50 to 70 percent of all mothers. This relatively mild postpartum depression can nevertheless include crying spells, restlessness, feelings of unreality and confusion--and, less frequently, feelings of depersonalization, guilt, and negativity toward husband and baby. The symptoms may disappear within a week. Ten to twenty percent of postpartum women will experience a moderately severe depression that lasts six weeks to a year or longer. The specific content of postpartum worries seems to distiguish it from mood disorders at other times in a woman's life. Postpartum depressed mothers have extreme anxiety about their infants' wellbeing, and they doubt their ability to have normal maternal feelings toward the child.
Pospartum depression may be worsened by outside events in the woman's life but it's quite clear that hormones play at least a role in the phenomenon. At some point within five days after delivery there's a dramatic drop in estrogen and progesterone and a large increase in prolactin. Studies correlating hormone levels with mood both before and after childbirth have found that the more the estrogen drops, the worse the new mother sleeps.
Plummeting progesterone also predicts problems. The lower the progesterone drops, the more likely it is the new mother will become depressed within the first ten days of giving birth.
A very small number of women--.01 to .02 percent--experience postpartum psychosis, a remarkable illness that hits between the third and fourteenth day after the baby is born. (It has virtually never been known to occur in the first two days postpartum.) When it happens, though, it happens fast. What at first may look like the onset of a mildly depressed mood very quickly intensifies into an entirely different phenomenon. Obstetric nurses will keep a sharp eye on any depressed new mother, knowing there's a chance that insomnia, exhaustion, agitation, and irritability could escalate to a full-scale psychosis, with alternating states of elation and depression, delusions, and hallucinations.
Sometimes the hallucinations--including auditory hallucinations, or "voices"--warn the mother of imminent harm to her children. This is the type of depression Andrea Yates suffered when she killed her children.
Women with a past history of depression--especially those who've previously experienced postpartum depression--are at risk. It's important, whenever possible, to try to prevent this illness from occuring, not only because of the suffering it brings to the mother, but because of its devastating effects on the child and the infant-mother bond.
Pregnant women should be sure to tell their ob/gyns of any prior experience with depression, no matter how far in the past--and particularly if the depression was moderate to severe. Antidepressant intervention either shortly before or immediately after birth can prevent both mother and baby from having to experience this physically and emotionally debilitating illness.
If the depression is of a bipolar type, intervention is especially important because the hormone changes after birth can trigger a manic episode in the mother.
Milder forms of postpartum depression should be treated with therapy. This is too critical a juncture in the life of mother and baby to "wait it out" in the hope that the illness will pass. Friends, loved ones, and young mothers' groups can b e hnelpful, but at the very least the mother should be professionally assessed to determine the nature and degree of her depression, and whether or not it requires clinical treatment.
The good news is that postpartum depression can be effectively treated. The sooner treatment is begujn, the better for both mother and baby.
To get therapeutic help with postpartum depression and other mood disorders see Colette's profile at Psychology Today.
New York psychotherapist Colette Dowling, LCSW, received her graduate training at the Smith College School for Social Work and her advanced training in psychotherapy anhd psychoanalysis at the Institute for Contemporary Psychotherapy, in New York. In addition she is trained in the use of EMDR for the treatment of trauma.
Colette has a private psychotherapy practice in Manhattan. You can reach her at firstname.lastname@example.org,or by calling 718-594-0201.
Copyright Colette Dowling, 2006-2010