How to Help Loved One w/ Postpartum Depression?

By Nada Stotland, MD, MPH

Postpartum depression simply means depression occurring after childbirth---any time from days after to up to a year after the birth of a baby. 

When we diagnosis depression---at any time in life---we don't mean the kind of "down" mood everybody experiences from time to time. We mean a real disease that causes symptoms including interference with sleep and appetite; thoughts of death; guilt; lack of interest in the activities of life; inability to feel pleasure---every day for weeks. It's a very painful, but fortunately very treatable, disease. 

Depression is particularly painful for a mother with a new baby. People are often telling her that this should be the happiest time of her life, that she should appreciate her good fortune in being able to conceive and bear a child when many others have so much trouble. 

Other people---and even the new mother herself--may also confuse the symptoms of depression with the inevitable interruptions of sleep and meals by the demands of a newborn and the common concerns about being a good mother. 

It's important to distinguish postpartum depression from postpartum psychosis. Postpartum psychosis begins within days after birth. The new mother with postpartum psychosis is seriously agitated, unable to relax. She is haunted by irrational ideas about herself and the baby--ideas, for example, that God wants her to send the baby to heaven or that the baby is a devil of some kind---and sometimes by irresistible urges to harm the baby. Postpartum psychosis is rare; it occurs after far fewer than 1% of births. It is a medical emergency. 

When postpartum psychosis is suspected, the new mother must be seen immediately by a physician, preferably a psychiatrist. 

Postpartum depression seems to be caused by a combination of genetics, the abrupt changes in hormones after birth, physical exhaustion, and the strain of adapting to a new role and the reactions and demands of friends and family. Postpartum depression is often a continuation of depression that was present, but not recognized, during pregnancy. In our society, we take it for granted that we shower medical and social attention on the pregnant woman---frequent visits to the obstetrician, baby showers---when all she has to do for the baby is to take good care of herself. 

After her baby is born---when she is exhausted from labor and delivery and when she has responsibility for the 24/7 care of a helpless infant--all that attention falls away. She may live far away from supportive family members. She may either have to go back to work before she is ready, or may feel isolated, away from the familiar duties and social contacts of the workplace. Usually there are no postpartum visits from nurses, and quality childcare is expensive and hard to find. Postpartum depression, although it occurs everywhere in the world, may be more common in our country for those reasons (occurs in about 15% of U.S. births). 

Postpartum depression can be successfully treated with psychotherapy and/or medication. Group therapy reassures the new mother that she's not alone and others are going through same issues. Family and friends can play major roles in the new mother's recovery. They should remind her that she is not responsible for her depression, and she can recover from it. 

Helping with her baby can be useful, but it's not a good idea to take over baby care completely; that will just make her feel more inadequate. 

It's better to take care of the mother herself. Offer simple diversions, like an outing, but without expecting them to treat depression. We don't want to make her feel unappreciative. Sympathize with her grief over missing the joys of new motherhood. Remind her of all the lovely things she planned and did for the baby before it was born, and point out what a good mother she is working to be. 

Depression makes people feel helpless and hopeless, so she may need encouragement to get the professional care she needs. Friends and family can help by contacting her family physician or obstetrician and by locating a mental health professional available to treat the new mother. With proper care, she will probably start to feel better within a few weeks.

Tweet

Why Women Must Exercise for Mental Health

By Claudia Reardon, M.D.

Exercise has mental health benefits for men and women of all ages.  However, there are unique factors to consider in thinking about the mental health benefits of exercise for women in particular.  Compared to men, women have a two-fold increased prevalence of major depression throughout their reproductive life cycle.  Exercise can be a very useful treatment for depression in women at any of a number of different times in their lives:   

• During pregnancy and breastfeeding:  Depression is highly prevalent in women of childbearing age.  Medications are often necessary to treat moderate to severe depression.  However, many women wish to avoid treatment with medications during pregnancy and while breastfeeding.  At least one study has shown that women who exercised regularly reported less depression in the first and second trimesters compared with women who did not exercise.  The American College of Obstetricians and Gynecologists has recommended 30 minutes of moderate exercise on most days.

• During the postpartum period:  Exercise can also help to treat and prevent postpartum depression.  One study has shown that postpartum women who exercised three times per week had less depression than postpartum women who did not exercise. 

• During the premenstrual period:  Exercise can be useful to treat physical and emotional premenstrual symptoms.  It is less clear if exercise by itself can treat the most severe of premenstrual syndromes (called “premenstrual dysphoric disorder”), but it is still a first-line treatment strategy that most physicians would recommend. 

• During menopause:  Several studies have shown that aerobic exercise can improve both depression and insomnia occurring during menopause.  Additionally, lower intensity exercise such as yoga has been shown to improve psychological well-being in menopausal women.

Importantly, women may experience barriers to exercise.  Here are some examples of these barriers, and strategies to help address them:

• Childcare issues:  Women are often responsible for childcare, which makes it difficult for them to find opportunities to exercise.  Gyms that offer childcare services can be helpful.  Also, partners can share the workload. 

• Intimidation:  Some women may feel uncomfortable working out in the coed environment of a gym.  Consider taking women-only exercise classes, or walking or doing other exercise with women exercise buddies.

• Self-consciousness about appearance:  If a woman is already uncomfortable about her appearance, then she might worry that she’s drawing even more attention to her body by exercising, especially if wearing skimpy sports clothes.  One strategy is to try walking, which can be done almost anywhere and in almost any type of clothing.

• Guilt:  Women, especially those who are family caretakers, sometimes describe feeling guilty about taking time for themselves to exercise.  Remember, it is not a selfish thing to exercise.  You are taking time to improve your physical and emotional health, which will allow you to more effectively be there for others.  Besides, you deserve to experience the benefits of exercise!   

Tweet

Maternal Mental Health: Can Stress Harm Your Chances of Getting Pregnant?

By Felicia K. Wong, M.D.

Getting pregnant is an exhilarating experience for some couples. But it can also be a very frustrating, and heart-wrenching, experience for others. Age, smoking, obesity, and alcohol are studied and known factors to effect pregnancy success.


Anecdotal reports have long linked stress with infertility, but to-date, there has not been much scientific evidence to prove the connection. On August 11, 2010, the BBC published an interesting article describing an Oxford University study that demonstrates for the first time that high stress levels may delay pregnancy. Their findings suggest that perhaps the best thing a couple can do to prepare for pregnancy is to relax.


Dr. Cecilia Pyper, of the National Perinatal Epidemiology Unit at the University of Oxford, measured stress hormones in 274 healthy women aged 18-40 planning to have a baby naturally. They found that those who were most stressed had a reduced chance of becoming pregnant that month. Dr. Pyper said: "The findings support the idea that couples should aim to stay as relaxed as they can about trying for a baby....In some people's cases, it might be relevant to look at relaxation techniques, counselling and even approaches like yoga and meditation."


The study, aimed to improve understanding of the factors that influence pregnancy in normal healthy women, was published in the journal Fertility and Sterility. The research was carried out in collaboration with the Eunice Kennedy Shriver National Institute for Child Health and Human Development in the US. It is part of a larger study looking at the effect of factors like smoking, alcohol, and caffeine on chances of pregnancy.


This being the first of such studies, more research is needed to further link the role of stress and pregnancy. In the meantime, it can’t hurt to relax! 
Tweet

Dads Get Postpartum Depression Too

By Gariane Phillips Gunter, M.D.

Over the past several years, with great help from Brooke Shields and others sharing their stories, postpartum depression in new moms has become well known. However, recent evidence suggests that new dads may be suffering too. A recent study in the May 19th issue of the Journal of the American Medical Association reports that “14% of American men develop depression, either during their partner’s pregnancies or in the first year after delivery”.

Unfortunately, dad’s depression may be overlooked as the symptoms may not present as sadness but as irritability, anger or isolation from their loved ones. Without identification and treatment of dad’s depression, negative outcomes for the new baby and family can occur.

New babies need secure, healthy attachments for their physical and emotional development and these attachments are strained when either parent is suffering from their own depression. If you are a new mom or dad and feel you may be suffering from depression, please talk to your doctor and ask for help.
Tweet