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Postpartum Depression: Diagnosis and Treatment
Postpartum Depression: Diagnosis and Treatment

Section 17
"Speak Up When You’re Down" – The Postpartum Depression Awareness Campaign

CEU Question 17 | CEU Test | Table of Contents | Depression
Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs

In January 1984, Richard and Mary Jo Codey got the best news of their lives: They were going to become parents. At no time during that day of celebration could the couple have imagined that one year later, Mary Jo, overcome by the devastating effects of postpartum depression, would be fighting for her life in a New Jersey mental institution while Richard and other family members cared for their beautiful new son.

Nor would they have ever dreamed that Richard, an aspiring politician, would one day serve as the 53rd governor of New Jersey, and that Mary Jo would use her influence as first lady to help make New Jersey the first state in the nation to mandate postpartum depression screening.

The first-of-its-kind law, co-sponsored by now Sen. Richard J. Codey, president of the New Jersey Senate, and state Sen. Diane Allen, requires health care professionals to screen mothers for postpartum depression and educate women and their families about the disorder. The Codeys stood by as current Gov. Jon S. Corzine signed the bill during a public ceremony at Hackensack University Medical Center in Hackensack, N.J., in April.

"I want the world to know that this disease is real," Mary Jo Codey, a kindergarten teacher, told The Nation's Health. "It's diagnosable and it's treatable."

To build awareness about the disease and offer resources for women, their families and health care professionals, Mary Jo Codey in July 2005 launched New Jersey's statewide "Speak Up When You're Down" campaign, which is quickly gaining national recognition as she criss-crosses the country to educate the public and encourage women to tell others when they are depressed. The campaign provides patient education materials, Web-based information, hotline numbers, brochures and graphics to health care providers, clinics and hospitals and a consumer brochure explaining postpartum depression symptoms and treatment options.

Now, New Jersey's bold moves have made their way to the floor of the U.S. Senate. Hoping to take New Jersey's legislation nationwide, Sen. Robert Menendez, D-N.J., and Sen. Richard Durbin, D-Ill., on June 16 introduced legislation that would increase education and access to screenings for new mothers and ramp up postpartum depression research. The legislation, called the Mothers Act, S. 3529, also proposes grants to health care providers who deliver care to women suffering from postpartum depression.

Taking its cue from New Jersey, Washington state in May became the first state in the nation to adopt New Jersey's "Speak Up When You're Down" campaign, said Chris Jamieson, communications director for the Washington Council for Prevention of Child Abuse and Neglect in Seattle. Jamieson said she believes the campaign has the potential to be rolled out nationally because the materials, such as the tagline, graphics, template, Web site and brochure, are "highly adaptable."

Washington's commitment to raise awareness about postpartum depression sprang from one family's tragedy. Thomas Soukakos, owner of a Seattle café, took up the cause after his wife committed suicide because of postpartum depression in 2003. His efforts led to the passage of a bill during the 2005 legislative session mandating a statewide awareness campaign on postpartum depression.

In the year since New Jersey's "Speak Up When You're Down" campaign launched, the state has trained more than 4,500 health care professionals, including doctors, nurses and social workers, who in turn will train other health care professionals about postpartum depression, said Celeste Androit Wood, MA, assistant commissioner of the New Jersey Department of Health and Senior Services.

Wood has been charged with developing the guidelines and protocols to implement New Jersey's new law, which goes into effect in late September. The law mandates screening but does not endorse a specific screening tool, said Wood, who uses the Edinburgh Postnatal Depression Scale, a simple, 10-item questionnaire, in the postpartum training program she conducts for physicians. But the guidelines of the new law will likely provide varied resources for practitioners to conduct screenings, Wood said, noting that certain screening tools might fit better into their practices, such as the Beck Postpartum Depression Predictors Inventory and Beck Postpartum Depression Screening Scale.

Mary Jo Codey, now 50, is philosophical about her struggle with the illness. Even a diagnosis of breast cancer three years ago and a double mastectomy "was easy compared to postpartum depression," she said.

"When I had to go for chemotherapy, everybody was greeting me with open arms, but when I had to go for shock therapy treatments I was so ashamed I couldn't even look people in the face," she said. "One you can see and the other you can't see, and the one you can't see you have to explain away."

Postpartum depression feels like a curtain coming down and shrouding your emotions, Codey said.

"I was a teacher," she said. "I loved kids and I couldn't wait to have my own. It hit me out of the blue. I remember being dumbfounded that I could be that depressed."

Codey's depression deepened over time, and then one day, as she bathed 3-month-old Kevin, the most frightening event yet occurred: "I had a terrifying thought that I could drown him, and I panicked."

Soon, the intrusive thoughts were coming as often as 12 times a day, and became so disruptive and disturbing that she contemplated suicide.

"Death seemed like a peaceful place compared to where I was," she said.

But Codey's family and physicians intervened. Four weeks of inpatient care set her back on her feet and home with her newborn, and with a combination of antidepressants and counseling, the symptoms disappeared and her upbeat, happy nature returned.

Later, through counseling and education, she learned that intrusive thoughts are just that -- thoughts.

"As terrifying as those thoughts are, they can be normal for someone who has postpartum depression," she said. "But when the thoughts become disturbing and the person can't dismiss them quickly, she should take the time to get psychiatric intervention."

But the intrusive thoughts of harming Kevin returned during her second pregnancy. On the advice of her doctors, she'd stopped taking her medication several months before becoming pregnant again. To alleviate the symptoms, shock therapy was. administered starting in the eighth month, and the treatments continued until the birth of her second son, Christopher.

After the delivery, Codey went back on medication, and within a few weeks her symptoms disappeared, never to return.

Postpartum depression common, treatable
Though tragic, the Codey family's struggle with postpartum depression is not uncommon. Doctors and researchers
say postpartum depression, often referred to as perinatal depression because it can occur during pregnancy as well as after delivery, is the most frequent serious complication of pregnancy. Postpartum depression can continue for months and even years, and should not be confused with the "baby blues," an extremely common condition that occurs in up to 80 percent of mothers following delivery and usually subsides within a few weeks as hormone levels stabilize.

Postpartum depression has long been called the "silent" disease -- an incredibly understated reference to an illness that can rip through families with the ferocity of a freight train, leaving pain and devastation in its wake. No longer silent, the disease is finally finding its voice as celebrity sufferers such as actress Brooke Shields speak up, and as postpartum depression screening initiatives such as those in New Jersey and Washington state are rolled out.

"Postpartum depression can make women feel as though they've been hit by a truck," said George Washington University psychiatrist Ralph Wittenberg, MD, founder and president of the Family Mental Health Foundation. "But there is no moral stigma attached to being hit by a truck, so it's unfortunate that this thing is listed as a so-called 'mental disorder.' Just because they have thoughts and feelings that are very scary, which they do, doesn't mean that they're crazy. It just means that they are suffering from a terrible disease."

Wittenberg estimated that postpartum depression will occur in conjunction with approximately 800,000 births in the United States this year, or in 10 percent to 20 percent of births. By comparison, there will be 40,000 new cases of AIDS in the United States this year, Wittenberg said, suggesting "that because postpartum depression is a disease of women, it has long been overlooked by physicians, most of whom have only a vague understanding of it.

Women who suffer from postpartum depression are often too depressed to get out of bed, Wittenberg said, and think they are simply bad mothers. They often have difficulty eating and sleeping, plunge into despair and lose interest in everything, including the new baby and their families. In severe cases, they may have thoughts of killing themselves or killing their babies.

Researchers don't know exactly what causes postpartum depression. To be sure, hormonal factors play a role, but Wittenberg said other biological and social problems also are involved. For example, postpartum depression occurs more often in women who have had depression in the past, or have a family history of depression.

"It's a range of illnesses that includes depression, but also anxiety disorders such as panic disorders and obsessive-compulsive disorder, and some women have the anxiety without depression," Wittenberg said.

Unless treated, 50 percent of postpartum depression sufferers will still have the signs of a major depression after one year, and for many women, it is the first episode of a lifelong depression, he added.

"They think they are the only person alive that this has ever happened to," Wittenberg said. "They're afraid that if they tell someone what's going on they will be thought of as terrible people, perhaps sent to jail or to a mental hospital, or have their children taken away."

In presentations and seminars, Wittenberg and his colleagues at the Family Mental Health Foundation are sharing the good news that postpartum depression is curable. With proper treatment, which includes a new class of selective serotonin reuptake inhibitors, more commonly known as SSRIs, in combination with therapy or counseling, most women recover completely and go on to live healthy, happy lives.
- Johnson, Teddi Dineley; More postpartum depression programs reaching mothers; Nation’s Health; Aug2002; Vol. 36, Issue 6

Personal Reflection Exercise #3
The preceding section contained information regarding the need for awareness of postpartum disorders in the community.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 17
If left untreated, what percentage of PPD sufferers will still show signs of major depression after one year? Record the letter of the correct answer the CEU Test.

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Postpartum Depression: Diagnosis and Treatment

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