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Depression is treatable, during and after pregnancy.
Hartman called her midwife and explained what was happening. "She said it was just the baby blues. She told me to find a hobby and I'd feel fine," Hartman says. But it wasn't simply the blues. Hartman had a severe case of postpartum depression (PPD).
Her crying jags and panic attacks continued. Soon she began to self-inflict pain by hitting herself on the head. Visits to her doctors and a psychological counselor at her local hospital brought no solutions.
Finally, Hartman found a psychiatrist who prescribed both an anti-depressant and an anti-anxiety drug in addition to weekly visits with a psychologist. After two months of the combination therapy, her depression lifted, but she looks back at those first months after her son's birth and feels a sense of loss. "Things were supposed to be so happy with a new baby in the house," she says, "and I feel like I missed it."
PPD: Common yet Undertreated
"The women who have PPD think they're the only ones, but 10 to 20 percent of women get it," Howard says. "It's vastly under-recognized, and as a result, it's vastly undertreated." But PPD can be treated with psychotherapy and antidepressant medications such as Zoloft and Paxil. Studies suggest that babies of moms who breastfeed while taking Zoloft or Paxil do not behave or develop any differently than babies who are breastfed by unmedicated moms.
Patients at the Day Hospital, a specialized treatment facility for pregnant and postpartum women who are suffering from depression, anxiety or other mood disorders, can receive group and individual therapy, lactation consultation, drug therapy and more without ever having to disrupt breastfeeding or separate from their newborn.
However, new mothers may be afraid to admit that they are depressed and seek treatment, says Ronald Rosenberg, M.D., a psychiatrist and OB-GYN on the faculty of Wayne State University School of Medicine in Detroit and coauthor of Conquering Postpartum Depression (Da Capo, 2004). "There's guilt, there's shame, there's a feeling that the baby will be taken away from them," Rosenberg says.
Despite the self-imposed stigma, PPD can strike any woman, regardless of her age, economic status or cultural background. However, your risk might be elevated if you have a personal or family history of depression, anxiety or depression during pregnancy, a more difficult than usual labor, little or no social support, marital problems or a baby with a birth defect or disability.
Depression can hit before delivery
It's common to feel mildly blue sometimes during pregnancy. But when the blues turn into depression, it's time to seek help. Prenatal depression is more likely to strike when you have a history of depression, if your pregnancy is unplanned, mistimed or marked by complications or if you are experiencing marital problems, says Victoria Hendrick, M.D., associate professor at the University of California, Los Angeles, Neuropsychiatric Institute and Olive View-UCLA Medical Center. Some 10 percent of pregnant women suffer from it.
Depression during pregnancy can be alleviated with psychotherapy, group therapy, couples counseling, medication or a combination of these treatments. Pregnant women may naturally worry about taking anti-depressants. Although there are medications that appear to be safe for the fetus, research shows that some babies born to mothers who take full doses of anti-depressants during the third trimester are born with respiratory distress, jitteriness and hypoglycemia (low blood sugar). These symptoms disappear within two to five days. However, a new study shows that baby mice given the anti-depressant Prozac early in life display more depression-like behaviors in adulthood, although it's unknown whether human fetuses exposed to anti-depressants in the third trimester might suffer similar effects later on. For this reason, nonmedicinal approaches usually are tried first. But if anti-depressants are prescribed, complications can be avoided if your doctor starts tapering your dosage during the third trimester.
Don't postpone treatment
Pregnant women and new mothers can benefit from talk therapy or programs like those offered at the Day Hospital in Providence. Many new moms feel overwhelmed because they think they have to be perfect mothers, and therapy can help them develop more realistic expectations. That was the case with Hartman, who was able to work through her feelings of inadequacy and her tendency to be a perfectionist.
About 10 months after her son was born, Hartman no longer needed medication. She was worried that her depression would prevent her son from bonding with her, but it turned out not to be the case. Today, she says, "My son and I couldn't be any closer."
Postpartum period: three distinct but continuous phases
- Romano, M., Cacciatore, A., Giordano, R., & La Rosa, B. (2010). Postpartum period: three distinct but continuous phases. Journal of prenatal medicine, 4(2), 22–25.
Reflection Exercise #6
Online Continuing Education QUESTION 20
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