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Treating Postpartum Depression
Postpartum Depression: Diagnosis and Treatment

Section 1
Postpartum Depressive Symptoms

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In this section, we will discuss symptoms and factors related to postpartum or postnatal depression.  These will include characteristics, predispositions, emotional causes, external factors and consequences for the family.  As you read, think of your client.  Which of these symptoms does she struggle with?

5 Symptoms & Factors Related to PPD

#1 Characteristics
First, let’s discuss a few general characteristics of postnatal depression.  If you are already familiar with postnatal depression, you might use this as a review.  Three major symptoms include excitability, anxiety and obsessive thoughts and fantasies. 

Three Symptoms of Postnatal Depression
-- 1. First, symptoms may include a high level of excitability that is characterized by the inability to sleep, frenetic activity that can lead to collapse, irritability, confused language, and difficulty in concentrating or reasoning properly.  I have found that this state usually starts shortly after childbirth and may be confused with the euphoria many mothers feel in the first days after a baby’s birth.

-- 2. A second symptom may include a feeling of panic that is manifested by extreme anxiety, inexplicable panic attacks, physical reactions such as palpitations, hot flashes, trembling, dizziness, excessive sweating, numbness, and tingling in the hands and feet, or even an impression of suffocation.  Panic attacks are sometimes brought on by a situation that reminds the new mother of a past trauma.

-- 3. A third symptom may include obsessive thoughts and fantasies.  I have found that women suffering from postnatal depression usually know that they are fantasizing and can control themselves.  However, a woman may feel extremely guilty about thoughts regarding harming herself or her baby, and may undertake complicated rituals to protect herself or her baby.

Shelby, age 29, described her postnatal depression as feeling "revved up."  Shelby stated, "After my son was born, I could not sit down and relax for a minute!  I felt like there was a motor inside that would not shut off!  I just thought it was the excitement of having the baby we had wanted for so long.  When I got home from the hospital, I couldn’t sleep at all.  I got so tired and irritable that when he cried I wanted to yell, ‘Shut up!’  This only made me feel worse.  I was worried that I was not going to be able to handle being a mother.  I found myself avoiding taking care of my baby."

Shelby learned to relax and not to worry so much about minor problems like diaper rash.  Shelby tended to "catastrophize."  Small events took on life-and-death proportions in her thinking.  Shelby learned to observe herself catastrophizing and to be more objective in her assessment of situations.  After several sessions, Shelby was less anxious, was beginning to enjoy her son, and was able to sleep when the baby slept.

♦ #2 Predispositions
Second, let’s discuss predispositions to postnatal depression.  Have you found, as I have, that postnatal depression can strike any healthy woman, regardless of the number of children she has, her socioeconomic level, religion, ethnic group, cultural origins or whether or not she is breast-feeding? However, I have found that certain women are at greater risk if they present the five following characteristics. 

Five Characteristics that Put Women at Risk for Postnatal Depression
-- A. Previous psychological troubles
-- B. Postnatal depression after a previous childbirth
-- C. Heredity, such as a mother, aunt or sister having postnatal depression.  In addition to a genetic predisposition, I have found that women who have seen their own mothers suffer from depression may be more prone to depression themselves.
-- D. A bad experience during fertility treatments
-- E. A difficult pregnancy.

♦ #3 Emotional Causes
Third, in addition to general "characteristics of" and "predispositions to" postnatal depression, let’s discuss some emotional causes.  Two emotional causes of postnatal depression include a negative reaction to birth by the mother and the mother’s psychological past.

First, severe, negative reactions to birth by the mother may induce psychological tensions that are the major cause of postnatal depression.  For example, a woman may be deeply disturbed by the feeling of "losing control" during her delivery.  Part of Shelby’s depression was her reluctance to accept her powerlessness when faced with such an overwhelming physical transformation.  Likewise, a woman who went through her pregnancy in a state of anger or frustration with her body may find that these feelings tend to persist after childbirth.

Second, a mother’s psychological past is yet another cause of depression.  Unresolved grief, such as after a divorce or following the loss of a parent or loved one may resurface after childbirth.  Psychological traumas dating from the mother’s childhood or adolescence, such as sexual or physical abuse or abandonment, may suddenly appear overwhelming to the mother immediately after childbirth, threatening her self-confidence and her ability to bond with her new baby.

♦ #4 External Factors
Fourth, in addition to emotional causes of postnatal depression, let’s discuss external factors.  Have you found, as I have, that stressful relationships can contribute to postnatal depression?  Before her pregnancy, a woman may have handled tension reasonably well within her relationships with her partner or with her parents and in-laws.  Once the baby is born, the mother’s impulse may be to protect herself from stressful situations by acting as a kind of "emotional shield."  Given the heightened psychological vulnerability of any new mother, this sort of pressure can rapidly bring her to the edge of clinical depression.

Social isolation can also contribute to postnatal depression.  If a woman finds herself alone with her baby for more than eight hours a day, if she is housebound due to lack of transportation or severe weather conditions, if she has no extended family to give support, the woman may have no one with whom to share her feelings, no one to help in practical ways.

♦ #5 Consequences for the Family
Fifth, in addition to external factors, let’s discuss consequences for the family.  Postnatal depression almost inevitably causes tension within a relationship.  The woman may feel abandoned and her partner may feel like a victim.  In Shelby’s case, although her depression was a difficult time for both her and her husband, the fact that they attended therapy together, as a couple, created a lot of goodwill in their marriage.

Have you found, as I have, that women suffering from depression usually worry about the effect of their illness on the baby?  The woman may need to be reassured that there is no time limit for establishing a strong mother-child bond, no critical point after which all is lost.  It may be important to explain to any older children that their mother is not well, that she will get better, that it is not their fault, nor is it the fault of the baby.

In this section, we have discussed symptoms and factors related to postpartum or postnatal depression.  These have included characteristics, predispositions, emotional causes, external factors and consequences for the family.

In the next section, we will discuss when a woman becomes a mother.  This will include a feeling of suffocation, everything revolving around the baby, making motherhood the only source of fulfillment and the "icing on the cake" technique.

Peer-Reviewed Journal Article References:
Beebe, B., Lachmann, F., Jaffe, J., Markese, S., Buck, K. A., Chen, H., Cohen, P., Feldstein, S., & Andrews, H. (2012). Maternal postpartum depressive symptoms and 4-month mother–infant interaction. Psychoanalytic Psychology, 29(4), 383–407. 

Cao, H., Zhou, N., Leerkes, E. M., & Su, J. (2020). The etiology of maternal postpartum depressive symptoms: Childhood emotional maltreatment, couple relationship satisfaction, and genes. Journal of Family Psychology. Advance online publication. 

Fredriksen, E., von Soest, T., Smith, L., & Moe, V. (2017). Patterns of pregnancy and postpartum depressive symptoms: Latent class trajectories and predictors. Journal of Abnormal Psychology, 126(2), 173–183.

Handelzalts, J. E., Hairston, I. S., Muzik, M., Matatyahu Tahar, A., & Levy, S. (2019). A paradoxical role of childbirth-related posttraumatic stress disorder (PTSD) symptoms in the association between personality factors and mother–infant bonding: A cross-sectional study. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication.

Incollingo Rodriguez, A. C., Tomiyama, A. J., Guardino, C. M., & Dunkel Schetter, C. (2019). Association of weight discrimination during pregnancy and postpartum with maternal postpartum health. Health Psychology, 38(3), 226–237.

Online Continuing Education QUESTION 1
What are three characteristics of postnatal depression? To select and enter your answer go to CEU Test.

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