Postpartum Depression: Darkest Secrets of Motherhood

After birth blues; Postpartum depression remains one of the darkest secrets of motherhood

It was supposed to be the happiest time of her life. But instead of joy at the birth of her daughter, Penny White was filled with sadness, guilt and an unshakable depression that convinced her she was losing her mind. There were days she put the baby in her crib and stood alone outside the house, afraid of being alone with her daughter.

There were panic attacks that left her feeling weak and drugged, like she was backing deeper into a tunnel. There were moments when she looked into her baby's eyes and saw nothing but despair.

And still White said nothing. How could she admit to anyone how trapped she felt, how totally consumed by a child for whom, no matter how hard she tried, she felt nothing? "I truly believed I had made the biggest mistake of my life having a baby," said White, 32.

"The worst of the whole situation was trying to hide these feelings from family and friends, who couldn't say enough how lucky I was to have such a lovely, healthy baby, and how proud and happy I must be."

The baby books and prenatal classes gloss over it; many obstetricians never bother to mention it. Yet perhaps one in four mothers will experience the profound despair of postpartum depression.

Centuries after it was first recognized, postpartum depression remains one of the darkest secrets of motherhood, despite the fact it is the most common complication of pregnancy. Most women suffer in silence, ashamed and guilty, worried that if they admit their feelings they'll be judged "unfit mothers," maybe even have their children taken from them.

But postpartum depression doesn't affect just the mothers. A growing body of research suggests that depressed moms raise depressed babies. And some fathers feel so stressed by the burden of caring for a sick wife and new baby, they will become clinically depressed.

Today, there's a growing recognition that postpartum depression is a clinical illness that women can't simply "snap out" of, says Dr. Ranjith Chandrasena, an Ottawa psychiatrist with a special interest in postpartum depression.

"You can't fight brain chemistry. This is a disease. Once people understand that, you can begin to help."

With counseling, group therapy and anti-depressants if needed, the vast majority of women will get better within six months. And many women who've gone through postpartum depression say they emerged stronger.

Through the centuries, postpartum depression was lost to medical science because instead of fitting "neatly" into one discipline, it fell somewhere between obstetrics and psychiatry, says Jane Honikman, founder and executive director of Postpartum Support International in California.

It wasn't until the 1970s, amid renewed scientific interest in mental illnesses in general, that postpartum depression gained new recognition. Even then, most women struggled with the illness on their own, using Valium or alcohol to blunt their pain. "We know that in previous generations there was a lot of self-medication going on," Honikman said.

No one knows for certain what causes postpartum depression. Most doctors blame the hormonal and biochemical changes that occur in the body during pregnancy and delivery, when the levels of progesterone and estrogen will rise to 50 times their pre-pregnancy levels. Within one to three days after birth, they'll plummet to below normal levels.

Chandrasena believes this dramatic change in hormone levels can affect the normal production of brain chemicals called neurotransmitters, which maintain a state of mental balance.

Postpartum depression doesn't discriminate. It affects women of all ages, cultural and social standing. And it is highly unpredictable - it can happen with a first birth or a fifth. It usually begins with the "baby blues," the mood changes that 80 per cent of women experience within the first few days of childbirth. These brief bouts of tearfulness, anxiety and irritability are believed to be triggered by the sudden drop in pregnancy hormones and exacerbated by the sleep deprivation all new mothers experience.

In one in four of those women, the blues will develop into post- postpartum depression.

Symptoms might begin within weeks of the baby's birth, or they might not appear until as long as a year or two later. These include feeling depressed, anxious or chronically tired, bursting into tears at an offhand remark, trouble sleeping, low self-esteem, loss of concentration and memory. In extremely rare cases, a woman might fear she is capable of hurting her baby or herself.

Not all women experience every symptom. But the one cardinal symptom, Chandrasena says, is guilt, that they are not a good mother or a good spouse.

Honikman says research shows that many women who suffer post- postpartum depression lack support from friends and family. "No mother should ever mother alone. No baby should ever be raised by one person. And that's what we've lost as we've become a more transient society," Honikman said. "No one is mothering the mothers."

When a woman suddenly realizes she can't cope, she feels weak, a failure, Chandrasena adds. And often family doctors and pediatricians are so concerned with the baby that the sick mother is overlooked.

Left untreated, the depression can take a horrible toll on the entire family. It can lead to divorce, child abuse, alcoholism and drug abuse.

In rare cases, the woman might develop psychosis, a condition that occurs in about one of every 1,000 deliveries. These women can become paranoid, hallucinate and feel as if they're losing contact with reality.

Some become a danger to themselves and their babies. Often they must be hospitalized, but even in the most severe cases, more than 90 per cent of women will recover with proper care, Chandrasena says.

Support groups offer women an opportunity to meet and share with others, to get suggestions for coping and general information about postpartum depression.

Chandrasena says it's important the spouse seeks support as well, either by joining his partner at professional counseling sessions or group support meetings. Support services, such as visits from a public-health nurse or home care, can also help.

For Penny White, recovery has been slow. White says she was lucky that a public-health nurse recognized her symptoms. Her family doctor put her on Prozac. After a few weeks, she began to feel better and decided on her own to stop taking the drug, afraid that if she soon didn't convince the doctor and everyone else that she was "cured," they would think she was not fit to be a mother.

After her illness worsened, she was referred to a psychiatrist. After months of professional counseling, attending regular support group meetings, support from family and friends and continued medication, the "dark cloud" of postpartum depression has lifted.

Although she has bonded with her daughter Alana, White isn't completely better. She has recently been diagnosed with a cyclable depression, in which she feels fine one week and depressed the next. Her husband is now also seeking treatment for a mild depression. Their daughter is doing well.

FACTS ON POSTPARTUM DEPRESSION

Some symptoms of depression:

* Crying for no apparent reason

* Sleeplessness

* Feeling overwhelmed

* Anxiety and/or panic attacks

* Feeling helpless or inadequate

* Inability to cope

* Thoughts of hurting yourself or your baby

* Other confusing feelings

New moms battle the Baby Blues: Fighting back when postpartum depression strikes

Dorothy Ruhwald had her second vivid reminder since spring of the most terrifying time in her life, when Liza May Espejo Santos of Calgary was charged with second degree murder in the death last week of her baby son.

The baby was found last Wednesday in a telephone booth, dead in the arms of his mother, who had made a 911 call. Santos had sought help for depression after the birth of the baby, and on Tuesday her lawyer indicated he is considering postpartum depression as a defence.

In June, another Alberta mother, Victoria Hamm, was found to have committed second-degree murder in the death of her 2 1/2-year-old son, but was not held criminally responsible because she had been in the grip of psychosis at the time. Hamm, too, had sought help for depression after the birth of her son.

Both cases point to the potentially deadly ramifications of untreated postpartum depression.

"My first thought is people need to take postpartum depression more seriously -- it's a very vulnerable time," says Ruhwald.

This she knows well: 11 years ago, following the birth of her first baby, she herself was in the grip of postpartum psychosis, a rare condition that affects slightly more than one new mother in a thousand.

"I know it was only a matter of time before I would have harmed myself or someone else," said Ruhwald. Now a self-assured mother of three, there is no hint in her ordinary-mom appearance, in her clean and tidy Arbour Lake Home, in her neat and happy children, of the nightmare she briefly lived.

Each year in Calgary a dozen or more new mothers develop postpartum psychosis and find themselves gripped by jaws as tight and remorseless as those a lion clamps on its prey. Their own grip on reality becomes tenuous, sometimes disappears. And they need medical help to get it back. "It's terrifying and it's devastating," says Honey Watts, executive director of the Parent Development Centre. Yet too often husbands and partners, friends and family dismiss increasingly bizarre behaviour, thinking `she'll snap out of it.'

But no one `snaps out of' psychosis.

Psychosis is at the extreme end of the spectrum of mental and emotional problems women can encounter after childbirth, miscarriage or termination of a pregnancy, says Watts.

About 90 per cent of new moms get the baby blues, and between 10 and 20 per cent become depressed, says psychiatrist Dr. Janet Wright, a specialist in women's health issues.

Psychosis is rare, singling out one in 1,000 women at the end of a pregnancy.

Postpartum blues usually hit three to five days after the baby's birth and are marked by tearfulness, sadness, irritability, anxiety and changes in sleeping patterns or appetite. The blues can last a week or so, and often disappear as quickly as they came.

When symptoms go on for two or more weeks, cause confusion or an inability to concentrate, prevent mom from properly caring for the baby, or cause thoughts of violence to self or others, it's likely postpartum depression, and the woman needs a doctor's help.

If symptoms include bizarre behaviour, hallucinations and delusions, it's postpartum psychosis -- a medical emergency.

Society's expectations that childbirth should be the most joyous and fulfilling event in a woman's life make it hard for a new mom to discuss commonplace baby blues, let alone more seriously disturbing thoughts, says Wright.

Only after being admitted to hospital did one patient talk about the compulsion she had every time she unloaded the dishwasher to take out a knife and stab the baby. So she avoided the dishwasher, and never mentioned the frightening thoughts to her family.

Such expectations also make it hard for family to ask for help. The family of another of her patients sought help only after the new mom stripped off all her clothes and ran out onto Crowchild Trail.

Though a cause has not been concretely determined, it's thought postpartum depression is kick-started by changes in the levels of hormones after childbirth. In some women those changes cause extreme anxiety, hopelessness, violent thoughts, even violent behaviour.

Women with a personal or family history of depression or psychosis are at a higher risk -- though risk is not certainty, says Wright. Some women with risk factors do not develop psychosis following birth; others with no risk factors do become psychotic. And though having one psychotic episode increases risk to 50 per cent in subsequent pregnancies, some women do not have a repeat performance.

The effects of psychosis can last months without treatment, says Wright. Treatment consists of a combination of anti-psychotic agents and mood stabilizers.

Such treatment did not come in time for Drumheller mother Victoria Hamm, who struggled with postpartum depression after the birth of her son Christopher in 1995. She lived in the jaws of the lion.

A month before her son's death she'd tried to commit suicide by drinking carburetor cleaner, and suggested to her husband the whole family should die by gassing themselves. She subsequently spent two weeks in hospital and under outpatient care for another week.

The world was frightening, and she found signs it was worsening - - increasing crime, wars, weird weather patterns. She decided to commit suicide and take her son with her, she told police after her arrest, because she didn't want him to grow up in such a world.

So she took Christopher into the basement, shoved his head in a plastic bag, and put her ear to his chest and listened while his heartbeat stopped.

Then she tried to hang herself and when that didn't work, took an overdose of medicine with wine and beer.

"I'm trying to find out what's wrong with me," she told RCMP after her arrest. "I'm not sure what it is I need to be able to fix. It comes and goes and just got worse again. I can't believe it would come to this . . . I can't believe that I killed Christopher. Oh, my God. I'm so sorry, I can't believe what I've done." Hamm was found not criminally responsible for Christopher's death in a trial in June.

In a rare ruling, Court of Queen's Bench Justice Suzanne Bensler found Victoria Hamm committed second-degree murder in the death of 21/2-year-old Christopher, but that she did not know it was legally or morally wrong.

"She did not understand the nature and consequences of her actions," Bensler said at the conclusion of Hamm's three-day trial. "The evidence showed she was suffering from a major depression and psychosis prior to and during the act on July 26, 1997."

Bensler ordered Hamm be kept in custody at Alberta Hospital in Edmonton, where she awaits an assessment to determine if or when she could be released.

Ruhwald knows Hamm faces a rocky time, whatever the decision.

Postpartum psychosis "really shatters you whole sense of identity. You wonder if the psychotic person is really you. It took me a long time to realize that's part of the disease."

Ruhwald's recovery was slow, but complete. It's believed a combination of a thyroid condition and a hemorrhage after the birth triggered her psychosis.

"I had a wonderful pregnancy," Ruhwald recalls, "and was euphoric after the birth."

The first sign something was wrong was subtle. "My mind seemed to be speeding up." She could remember long-forgotten incidents from childhood; didn't seem to need sleep; stayed up late to write poetry.

In one week, the euphoria had turned to something horrific. "I thought if I didn't think of 100 things that began with A, then B, then C, and so on, my husband would die and my baby would die and I would die and the whole world would die." She began seeing things, hearing voices. "One night I was wrestling with Satan all night."

It's quite common after birth for women to have frightening thoughts, says Marta Dixon, postpartum support co-ordinator at the Parent Development Centre. In psychosis, these thoughts become obsessive.

A psychotic woman has lost touch with reality. "Homicide, suicide and infanticide can happen," says Watts.

"If you think the world is the worst place possible and you are useless," says Wright, it's a short slide to thinking "I'd be better off dead and so would my baby."

Ruhwald suffered delusions that threatened her own safety. "I was certain if I jumped out of the window I'd be able to fly."

Family members will notice an unusual pattern with new moms in psychosis, says Watts. "Usually, a new mom will look after the baby and sleep when the baby sleeps. But a mom in psychosis doesn't lie down. She can go 24 hours a day, and keep going."

Paranoia and hallucinations are common.

"This is an emergency," says Watts. "The psychotic new mom might harm herself or the baby."

There was no doubt Ruhwald needed help: when taken to hospital, about a week after she'd come home with her new baby, she no longer reacted to the outside world. "I saw blood running from the nurse's fingers, down her face. I felt like the wheelchair was bouncing off the walls as they took me down the hall." She was kept in restraints for the first week. "I was convinced I was fighting for my life."

Ruhwald was in full thrall to demons within for six weeks until doctors found a combination of medicines that altered her brain chemicals. "It was like waking up," she says. "My husband knew I was in there somewhere; he just couldn't reach me."

With treatment, the psychosis abated, to be replaced by a depression that gradually ebbed away over six months.

"By the time I got home I felt capable to be a mom, but far from what I was before. As frantic as I had been before (during the euphoria), that's how dull and dead I felt afterwards."

She felt cheated because she had missed the early months of her daughter's life, and frightened because she had been told there was a one-in-three chance psychosis would happen in subsequent pregnancies.

It didn't, and "I treasured every moment," of the babyhood of the two children that followed.

Now Ruhwald volunteers with the Parent Development Centre, where she is matched with new moms suffering postpartum depression.

Volunteers are especially important for women going through the trauma of postpartum depression or psychosis, says Dixon.

"It's very important to have support from a volunteer who's been there," she says. "The volunteer isn't making big decisions about your life, you're not being therapized."

The Parent Development Centre offers telephone support, matching new moms with trained volunteers for chats a couple of times a week. A support group of eight to 10 women also meets once a week to help women understand the depression and resolve adjustment difficulties. Evening discussion sessions for the families and friends of women having postpartum problems provide a chance for them to understand what the woman is going through.

And there's an infrequent Father's evening to provide dads with information about symptoms of postpartum difficulties, suggestions to provide support, and how to take care of themselves while supporting the new mom and family.

"It would have made such a difference to have had someone to talk to when I went through it 11 years ago," says Ruhwald. Now, she prizes comments from the women she helps when they say her help, her steady, calm manner and the hope she ladles with advice, helped them through the darkest days of their lives.

For these women, Wright has some parting words: "It's not anything you brought on or that you failed at. Postpartum psychosis is a treatable problem. The sooner you seek help, the better the prognosis."

The postpartum program at the Parent Development Centre can be reached at 253-6722.

RELIEF FROM THE BABY BLUES

* Rest and eat nutritious foods

* Allow others to help with housework and baby. Share responsibility with your partner or spouse.

* Get out of the house and spend time with people who are supportive, even if the time is short.

* Pamper yourself whenever possible.

* Feel free to decline visitors. Don't entertain if having extra people around is stressful.

* Cry if you need to. Depression worsens if it's bottled up.

* Do things with other new mothers, even if it's just a coffee or a walk around the block.

* If your blues don't go away within a week, seek professional help. You may have postpartum depression.

Source: Baptist Hospital East website www.bhsi.com

SYMPTOMS OF POSTPARTUM PROBLEMS

Baby blues

* Crying for no apparent reason

* Impatience

* Irritability and restlessness

* Anxiety

* Symptoms peak between 3-5 days and usually disappear on their own

Depression:

* Sluggishness, fatigue, exhaustion

* Insomnia or excessive sleep, nightmares

* Confusion, anxiety, panic

* Sadness, depression, hopelessness, helplessness

* Poor concentration, confusion

* Memory loss, lack of concentration

* Fear for the baby and of the baby

* Fear of being alone or going out

* Uncontrollable crying, irritability

* Lack of interest in the baby

* Feelings of guilt, inadequacy, worthlessness

* Fear of harming the baby or self

* Exaggerated highs and/or lows

* Lack of interest in sex

* Inability to think clearly and make decisions

* Ideas about suicide

Postpartum anxiety and/or panic disorder:

* Intense anxiety and/or fear

* Rapid breathing

* Fast heart rate

* Sense of doom

* Hot or cold flashes

* Chest pain

* Shaking

* Dizziness

Postpartum Obsessive Compulsive Disorder:

* Intrusive, repetitive thoughts (including thoughts of harming the baby)

* Avoidance (i.e. avoiding the baby to alleviate intrusive thoughts)

* Anxiety

* Depression

Psychosis:

* Above symptoms are exaggerated

* Hallucinations and/or delusions

* Severe insomnia

* Agitation

* Bizarre feelings and behaviour

* Postpartum psychosis is a serious emergency

Breaking the silence . . . of postpartum depression

The world reacted with horror with news that a Houston mother killed her five children.

Andrea Yates methodically drowned her young children and now faces a capital murder charge.

It's since been revealed that Yates has postpartum psychosis, a hormonal condition that affects mothers after one or two of every 1,000 births. It's the worst of the three levels of postpartum depression. New mothers with postpartum psychosis lose contact with reality and may hear voices, have hallucinations and are often delusional.

What Yates did to her five children illustrates an extreme example of how postpartum depression can manifest itself.

Alice Verwegen, a public health nurse with the Lambton Health Unit and co-facilitator of the postpartum adjustment disorder support group, calls postpartum depression the most common complication of pregnancy.

"Postpartum depression can occur in the early weeks following delivery or can (develop) over a period of months," she says.

Postpartum depression is a collection of symptoms that range from difficulties with sleep, having thoughts of hurting yourself or your baby to intense feelings of anxiety and an overwhelming feeling of hopelessness and sadness, says Verwegen. The Yates case illustrates postpartum psychosis, postpartum depression at its most extreme.

Postpartum depression is not a simple case of the blues, something which is experienced by 50 to 80 per cent of mothers and is considered a normal reaction. Blues can last from three days to two weeks when a woman may be feeling tearful and fatigued.

It's when the mother experiences these symptoms day in and day out for longer than two weeks and having these feelings intensify that she should seek professional help.

"It can affect any woman regardless of age, income, social- economic status," says Verwegen. In fact postpartum depression happened to Verwegen twice.

"I didn't think it could happen to me," she says, calling herself a strong person.

She received the help she needed from a London support group. She felt so strongly about helping other women that she volunteered to co-facilitate the group.

Women don't have to go to London for help now. A postpartum adjustment disorder support group holds regular meetings in Sarnia and offers a support network.

Verwegen describes the various factors that could set the stage for postpartum depression: Hormonal shifts happen within a woman's body as soon as she becomes pregnant. Often sleep deprivation follows bringing the baby home from the hospital. If a family history exists, this is thought to play a role and a recent life stress can also compound the problem. In fact, Yates' father had recently died.

"All the facts compounded can set the stage," she said. "When a woman is depressed it can prevent her from meeting the needs of her baby. If she doesn't respond to cues from her baby in a consistent manner, there can be developmental delays."

Postpartum depression is a biochemical imbalance in the brain that can be compounded by other factors.

But Verwegen warns that sometimes depression in new mothers is caused by thyroid dysfunction. She advises seeing your family doctor.

Afsaneh Yazdani is still tearful when she talks about her postpartum depression. The mother of two had no problems after the birth of her first child, but instead experienced it after the birth of her second child.

The experience between the births was like night and day. When her first child was born, her mother came from India to stay with her for five months.

"I had tremendous support with the first baby," she recalls. "Just having her (mother) here was such a joy."

When her second baby was born four years later in March 1999, the stage was not set so positively. She experienced emotional stress during her pregnancy and distress during childbirth when the baby's heart rate dropped.

"I had read that if you have stress during pregnancy, it raises the chances of postpartum depression," she said.

Within weeks of bringing her new baby home, Yazdani began feeling overwhelmed and scared and had panic attacks. She couldn't sleep and was afraid her baby would die.

"I was thinking it was because my mother wasn't there," she recalled.

With no appetite, she had to force herself to eat because she was breastfeeding. Her family doctor diagnosed her with postpartum depression. Although she was prescribed an antidepressant, with fatigue being a common side-effect, the treatment only made her more tired. She chose to return to work, thinking this might solve her problem.

It's didn't.

She felt as though she was going to "crash" and have a breakdown and a co-worker found her shaking and crying.

Almost one year after the birth of her second child, Yazdani woke up one morning with thoughts she was going insane. Thoughts of suicide came back to haunt her again and recurring fears that she was a bad mother. She contacted the Canadian Mental Health Association who connected her with the Postpartum Adjustment Disorder Support Group, operated through the St. Clair Child and Youth Services.

"I know that I'm not alone," she said. "It happens to other new mothers."

Although group support is offered through the postpartum group, new mothers who don't want to share with a group can contact the St. Clair Child and Youth Services for other supports.

Yazdani believes the postpartum component of her depression has been resolved, but the depression is still present.

She offers advice for others suffering from postpartum depression.

"There is hope. Believe me there is light at the end of the tunnel. Reach out, call out for help, access all the support lines that are out there."

She cautions expectant mothers to become educated about postpartum depression in case it should happen to them.

Yazdani says the Andrea Yates case shows how important it is to make people aware of postpartum depression and the supports available.

Woman has fears she will suffer severe postpartum depression

DEAR DR. REINISCH: Up until three years ago and the birth of my first child, I was an extremely happy, well-adjusted woman with a love and zest for life. Three days after the birth of my child, I started experiencing bizarre psychological and physical symptoms. I became very nervous, agitated and depressed.

I was put through many tests and when the doctors could find nothing physically wrong with me, I was committed to a mental institution where I was told I was suffering from "postpartum depression." I was put on many different medications and endured 24 electric shock treatments.

The doctors could not tell me much about my disorder, except that they believe it is caused by a "chemical imbalance" brought about by hormonal changes following pregnancy.

For the past six months I have been feeling myself again, and I long for another child. However, as you can imagine, I am terrified of experiencing "postpartum depression" again.

DEAR READER: Between 60 and 90 per cent of women experience some mood changes a few days after giving birth (the postpartum period). These changes include irritability, restlessness, anxiety, fatigue and crying.

For most women, these changes are minor and disappear in a week or two. However, for about one out of 10 women, there is moderate to severe depression that occurs during the postpartum period which is more serious and lasts longer.

Research has not established a single cause for postpartum depression. In fact, current evidence suggests that this problem may be a combination of physical and psychological factors.

During delivery and lactation, there are hormonal fluctuations and changes in body chemistry that some researchers feel may contribute to postpartum depression.

Some studies have found some cases of postpartum depression are related to an abnormal level of thyroid hormones and that treating this problem can help these cases of postpartum depression.

Other researchers have examined the psychological and social aspects that may contribute to postpartum depression. A few studies indicated that some women who experienced postpartum depression were also prone to depression before pregnancy. Other studies found that a lack of supportive relationships with spouse, family and friends may also contribute to depression following childbirth.

Modern treatment of severe postpartum depression usually consists of some combination of tranquillizers, antidepressants and hormones.

Most recent information indicates that electroconvulsive shock treatment is not recommended as a treatment today.

It's difficult to say whether or not you will have this same problem if you give birth again. Some studies have shown that first-time mothers are more likely to experience postpartum depression.

It is important for you to have a complete physical -- including thyroid hormone and a neurological evaluation -- before you plan to become pregnant. You also should discuss with your gynecologist what medications you can and cannot take during pregnancy.

Support comes from other moms

Six women, looking weary and frightened, are sitting in a church basement, pouring out their hearts.

One hangs her head and admits in a whisper: "I can't stand my baby. I can't stand how he's dragging me down."

No one is horrified. No one accuses her of being a terrible mother. Everyone in the room knows what she has been going through.

This is a meeting of MOMS - Mothers Offering Mothers Support - a self-help group for women suffering postpartum depression. Run by the Ottawa-Carleton Health Department, it offers women an opportunity to meet weekly with others who are going through one of the most frightening experiences a new mother can have.

Because this massive change in a woman's life can lead to more serious problems, like postpartum depression, which is thought to affect at least one in 10 women, either in the early weeks after delivery of her baby or up to a year later.

It is characterized by tearfulness, chronic exhaustion, despondency, sleeplessness, anxiety attacks and the inability to cope with even the routine matters of life. And unlike "the blues," which affect most mothers a few days after delivery, the symptoms of postpartum depression persist and often worsen unless she gets help.

Even though postpartum depression is common, it often remains undiagnosed and untreated. When a women tells her family and friends about her symptoms, they may minimize her problem and urge her to get back on her feet. Even doctors sometimes miss the diagnosis, putting her problems down to the usual exhaustion of new mothers.

"The average person just doesn't understand the word depression and how debilitating it can be," says Madeleine Ryan, a public health nurse who co-ordinates the MOMS group. "They don't understand that it is an illness."

Left untreated, the depression can take a terrible toll on the mother and her family. It can lead to further deterioration of her mental health, alcoholism, drug abuse, suicide attempts, marital breakdown and child abuse.

Fortunately, when the mother does get help, her prognosis is excellent.

The use of anti-depressant drugs is sometimes necessary and some women need help from psychiatrists.

Women who attend MOMS are offered the support of other mothers like themselves, at the weekly meetings and through regular telephone contact. With a family doctor's referral, a homemaker can help the new mother with household chores until she is feeling better. A public health nurse will also visit her home two or three times a week.

Paola MacQuarrie, who suffered postpartum depression after the birth of her son 2 1/2 years ago, says she felt like she was losing her mind until she got involved with MOMS. Her family doctor had quickly recognized her symptoms and phoned the health department on her behalf to arrange for help.

"At first, Madeleine Ryan just kept calling me to offer me support over the phone," recalls MacQuarrie. "I was at the point that I couldn't even get myself out of the house. That was the worst stage, because you just don't know what's going to happen to you.

"But Madeleine was very helpful. She made me focus on the fact that I was going to get better."

When MacQuarrie finally did join the group, it was a relief to hear that other mothers were feeling the same way she was. "It was a very safe place to share my thoughts. We did a lot of crying but we also laughed sometimes."

Once women receive help, they usually are back to their "old selves" within three or four months. But although she began to feel better after several months, MacQuarrie continued her involvement with the group for more than a year, and still meets with the other mothers from time to time.

"We're very close. They are quite an indelible part of my life."

New mom is having a hard time feeling happy about motherhood

Question: I am a new mom with a two-month-old baby boy. He is beautiful, bright and healthy. The problem is I don't feel happy about being a new mom.

I am scared, irritable and I cry all the time at what seems to be nothing at all. I constantly worry about the health of my baby as well as my own. I really don't feel like myself anymore. I don't know who I am. I know I shouldn't feel this way, I should be very happy. There are days when I feel like running away from everything.

My husband and family don't seem to understand me, I can't really explain to them why I feel so sad, scared and alone. People tell me to "snap out of it" or "don't feel like that" or " you have nothing to feel depressed about". I guess they are right, maybe I shouldn't be a mother. Maybe I am not a very good mom. I love my baby, but I am just so tired all the time and have very little energy to give.

Please help me, I feel so alone.

Dear Alone: First of all you are not alone, what you are experiencing is very real. There is a name for what you are feeling, it is called Postnatal Mood Disorder, or a more familiar name is Postpartum Depression. Postpartum Depression is an illness which can happen to any woman who has had a baby. Postpartum depression is not the 'baby blues', the symptoms are different and last much longer. Postpartum depression requires treatment unlike the baby blues which generally only lasts for a few days and requires no intervention.

Approximately 30 per cent of mothers will experience a postnatal mood disorder to some degree. The exact cause of postpartum depression is not known but we know that the hormonal, biochemical and psychological changes that occur after childbirth do impact how a mother feels. A previous experience with anxiety, depression, emotional, physical or sexual abuse may increase a womans susceptibility to postpartum depression. The symptoms of postpartum depression vary with each individual but anyone experiencing any or all of the following should be seen by a Health Care Professional;

- feeling constantly tired

- frequent crying

- panic attacks

- excessive worrying about your or your baby's health

- difficulty sleeping, or sleeping all the time

- difficulty concentrating

- having frightening thoughts

These symptoms are very frightening but remember you are not alone, it is not your fault and you did nothing to cause this.

Here are some things that you can do to help yourself:

-Make an appointment to see your Doctor, Midwife or Nurse Practitioner. Tell him/her exactly what symptoms you are experiencing. Bring someone with you to the appointment, it helps to have another person there to offer support as well as listen for information.

- It really helps to educate yourself about postnatal mood disorders. Information is power, by reading and understanding what you are experiencing, it can often help not only to alleviate some of your fear, guilt and confusion but also validate and confirm that this is real and not something you are making up. A great web site for information is www.depressionafterdelivery.com

Another great reference is a book titled: Postpartum Depression and Anxiety A self help guide for mothers.

- Here are some practical ways to help you cope

- Keep reminding yourself that this is an illness, and you will get better.

- Avoid making any important decisions until you feel better.

- Don't expect too much of yourself right now, try to delay any major responsibilities and get help from others.

- Avoid alcohol ( it makes depression worse).

- Take medication as prescribed, even if at first you don't think it is helping.

- Keep your follow-up appointments with you doctor or therapist.

- What can a friend or partner do to help a woman with Postnatal Mood Disorders?

- Learn about postnatal mood disorders by reading current information.

- Listen to her feelings and treat them respectfully - it doesn't help to say "oh, don't feel like that", or "snap out of it", "or you have nothing to be depressed about".

- Encourage her to seek help from her family doctor, therapist or a support group, help make this possible by providing transportation or childcare.

- Offer practical help, the best gift you can give a new mother is to give her time to care for herself and her baby. Offer to clean, do laundry or cook some meals.

- Encourage her to keep follow-up appointments and take prescribed medication.

It is very difficult for women experiencing postnatal mood disorders to tell others what they are feeling, because of lack of knowledge, fear of being judged by others, or hoping that things will just get better. Women will often suffer in silence. This can be a very difficult time for you and your family, asking for help does not mean that you are weak.

Swift help needed for postpartum depression

Book by Brooke Shields draws attention to misunderstood ailment

When a celebrity writes about experiencing a health problem, especially an emotional disorder that severely disrupts feelings of self-confidence and competence, it is bound to receive considerable public attention.

And so, I hope that Brooke Shields' new book Down Came the Rain about her recent battle with a serious postpartum depression will call attention to this common but underdiagnosed and undertreated problem.

Ten to 20 per cent of women experience a serious depression within weeks or months of giving birth, but fewer than one woman in five is treated for it. Yet failure to get help can prolong the misery, resulting in a battle with depression that can last a year or more and create havoc in a household.

Shields, too, let far too many weeks pass -- weeks that found her hiding in her bed, barely able to care for herself or the child she struggled for years to bear -- before she finally sought professional help.

Here's her message to women who find themselves surprised and overwhelmed by a postpartum mood disorder:

"Do not waste time! Get help right away. Postpartum depression is extremely treatable, and there are many ways to cope with and get through it. And remember: postpartum depression is beyond your control. Having it does not mean you are not a good mother or that you are crazy. The most important thing is that you don't wait for it to pass."

The so-called baby blues experienced in the days after childbirth are very common. About 70 per cent of women are likely to experience mood swings or feel weepy and emotional about the slightest untoward event or remark.

These feelings, which mimic the symptoms many women experience just before their menstrual periods, are most likely brought on by the abrupt decline that occurs at childbirth in the hormones estrogen and progesterone. These baby blues pass on their own, usually within two weeks, and do not require treatment.

But for some 10 per cent of new mothers a more severe mood disorder results. They may feel sad, hopeless, overwhelmed, unable to cope, irritable and afraid of harming themselves, their partners or their babies.

Crying, uncontrollable mood swings, a fear of being alone, a lack of interest in the baby, loss of energy and motivation, withdrawal or isolation from friends and family, and an inability to make decisions or think clearly are also common symptoms. Physical symptoms may occur as well, including extreme fatigue, sleep disturbances, loss of appetite, headaches, chest pains, palpitations and rapid breathing.

Shields experienced most of these, yet resisted the urging of friends and family to seek the help she clearly needed.

She felt unattached to her daughter and feared harming herself as well as her marriage and the emotional development of her baby.

The most severe form of the disorder, postpartum psychosis, occurs after one or two of every 1,000 births, usually within six weeks of delivery. Symptoms may include delusions, hallucinations, sleep disturbances and obsessive thoughts about the baby. Untreated, the result can sometimes be suicide or murder of the baby, the spouse or other children in the family.

Some women are more likely than others to be afflicted with postpartum depression, and researchers are trying to identify them and devise therapies to use before childbirth or immediately after it.

Known risk factors include a personal or family history of depression or substance abuse (Shields has a family history of alcoholism); lack of support from family and friends; problems with a previous pregnancy or birth (Shields went through numerous in vitro attempts and a miscarriage); depression after a prior pregnancy; marital or financial problems; being a young or single mother; complications during labour and delivery (Shields required an emergency Caesarean delivery); a major life change at the time of the birth; and having a baby with serious health problems.

Treatment possibilities include individual or group psychotherapy; medication with antidepressants, hormones or both; and various things a woman can do for herself.

Psychotherapy usually is six to 12 sessions, and is especially helpful if symptoms are severe, as they were for Shields.

Many cases of postpartum depression are treated with the newer antidepressants called SSRIs, selective serotonin reuptake inhibitors. Though such drugs are excreted in breast milk, they are considered generally safe, but the effects are not well studied.

Neglecting to treat postpartum depression can definitely cause lasting damage, including poor mother-infant bonding and later cognitive and behavioural problems in children.

Studies under way are testing the effectiveness of estrogen therapy in preventing and treating postpartum depression. One study showed that women with postpartum depression who used an estrogen patch every day were less depressed than those who did not. But there can be side effects, since estrogen can decrease milk production in nursing women and may raise the risk of blood clots.

Women can help themselves by turning to family and friends, getting rest, eating properly, getting exercise, making time for themselves, talking to others about how they feel and discarding notions of perfection. Friends and family can care for the baby during the night, preparing nutritious meals, run errands, pay bills, clean house, care for older children and make appointments with doctors or mental health professionals.

Grandparents can be a lifeline for new moms

It often becomes a family joke that when a grandchild is born, everyone focuses on the baby, to the point where the mother feels like a nonentity. We've all seen what happens when new parents arrive at the door and the relatives aren't looking anywhere other than at the baby.

We laugh about it, but the baby-focus has its downside as well -- as joyous an event as the birth of a grandchild is, grandparents should be urged to keep an eye on the new mother as well as the baby.

The reality is that many women, particularly first-time mothers, are challenged in handling the demands of new motherhood. Grandparents should be alert to these difficulties and the various ways they can arise.

General coping difficulties, the "baby blues" and outright postpartum depression are three potential problems that grandparents may observe. General coping difficulties include problems adjusting to motherhood, problems with feeding and an overall feeling of being overwhelmed. The baby blues is a mild form of depression that affects up to 80 per cent per cent of new mothers for up to two weeks after the birth. Postpartum depression is more serious and often requires a longer intervention.

How can grandparents tell if a new mother is having difficulty coping or is experiencing the baby blues? Difficulty in completing routine household tasks or personal care is one red flag -- if you notice the dishes are piling up in the sink, she hasn't showered in a couple of days, or even that the curtains aren't opened at the usual time, these things can signal that something's wrong. The mother may be irritable, sad or worried.

If symptoms continue it may indicate that the blues are actually something more serious -- postpartum depression. Postpartum depression is a form of clinical depression, which is caused by a chemical and hormonal imbalance in the brain, and specifically occurs in the postpartum or post breastfeeding time period. Approximately 10 to 15 per cent of new mothers are affected by postpartum depression, which usually appears within six weeks of the birth and can last as long as six months, or longer in extreme cases.

Symptoms include expressions of guilt on the mother's part, including statements that she feels she is a poor mother. Feelings of panic or anxiety about the baby are another sign of trouble. While it's normal for new parents to be a little nervous about looking after their newborn, mothers with postpartum depression may seem obsessed with such things as checking the baby's breathing while it sleeps, or excessively worrying that the baby isn't getting enough to eat. Grandparents should also watch for sadness, weepiness, reports of insomnia or sleeping too much, expressions of hopelessness and lack of interest in eating.

Watch also for lack of interest in the baby -- if your daughter or daughter-in-law appears apathetic about the infant and displays little emotion in caring for it, she may be suffering from postpartum depression. Another red flag is the mother shutting people out -- grandparents may find they are discouraged from coming over. On the other side of the coin, the mom may cling to visitors and appear terrified to be left alone with her baby. Both reactions are out of the ordinary and shouldn't be taken lightly.

If the baby blues last longer than two weeks, it's usually recommended that a talk with a physician is needed, and medication may be required. Women experiencing coping difficulties, the baby blues, or full-blown postpartum depression can also be greatly helped by regular home visits from a nurse specializing in maternal/ infant care. Some mothers need only one or two visits while others will benefit from regular care over a longer period of time.

Both general coping difficulties and postpartum depression should be taken seriously and grandparents can help tremendously in this regard. If your daughter or daughter-in-law is displaying any of the symptoms mentioned above, talk to her and express your concern. Even more importantly, allow her to say what she's feeling. Don't censor her or correct her -- just let her talk and then reassure her that you're there to help.

Grandparents can also assist new mothers to get the help they need by identifying the problem in the first place. New mothers are often reluctant to say they're having difficulties and grandparents can put the subject on the table with statements like, "Things seem rough right now, let's work together to get help."

Grandparents can also provide direct support. Sometimes this assistance is as basic as sitting with the baby while mom goes out by herself and gets a much-needed break. It may mean helping with household duties, or arranging for someone else to help cook and clean if you're not able to do it yourself. Even regular, supportive phone calls can help a new mother feel less isolated.

In my practice I see what a difference grandparents can make. Even when things are going smoothly, their love and support means a great deal to new parents. When troubles come, their support can be a lifeline.

Postpartum depression support group wanted

On the last weekend in June, Wendy Flecker kissed her husband and two children goodbye and set off to Toronto for the Eighth Annual Postpartum Support International Conference.

Approximately 190 people from Canada, the United States, South Africa and England took part in the three-day meeting, the first to be held in this country. Participants included psychiatrists, obstetricians, pediatricians, family doctors, nurses, social workers, childbirth educators, midwives and psychologists - and women like Wendy Flecker.

The conference was Flecker's first exposure to a large group of people who talked openly about a very private - and certainly a socially taboo - subject. Postpartum depression is a recognized medical condition afflicting as many as 20 per cent of new mothers. But women rarely talk about it for fear of being branded a bad mother or, worse, as crazy.

Shortly after the conference, this newspaper published a story about a U.S. study of women considered likely to develop postpartum depression. The study found that women sharply reduced their chances of becoming depressed if they took anti-depressants immediately after giving birth. Only women who had already suffered postpartum depression were included in the study.

The conference - and what Flecker felt was the news story's message that drugs are the only solution - convinced her it was time to "go public." In an attempt to stamp out the stigma associated with postpartum depression - "If you say you are feeling awful, you are not a good mom," she says - Flecker talked with me the other day about her own experiences with the illness.

In many respects, Flecker is a typical victim of postpartum depression. She has no history of depression, she is happily married, and she was perfectly fine until three months after the birth of her second child on June 16, 1992. "I went to bed and woke up and didn't know who I was any more," she says.

Flecker, who is now 32, suddenly began having frightening anxiety attacks and mood swings. She became weepy for no apparent reason. She couldn't eat. She had terrible insomnia. Often, she simply felt numb.

"It was like falling into a black hole," she says. "For the first week or so I kept it hidden, which was very odd for me. My partner and I have a very open relationship, but I felt so afraid that he would commit me to an institution. On the outside, I looked like my old self but on the inside, there was all this turmoil."

Trying to look normal is classic. Flecker knows other women who have silently endured postpartum depression for many months. Flecker herself sought help from her doctor in the second week and was immediately diagnosed with postpartum depression.

She began taking medication and in two weeks felt like her old self. With the symptoms under control, she also began meeting regularly with a group of women. "I knew I needed support," she says.

Since then, Flecker has lent a sympathetic ear to a number of other mothers in the Kingston area. The local health unit and the Kingston Childbirth Education Association have permission to give her telephone number to women who seem depressed.

Flecker also has stacks of information about postpartum depression. In Canada, the non-profit Pacific Post Partum Support Society has published an excellent self-help guide called Post Partum Depression and Anxiety. Flecker has several copies and is happy to lend them.

No one knows what triggers postpartum depression. Although the tendency is to blame postpartum hormones, the incidence of depression is the same for mothers who adopt a child as it is for those who give birth.

In Post Partum Depression and Anxiety, the authors blame the myth of the supermom: "The incredible pressure to be perfect causes many women to feel ashamed of their feelings and experiences and makes it very difficult for them to seek out and receive help."

An article in a 1985 issue of The Canadian Nurse also suggests it would be useful to explore the cultural aspects of the illness. Rather than drugs, the article says, the treatment that is most useful is "one which encourages talking in confidence to other women who have experienced the same difficulties."

Flecker believes that a postpartum support group is badly needed in this community. She is willing to help organize one but with two small children and a part-time job, she can't do all the work herself. "I feel that if there had been a support group, this would have been way behind me right now," she says.