Understanding postpartum mood disorders

Expecting a child can bring tremendous joy and excitement, and the period following the birth may well be the happiest time in parents' lives. Unfortunately, it may also be one of the most stressful and anxiety provoking periods in the life of a young family.

About three quarters of women who give birth experience at least some kind of mood change following the birth. The so-called Postpartum blues or baby blues typically surface within a few days of delivery and are mainly caused by hormonal changes, disrupted sleep patterns, fatigue, physical discomforts, or adjustments to the demands and responsibilities of caring for a newborn baby.

Symptoms like frequent tearfulness, anxiety, irritability, and a sense of feeling overwhelmed are all considered a normal part of early motherhood and will most likely vanish within one or two weeks, after the mother has had some good rest and support, and has eased into her new tasks.

However, about 15 per cent of women who give birth experience more depressive symptoms, and will be diagnosed with Postpartum Depression (PPD), an illness that can affect mothers not only right after birth, but also several weeks or months later. PPD generally lasts longer than the baby blues and its symptoms may include:

- crying more than usual

- feeling sad most of the time

- having thoughts or worries about hurting oneself or the baby

- lack of energy, motivation, and pleasure in life

- fear of being alone

- feeling exhausted but being unable to sleep

- loss of appetite

- difficulties concentrating, remembering things, or making decisions

- feeling worthless

- feeling guilty

Although the exact cause of Postpartum Depression is not known and PPD can thus not be predicted, there seem to be certain risk factors that increase the likelihood of the illness such as previous postpartum depression, a history of depression, bipolar disorder, or PMS, stressful life events during and after pregnancy (e.g. marital problems, health issues, a complicated birth), and a lack of social support.

Eliminating stressors in one's life, putting a good support system in place (doctors, counselors, coworkers, friends, family, neighbours), and talking about one's feelings rather than denying them are some of the coping skills that may not necessarily prevent a postpartum depression, but could certainly diminish the severity of symptoms.

Should postpartum depression occur, it really does not mean that the woman is not cut out to be a good mother, but rather that she will need some help to get back to her old self in order to respond adequately to her child's needs.

Experts generally agree that the use of anti-depressants (doctors will prescribe a medicine that can be used while breast feeding) in combination with therapy (individual or couple) and relaxation techniques work best, unless psychotic symptoms would be present.

Although postpartum psychosis (PPP) is rare (about one in 1,000 women), psychiatric help should be sought immediately when there is a rapid onset of severe symptoms such as hallucinations, suicidal ideations, incoherence, irrational behaviour, delusions about special powers of self or the baby, frantic energy, or a refusal to eat.

Once in stable condition, treatment will be more or less the same as for postpartum depression.

Finally, educating oneself about postpartum mood disorders is one of the best ways to ensure early diagnosis and proper treatment. Along with discussing the matter with a physician, one can consult several informative books including: Beyond the Blues: a Guide to Understanding and Treating Prenatal and Postpartum Depression by Shoshana Bennet; Postpartum Depression: Every Woman's Guide to Diagnosis, Treatment, and Prevention by Sharon Roan; and Down Came the Rain: My Journey Through Postpartum Depression by Brooke Shields.

Mothers may face a `dark tunnel'

For many new mothers, having a baby is the dream of a lifetime. For others, the experience is a nightmare.

"I've seen some women that are really suicidal, some that have either hit their babies or their older children," says Cathy Harlan, co-ordinator of a support group for mothers suffering from postpartum depression, offered by the Family Service Association of Edmonton.

Up to 80 per cent of women suffer some form of the "baby blues," a mild depression thought to be caused by a change in hormonal levels after childbirth, said Harlan.

Between 10 and 20 per cent of new mothers experience the more serious symptoms of postpartum depression, she said. For a few, the depression becomes so severe, it is termed postpartum psychosis.

In a few U.S. cases, mothers who have killed their children have been found to be suffering from postpartum psychosis. Some have been found not guilty of the killings by reason of insanity.

In Edmonton last Sunday, police found the body of a newborn baby in a dumpster outside a downtown apartment complex. An autopsy has shown the child was not stillborn, and police are treating her death as suspicious. They have yet to find the child's mother.

Harlan said the infant's mother could have been suffering from postpartum depression or psychosis. "She probably wasn't getting a lot of support that she really needed."

In many of these cases, "if their families and hubands and friends could have seen the little symptoms and signs, they could have prevented a lot of these deaths," she said.

Pat, an Edmonton mother who suffered postpartum depression after the birth of her first child 2 1/2 years ago, described the feeling of "being in a dark tunnel, where you just don't see any light."

She slowly withdrew from her family and friends after her daughter was born. Plagued by thoughts of suicide, she headed to the garage, planning to hang herself. She was stopped by the sound of her daughter crying.

She was admitted to hospital for a short time and treated with anti-depressants. It took a full year before she felt any better.

"I thought I was going crazy. I really thought I was an absolute basket case," she said.

In the case of the infant found last weekend in Edmonton, Pat said she hopes police will find the mother "and give her the help she needs."

Now pregnant with her second child, Pat is attending Harlan's postpartum support group to avoid the depression she suffered with her first baby.

This time, however, she has the support of the year-old group, which has about 16 members.