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Ask the Expert

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Updated: Postpartum depression

More than 800,000 women annually suffer from this debilitating illness.

Posted: March 7, 2008 1:12 a.m.
Updated: May 8, 2008 5:02 a.m.
 
The odd feelings of despair and rejection started when Tracy was pregnant. During the first trimester, when she found out she was going to have a boy, she felt disappointed that she was not carrying a girl. Since she already had a little boy, she would have liked a girl.

The feelings gradually grew through the second trimester. Tracy started to feel as if she didn't want another child. She began to panic and even started researching where she could get an abortion.

"I didn't expect to feel that way at all," said Tracy, who lives in Castaic.

Her anxiety worsening, Tracy began having panic attacks and trouble sleeping. Her disconnection with the baby growing inside her made her wish she would miscarry. Her mind raced constantly with thoughts she could not control.

"I contemplated barbaric things," she said.

A doctor diagnosed Tracy with depression and anxiety and put her on Prozac and Ativan in an attempt to relax her and control her thoughts and symptoms. He said it would not harm the baby.

However, Tracy, who has a family history of depression and anxiety, got worse instead of better. After her son was born, she did not bond with him at all, and contemplated adoption. The doctor told her she was suffering from postpartum depression (PPD), but she didn't know what to do about it or how to cope.

She constantly felt weepy, lethargic, foggy and experienced strange tics in her body. Friends shunned her because they didn't understand her strange behavior, and at work she was re-assigned to different duties. She and her husband almost divorced because of the stress her condition was causing.

Tracy felt like her life was out of control. She was confused by why she felt so awful and depressed at a time when she should be excited about the new life she had just given birth to.

Within a few weeks, it became clear that Tracy was unable to care for herself or her baby, so she put the infant in the care of her mother while she sought more serious treatment. She tried several new combinations of drugs and therapy, but she continued to deteriorate. She even made a half-hearted suicide attempt. Over the course of four months after her baby's birth, Tracy was hospitalized three times in a psych ward.

Fortunately, Tracy's story has a happy ending. She eventually found a doctor and a combination of drugs and other therapies that stabilized her. Within four weeks she was feeling 100 percent better and was back to her old self. Her son, who is now almost two years old, is back in her care and she is fully bonded with him. She and her husband have also worked out their issues.

Symptoms
Though Tracy's case is extreme, it contains many of the core elements that are typical of PPD: anxiety, fogginess, feelings of revulsion for your newborn, racing thoughts, and a sense of being a failure.

Diana Barnes, Psy.D., a licensed marriage and family therapist specializing in the assessment and treatment of postpartum illness, says that between 15 and 20 percent of all women experience PPD in some form, ranging from mild to severe. Barnes, who consults with Henry Mayo Newhall Memorial Hospital, said that many people are surprised at how common PPD is, partly because they buy into myths surrounding motherhood.

"We live in a culture that romanticizes pregnancy and childbirth without accounting for any of the stress of this extraordinary life change," she said.

However, more than 800,000 women suffer from this debilitating illness in the U.S. every year. Barnes described the different ways PPD can manifest itself, and the accompanying symptoms.

"One version normally starts with paralyzing anxiety," Barnes said. "The trigger is usually the baby. When the baby cries, the mom becomes paralyzed. The woman starts feeling inadequate and unable to cope, and feels as if she is just mechanically going through the motions of motherhood."

"Another version is where the woman has intrusive, repetitive thoughts such as wanting to hurt her baby," she said. "She is horrified with the thoughts and knows they are bizarre, and tries to avoid what she thinks is inevitable by doing things like hiding all the knives in the house."

One important distinction to make is the fact that PPD is an entirely separate disorder from the "baby blues," and from postpartum psychosis.

The baby blues is a temporary period of post-birth adjustment characterized by sudden mood swings, irritability and sadness. It affects 75-80 percent of women and is not considered a disorder. Postpartum psychosis, which affects only 1-2 percent of women, involves delusions, false sensory perceptions and sometimes a total break with reality.

Treatment
If you do feel like you might have PPD, Barnes advises staying calm and getting help from an expert. PPD is not something that just "goes away" by itself.

"There is no need to panic if you feel these symptoms, because mood disorders are treatable," she said. "If you're not doing well postpartum, don't ignore it. Talk to a doctor or therapist, and don't stop talking until you find someone who listens."

Treatment options include drug therapy, talk therapy and taking better care of yourself.

Antidepressant medications like Prozac or Zoloft, as well as anti-anxiety drugs like Xanax and Prozac, are very effective in combatting PPD, along with medication to promote better sleep.

"Sleep is very important for people with PPD," Barnes said. "Disrupted sleep patterns contribute to the disorder and make it harder to recover from."

Barnes added that many medications are compatible with breastfeeding.

There are two types of talk therapy that can be combined with drug therapy to treat the psychological aspect of PPD. Cognitive behavioral therapy deals with the distorted thoughts that can flow from PPD, and interpersonal therapy looks at the role transitions that new mothers often experience after the birth of a child.

"The shift from independent woman and wife to mother and caretaker constitutes something of an identity crisis for many women," Barnes said.

Lastly, Barnes advises women to slow down and take care of themselves if they find themselves suffering from PPD. This means getting more sleep, asking for help with the baby and household chores, exercising and eating well.

"Self-care is important," she said. "We tend to put ourselves last."

It takes around three months on average to recover from PPD. Seeking help early is crucial though, because the earlier treatment is started, the higher your chances are for a speedy recovery.

"The longer a woman waits, the more likely it is that PPD will become chronic and treatment-resistant," Barnes said.

Prevention is Key
Since screening for depression is rarely done on pregnant women, knowing your own risk factors and taking care of yourself both before and after your baby is born are key ingredients to avoiding PPD in the first place.

"It's a shame that we screen pregnant women for Down's Syndrome, but we don't screen for depression, even though it's much more common," Barnes said.

Those at higher risk of developing PPD include women like Tracy with a personal or family history of PPD or other mood disorders, those who have significant mood changes around their menstrual cycle, and women undergoing fertility treatment.

"If you had one episode of PPD already, the risk of having a subsequent episode during a different pregnancy is 75 percent," Barnes warned. "If you have been treated for depression or anxiety in the past, you are at risk."

Barnes added that if you develop depression while you are still pregnant, like Tracy did, your risk is even higher of being depressed after the baby is born as well.

Though many women have these risk factors, Barnes cautions against panic. Just because you are at risk does not mean you will develop PPD, but being aware of the possibility means that if you do develop it, you will be able to nip it in the bud that much sooner.

"Awareness is key," said Barnes. "Women should educate themselves and their families during their pregnancy."

Barnes also encourages women to slow the pace of their lives before and after a baby is born. Don't try to change houses, jobs, or make other major life changes.

"Try to keep things status quo for at least one year postpartum," she said. "Women often put too much stress on themselves around pregnancy time, which is not good. We underestimate how big a change we are going through, and overestimate what we can handle. Other cultures make a much more sacred space for women to be pregnant, and we don't, but we should."

Get Help and Support
To help yourself get well if you are in the throes of PPD, experts advise that you not be afraid to ask for help, and accept as much as you can.

Since getting enough sleep is important for recovery, Barnes suggests bringing someone in to your home who can get up at night with the baby if necessary. Tracy chose to hire a nanny, but you can also call on your spouse, a friend, or a family member as well.

In addition, finding other mothers suffering from PPD or a support group that caters to women with PPD can be a lifesaver during the most difficult moments.

"Support groups are excellent," Barnes said. "When you have PPD you feel that no one could feel as bad as you, but when you are sitting across the room from someone who gets what you are going through, there is nothing as good as that. You have less of a sense of isolation, and it can make you feel more hopeful."

Barnes recommends finding a group that specifically deals with mothers with PPD, as opposed to a general "new mothers" club, since moms with PPD are going through an entirely different experience of motherhood than those not suffering from it.

Don't Feel Ashamed
Societal and internal pressures to be a happy, organized new mother, coupled with the stigma of mental illness, are two of the reasons that women often ignore the warning signs of PPD and fail to seek help as soon as they should.

Barnes emphasizes that women with PPD do not have a character flaw, nor are they weak or bad mothers. They simply have a reversible illness that can strike anyone from celebrities to suburban soccer moms.

"We don't honor PPD as an illness in our society," Barnes said. "If someone had a baby and had cancer, we would never expect them to function when they were throwing up and in pain. But with PPD we often feel ashamed and think we need to just force ourselves to cope. There are a lot of stigmas in society around what it means about your strength and resilience as a person."

Most important, Barnes said, is for women to not deny their symptoms, and to not fear reaching out to others for help.

"Women with PPD have to remind themselves that they are in pain," she added. "Anyone who is judging them is a very misinformed person."

Resources for PPD
Henry Mayo Newhall Memorial Hospital's Labor of Love Childbirth Education program - (661) 253-8607
Dr. Diana Barnes at the Center for Postpartum Health - (818) 887-1312
Postpartum Support International - www.postpartum.net
Candace Guzman, Santa Clarita Postpartum Meetup Group - (818) 489-6811 or http://postpartum.meetup.com/109
'The Mother to Mother Postpartum Depression Support Book' by Sandra Poulin

(Editor's note: In a previous version of this story, a poor choice of words may have led readers to believe that Dr. Diana Barnes had discussed details of Tracy's medical history with The Signal. This was not the case. At no time did Dr. Barnes discuss any details of Tracy's or any other patient's medical history, nor did she acknowledge a relationship with Tracy. To do so would have been a violation of her legal and ethical obligations as a therapist, which Dr. Barnes obeys scrupulously. We regret the error.)

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