The Importance of Education on Postpartum Depression and Anxiety

Posted on 08. Feb, 2012 by in Anxiety, Depression

It is important to learn about Postpartum Mood Disorders because knowledge is often the best defense.  Our society, unfortunately, still stigmatizes these experiences,  causing new mothers and fathers to be afraid to talk about it and seek help. 

This quote comes to mind:

“…there are two ways of going about liberation: one of course, is the political way, changing the laws and fighting for equalities… But the other I stress simply because it is the one I know: the psychological way, which is the removal of obstacles so that you can create your own freedom and you don’t have to ask for it.  You don’t have to wait for it to be given to you.  And the women I chose as my heroines were women who created their own freedom.  They didn’t demand it, they didn’t ask for it.  They created it. It is very easy to blame society… but it actually makes you feel even more helpless. Because that means you are waiting for [society] to liberate you, for the government to liberate you or for history. And that takes a long time. It takes centuries, and that is too slow for me.  We only have one life.”  Anais Nin

Now this quote may be referring to women’s equality, but I feel it also fits with what stands in the way of families getting help.  Certainly the stigma isn’t the only barrier, but it is a big one.  So what if mothers and fathers stood up and felt that they could get help without self judgement or judgement from others.  Our own self judgement is something we can control and that is all that matters, really. 

Here is an overview of Postpartum Mood Disorders:

 

Baby Blues -

• Considered transient and non -pathological

• 60 – 80% of mothers experience symptoms of tearfulness, irritability, anxiety, sadness, exhaustion

• onset is within the first 3 days after delivery and can last up to 3-4 weeks

 

Postpartum Depression (PPD) –

• Can be considered serious and disabling

• Affects around 13% of women and onset anytime after delivery, up to a year, and in some cases, even later

•DSM-IV-TR has as postpartum-onset specifier for diagnosis; however it is limited to within 4 weeks of delivery

• Later onset can be triggered by onset of menstruation or weaning of breastfeeding, however, it is highly individualized for every woman

 Symptoms of PPD include:

  • feelings of loneliness and isolation
  •  tearfulness
  • despondency
  • sleeping and/or eating problems
  • frightening thoughts or fantasies
  • exhaustion
  • feelings of worthlessness
  • feeling detached from the baby
  • suicidal thoughts

 

Postpartum Anxiety Disorders –

•Symptoms of anxiety are very common during pregnancy and postpartum, and can present alone or with depression

• The most common symptoms include: nervousness, hypervigilant concerns about the baby, extreme lability, appetite and sleep disturbances, distractibility or inability to concentrate, a sense of memory loss

•Timeline can be up to year after delivery and in some cases, later

 

Postpartum Panic Disorder –

• Affects about 10% of postpartum women

• This is a more extreme version of postpartum anxiety disorders with symptoms including: chest constriction, shortness of breath, heart palpitations, hot or cold flashes, excessive worry or nervousness, dizziness, fear of losing control or going crazy, and feelings of terror that a panic attack could happen while driving, holding the baby or some other perceived risky activity

•Due to these symptoms appearing out of the blue, mothers are fearful of their return which exacerbates the anxiety

 

Postpartum Obsessive Compulsive Disorder –

• Affects about 2 – 5% of mothers

• May include a combination of depressive and anxiety symptoms

•OCD symptoms include: repetitive and unwanted thoughts (intrusive thoughts of harming the baby or harm coming to the baby) and behaviors. The thoughts can include: stabbing, suffocating, throwing or dropping the baby, as well as sexually abusing the baby. These thoughts are terrifying and repulsive to the mother. The mother may engage in ritualistic behaviors such as compulsive cleaning or counting for fear of harm coming to the baby.

• Avoidance of the child for fear of harm coming to the baby creates a risk of maternal attachment difficulties

• Recurrent thoughts of hurting oneself or the baby become further convoluted by extreme and persistent feelings of anxiety, shame, and guilt

• Onset is first year postpartum, sometimes later

 

Postpartum Generalized Anxiety Disorder –

• Symptoms include: intolerable worries such as, fear that she will accidentally make the baby sick or die due to contamination, that the baby will be harmed if she is not hypervigilant about details, that her stress levels during pregnancy my have harmed the baby while in utero, or that the slightest physical symptom may mean that the baby is deathly ill.

• Onset is up to year after delivery, sometimes later

 

Postpartum Post Traumatic Stress Disorder –

 • A traumatic experience during pregnancy, labor and delivery, or after delivery which can trigger post traumatic stress

• Trauma can range from a medical emergency of mother or infant, death of infant, to a degrading labor and delivery experience

• Common symptoms include intrusive thoughts, nightmares and flashbacks

Postpartum Bipolar Disorder –

• If diagnosis of Bipolar Disorder has been given and medication has been discontinued during pregnancy, there is a 50% rate of relapse

• Bipolar disorder is closely related to Postpartum Psychosis

• This is a period of heightened vulnerability, so early intervention is important to avoid a psychiatric emergency

•Symptoms include depression that is resistant to therapy, poor response to medication, anxiety, rage and high risk behaviors

•Statistically, 1 out 50 women with a diagnosis of Bipolar may develop Postpartum Psychosis

•Hypomanic phase can develop immediately after delivery with severe depression occurring several weeks later (Bipolar II)

•Symptoms include depression that is resistant to therapy, poor response to medication, anxiety, rage and high risk behaviors

•Statistically, 1 out 50 women with a diagnosis of Bipolar may develop Postpartum Psychosis

•Hypomanic phase can develop immediately after delivery with severe depression occurring several weeks later (Bipolar II)

 

 Postpartum Psychosis –

 • This is a rare disorder occurring in 1 – 2% of all post-delivery women

•  Personal history and family history of psychosis, Bipolar, schizophrenia, schizoaffective disorder are at risk

• Onset can occur 3 – 14 days after delivery

• Symptoms include irrational and incoherent statements, extreme confusion, thoughts of harming self or baby based on delusional thoughts or hallucinations, agitation, and a loss of touch with reality

• An elevated risk of suicide or infanticide when delusions or hallucinations focus on the infant believed to be evil or destined for a terrible fate

 

Possible Risk Factors:

  • History of depression, anxiety, OCD, eating disorder, panic, or mania
  • Family History of depression, anxiety, OCD, panic or mania, PPMD
  • Marital conflict
  • Low confidence level as a mother
  • Temperament- perfectionism, rigid, need for control
  • Codependency – responsibility for everything and everyone without self care
  • Temperament of the baby
  • Baby disability, prematurity
  • Life stress and lack of coping skills
  • Single Parent
  • Unsure about having the baby
  • Hormonal risks – infertility, PMS, PMDD, irregular periods, early onset of period
  • Miscarriage, elective termination, or loss of a newborn
  • Mothers with a greater emotional investment due to older age, pregnancy loss, or long time period between last baby

 

 

 

 

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