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It is now recognized that mothers, fathers, and adoptive parents can experience a range of mood disorders in the postpartum period beyond depression. These Postpartum Mood Disorders (PPMD) differ from the "baby blues" in that they last beyond the first 2-3 weeks postpartum, and the symptoms are more severe and more diverse. Not only does this interfere with the family's enjoyment of their growing family, but it also interrupts the parent-infant bonding process. PPMD can also have a late onset, sometimes not appearing until several months postpartum. Since PPMD are linked with hormonal changes, they can also resurface when there is another significant hormonal change, such as weaning from the breast or the return of menstruation. The sooner the mother gets good quality professional help, the better, as it has been shown that the longer a mother suffers from untreated Postpartum Mood Disorders, the longer her recovery period, which can extend into years in some cases. The most effective treatments involve a combination of counseling, social support, and in some cases, medical treatment. Breastfeeding is compatible with many medications used to treat Postpartum Mood Disorders; be sure to consult a physician that is current with information on lactation and medications. Risk factors for Postpartum Mood Disorders include: • History of Bipolar Disorder in self or family • History of Depression in self or family • History of Postpartum Depression in self or family • History of Anxiety Disorder in self or family • History of Premenstrual Syndrome • History of eating disorders • Thyroid disease • History of insomnia or not receiving at least 2 blocks of 3 hours of REM sleep per night in the postpartum period • Traumatic or disappointing childbirth experience • Unresolved losses (especially reproductive in nature - i.e., miscarriage, infertility, abortion) • History of sexual or physical abuse or neglect • Recent stresses (i.e., an illness in self/family, divorce, a move, a change in jobs, death, change in financial status, etc.) • Perfectionist personality; highly task oriented; inflexible • Isolated (lives far from family, few if any friends or peers with children) • Relationship struggles with partner • Relationship struggles with mother • Relationship struggles with the baby (i.e., colicky, high needs, temperament differences, illness/injury, developmental delays) Symptoms of Postpartum Mood Disorders Depression • Feelings of despair/hopelessness • Crying, tearfulness • Anger and irritability • Sleep disturbances (too much/little) • Loss of energy and interest • Physical symptoms (clumsiness, slowed speech, etc.) • Suicidal thoughts • Frightening thoughts about self, baby or other family members • Weight loss or gain • Feelings of guilt, shame, inadequacy • Hypochondria, excessive worries Bipolar Disorders (formerly referred to as Manic-Depressive Disorders) Although Bipolar Disorders are not technically classified as Postpartum Mood Disorders per se, it is important to understand the serious impact of these disorders in the postpartum period. Approximately half of all women who have Bipolar Disorder are first diagnosed postpartum. Bipolar Disorder has two subcategories, Type I and Type II. Bipolar Type I presents periods of depression and mania in which the patient may experience psychotic episodes and lose touch with reality. Bipolar Type II differs in that the patient remains lucid throughout the swings of depression/mania and the manic times are often characterized as very productive, high energy moments when the patient feels quite good. Bipolar Type II can easily be misdiagnosed as depression, as the manic times feel so normal and good. If a bipolar condition is misdiagnosed and treated as depression, the resulting medical treatment of prescribing only antidepressants can potentially have serious consequences by causing a rapid-cycling manic episode which may require hospitalization in some cases. Thus, it is critical that the patient reviews her own as well as her family history for Bipolar Disorder, as well as seeing a professional that is very well trained in Postpartum Mood Disorders and Bipolar Disorders. Mania (part of Bipolar Disorders) • Feel great/high energy • Irritability • Decreased need for sleep/insomnia • Feeling "speedy" • Easily distracted • Mind racing, cannot shut off thoughts • Pressured, fast speech Anxiety/Panic • Muscle tension • Chest pain • Shortness of breath; choking sensation • Hot/cold flashes • Tingling hands/feet • Agitation/restless • Fear of dying • Fear of going crazy • Faintness • Irritability • Anger/rage • Fear of being alone, fears about baby's health, agoraphobia • Feeling trapped, immobilizing guilt • Racing heartbeat • Hyperventilating • Nausea/vomiting • Diarrhea • Dizziness Obsessive-Compulsive Disorder • Recurring, persistent and disturbing thoughts, ideas or images (scary images of accidents, abuse, harm to baby) • Ritual behaviors done to avoid harming baby (e.g., put away knives) or to create protection for baby (e.g., don't leave the house), constantly checking the baby, house, etc. • Intrusive thoughts, fears, images • Person cannot control thoughts • Person understands that to act on these thoughts would be wrong • Hypervigilant (e.g., can't sleep for fear that something will happen to baby/ constant "fight or flight" mode) Post-Traumatic Stress Disorder (usually occurs quickly after birth) • Previous trauma (recent or in the past - abuse, accident, etc.) • Feeling of anxiety when exposed to situations similar to the trauma • Sensations of "being in the trauma" now • Nightmares • Emotional numbing/detachment Psychosis (very rare)* • Paranoia • Delusions (often about baby) • Hallucinations • Irrational thoughts • Impulsivity • Refusal to eat • Poor judgment • Lack decision making abilities • Break with reality • Severe insomnia • Confusion • Higher risk if Bipolar Disorder in self or family *Requires immediate treatment often including hospitalization and medication. Treatment Treatment for the different Postpartum Mood Disorders varies, depending on the type and severity of symptoms. All of the symptoms, from the mildest to the most severe, are temporary and treatable with skilled professional help and support. A woman experiencing any of the symptoms described above should contact her health care professional. She should have a complete medical evaluation, including a thyroid screening. The "ideal" treatment plan includes: • Medical evaluation (to eliminate physiological causes, i.e. thyroid) • Psychotherapy • Psychiatric evaluation and medications, if deemed appropriate • Participation in a support group for emotional support, connection, and education You should be aware that there are certain medications that are considered safe for nursing mothers. If necessary, a knowledgeable prescriber will be able to assess and determine a medication that is right for you. Reaching out for the proper help is an important step toward recovery. If you are experiencing the symptoms described above, do not continue to suffer in silence. Share your concerns with your health care professional and get in touch with us at 1-888-404-7763 (PPMD). |
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P.O. Box 15535 Seattle, WA 98115
Toll-Free Support Line: 1-888-404-7763 (PPMD)