I was recently asked to put together a list of things women should know about postpartum depression. I thought a lot about what I went through in 2001 with postpartum OCD, and the things I wish I had known that I believe would have lessened the severity of my experience. While the list below certainly doesn’t cover everything, I think it’s a good start and I hope it will help many women in their journey as new mothers.
PPD can and often does happen.
Many pregnancy books and childbirth educators gloss over postpartum mood disorders. They minimally describe the symptoms and emphasize how rare it is. Actually, 10-15% of new moms experience these illnesses, and some studies report it may be as high as 25%. My childbirth educator told our class that we really needn’t spend too much time worrying about it, so I didn’t, and thus I was completely unprepared for what hit me.
Postpartum depression is only one in a spectrum of postpartum illnesses.
Postpartum mood disorders include postpartum depression (PPD), postpartum obsessive compulsive disorder (PPOCD), postpartum psychosis (PPP) and postpartum post-traumatic stress disorder. PPOCD is often characterized by intrusive thoughts, which are disturbing unwanted thoughts. When I experienced my first intrusive thoughts — about smothering my infant son with the burpcloth — I had never heard of such things. No one ever told me they were possible. I was convinced I had just gone permanently crazy, and it never occurred to me that I had PPOCD. If I had been better informed, I would have felt comfort in knowing what was wrong and that immediate treatment was available. Instead I kept quiet for weeks because I was afraid I’d be locked up forever and lose my family. (For more information on each illness and its symptoms, visit the Postpartum Support International website at http://www.postpartum.net/brief.html )
Symptoms can appear anytime during the first year after birth.
Many women think that if they start feeling bad when their child is 3 or 4 months old, or even older, that it can’t be related to postpartum depression. Apparently, even the DSM-IV, the manual that psychiatric professionals use to diagnose psychiatric illnesses, states that your illness can only be diagnosed as postpartum if the symptoms show up within the first four weeks after birth. This isn’t necessarily true. Postpartum mood disorders can occur any time within the first year after the birth of your baby, though it is true that most are diagnosed within 2 to 4 months postpartum.
Ask your friends and family to be prepared.
It’s important to talk about the possibility that you might experience some form of postpartum mood disorder with the people closest to you. Ask them to educate themselves. Sometimes we can’t see that we’re acting differently, or we try to convince ourselves we’re fine and purposefully ignore our symptoms. In that case, it often takes someone close to us to point out that we might need help. Neither my husband nor my mother knew about what to look for or what to do about it, which made it harder on all of us.
The sooner you get treatment the better.
Many recent studies show that children of mothers with postpartum mood disorders who go untreated for long periods can be negatively impacted over the long term with behavioral problems. A study published in 2006 in the Journal of the American Medical Association (http://jama.ama-assn.org/cgi/content/short/295/12/1389), for instance, found that children of mothers who have received treatment via medication for major depression or anxiety are less likely to be diagnosed with anxiety, disruptive and depressive disorders themselves, compared to children of women who remain untreated. You MUST push past the fear and speak up to lessen the impact of these illnesses on yourself and your children. You must be willing to say how you are feeling and seek treatment so that not only you, but your whole family can heal.
Fantastic article, Katherine! Especially the part about asking family and friends to be prepared. Education is key for everyone, not just the new mom. When I was suffering from PPD, the thing that was most astounding was the fact that my and my husband's extended family members were so clueless (as we were) about PPD, but not only that, they were not supportive at all as we struggled through it. They all thought it was more about me getting out of bed, simply ignoring my depression and taking care of my babies. So, yes, not only does every pregnant woman need to be educated to be prepared for perinatal mood disorders, but their families and friends need to be aware as well in order to provide support.
As always, great post!! Keep it up!!!
Best,
Kristin
Great post!! I think you bring up an important issue regarding onset of depression after delivery. Interestingly, in the current version of the DSM, PPD isn't actually it's own diagnosis, per se. Rather, it's listed under major depressive disorder (MDD) with the option to specify postpartum onset if the depression initially occurred within 4 weeks of delivery.
There has been a lot of discussion in the mental health community about whether this way of diagnosing is appropriate. Some have argued that the depression likely began perinatally and worsened over time, only to be diagnosed postpartum. Others suggest PPD is its own diagnosis with some features that are distinct from MDD. For example, some characteristics associated with MDD are just a function of being a new mother, such as sleep disturbance, weight loss, loss of energy, and difficulties concentrating.
The DSM is currently being revised and I *think* this is on the list of possible revisions. The "current" version is actually 13 years old, and version V isn't scheduled for publication until 2011, so as you can imagine, this isn't the only diagnosis that's out of date. But take heart that the DSM is definitely a guide with a surrounding history of inaccuracies and debate. In version II, homosexuality was listed as a disorder. Change is slow to happen, but it does eventually. As more women like you bring PPD to the forefront, and as health care professionals and researchers work together to better understand PPD, the diagnostic criteria, and thus in my view the treatment, will only improve.
I'd like to email you, but have been unable to do so through your link. Would you please send me your address? Thanks.
"children of mothers who have received treatment via medication for major depression or anxiety are less likely to be diagnosed with anxiety"
That is so true and I am glad that there are such kind of treatments.