Dear New Moms,
Mood and anxiety disorders take a tremendous toll on the individual woman. There are consequences for those who love and depend on her. Motherhood is a tough gig. When a mother is suffering, the basic tasks of caring for an infant or older child are daunting. Emotional wellness is essential for a mother to meet the emotional needs of her children.
Maternal depression at any time affects the woman and her entire family. Postpartum depression is especially complicated. Factors include a major life transition, recovery from childbirth, sleep deprivation, hormonal changes,and the incredible neediness of the human infant. At best, a new mother is profoundly exhausted. At worst, she is faced with a marathon of monumental tasks of extreme importance when she is ill. Meeting the physical needs of a newborn baby is only part of the job. Perhaps the most important part, the most difficult for moms who are suffering, is what is supposed to be the fun stuff. A baby needs mom to fall in love, bond and attach, snuggle, sing and play. She needs to engage the new baby in this new central relationship that will foster security and help him or her lay a foundation for a healthy sense of self and future relationships. This is a tall order for a woman who is not herself due to a mood or anxiety disorder.
The consequences of a mother's depression upon her children are well-studied and well-documented. The consequences of depression among mothers and fathers are important, but maternal depression has received a larger amount of study. Negative effects observed in children when mothers have untreated depression are virtually global across areas of child development. These include problems with bonding and attachment, relationship problems later in life, poorer neurocognitive development, behavioral problems and risk of depression and other psychiatric disorders. The long-term impact of anxiety disorders has received less attention, but it stands to reason that a mother's untreated anxiety will also effect her children.
The impact of the treatment of a mom's depression has been recently and dramatically demonstrated. In a pivotal study, investigators assessed children of mothers participating in a treatment study for major depressive disorder (MDD). In the large, national STAR*D study (Sequenced Treatment Alternatives to Relieve Depression), mother and child pairs were assessed as the mother entered and underwent treatment for MDD. Children participated in assessments when their mothers started treatment and had repeated assessments for up to one year. Children did not receive any mental health treatment during the course of the study.
Of the mothers who participated, almost half responded to treatment within three months. Children of women who responded to treatment experienced a significant reduction in psychiatric symptoms and diagnosable psychiatric disorders. On the other hand, children of mothers who did not respond to treatment experienced a slight increase in symptoms and diagnosable conditions. The results were similar at one-year follow-up. These data demonstrate that successful treatment of a mother's depression has important beneficial consequences for her child's emotional well-being.
In the above study, the first treatment offered was medication. The key, however, does not appear to be the choice of treatment but the response to it. Therefore, the take-home message to mothers is to pursue treatment until they feel better, back to themselves, free of symptoms. Treatment should be individualized for her specific needs and preferences, and my include psychotherapy, medication, other treatments and often combinations of treatments.
Sometimes women have difficulty seeking or accepting help. They may feel guilty about taking the time to see healthcare providers or other activities that support their own wellness. Many women feel shame around having depression or another psychiatric disorder. It is important to remind mothers that taking good care of themselves is good for their children. In the midst of a depressive episode, some women will not feel motivated to care for themselves but would do absolutely anything for the well-being of their children.
If you are a mother who is suffering from a mood or anxiety disorder and has put off seeking help, know that taking good care of yourself and recovering is of great importance for your children. It also role models self-esteem. Would you not hope that your child would seek help if he or she were suffering? Depression, anxiety, shame and self-doubt can get in the way of valuing your own health simply because you are worth it. If that is the case, take care of yourself now for your children. You can look forward to the day when you will appreciate your own recovery and value your own wellness. That will be a great Mother's Day.
Marlene P. Freeman, MD, is a psychiatristwith Massachusetts General Hospital's Center for Women's mental Health. Shealso serves as vice-editor-in-chief of the Journal of Clinical Psychiatry and chairs the American Psychiatric Association's Task Force on Complementary and Alternative Medicine.