Postpartum depression (PPD) has been in existence since the dawn of civilization. Hippocrates and other doctors documented symptoms akin to modern-day postpartum depression. But it was only until recently PPD has been acknowledged widely as a real illness deserving of treatment.
Still, postpartum depression isn’t separately recognized by DSM-IV. DSM-IV stands for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. It’s a manual published by the American Psychiatric Association that includes all mental disorders currently recognized.
Rather than a separate diagnosis, patients with postpartum depression must meet certain criteria for both major depressive episode and postpartum onset specifier.
Criteria for major depressive episode include having depressed mood, significant weight loss, insomnia, fatigue, etc. It’s the criteria for postpartum onset specifier that makes seeking treatment more difficult.
The criterion for postpartum onset specifier is that patients must have a major depressive episode within 4 weeks after delivery.
Why is this a problem? It is widely accepted that postpartum depression can happen anytime within the first year of giving birth. But because DSM-IV says otherwise, many women report being told by their doctors that they don’t actually have postpartum depression, if they’re experiencing the symptoms well after the first 4 weeks.
If mood swings, anxiety, irritability, loss of self, and negative feelings towards the baby aren’t signs of postpartum depression if they don’t happen within 4 weeks after delivery, there should be another explanation for those symptoms. There currently aren’t.
Fortunately for you, many medical professionals recognize postpartum depression symptoms even if they don’t strictly meet the DSM-IV’s criteria. They’ll set up a treatment plan accordingly.
For that to happen though, you have to come to terms with your feelings and be ready to discuss them.
PPD has gotten more publicity in the recent years. As a result, many women are aware of their symptoms. But they still may feel reluctant to seek treatment. Why is getting treatment for postpartum depression so hard?
The answer is judgment.
It’s a classic case of “damned if you do, damned if you don’t.” Today’s mothers face more judgment than ever. Everyone seems to want to have a say in your mothering ways. Sometimes the media fuels these arguments.
- Working mothers vs. stay-at-home moms
- Breastfeeding mothers vs. formula moms
- Natural birthing mothers vs. C-section moms
These are just a few examples of how mothers are pitted against each other, dissected and judged in today’s society.
While postpartum depression is not an unknown phenomenon, it’s currently estimated less than a quarter of new mothers experience it. Most mothers will have what’s known as the baby blues, which go away after two weeks without intervention. Feelings of irritability and anxiety are normal baby blues, but only for a short period of time.
Since the majority of women won’t experience postpartum depression, no wonder those who do, feel like they can’t admit it. They fear judgment from their non-depressed counterparts. If most mothers feel perfectly normal after the baby blues, admitting you’re having possible issues with bonding with your baby may raise some eyebrows.
In the press, postpartum depression gets negative coverage. While many celebrities have come forward and discussed their experience with PPD openly, they’re forgotten easily in favor of the “moms who kill,” like Andrea Yates who drowned her five children in their bathtub.
Such a sensational approach to postpartum depression makes it even more reluctant for women with PPD to come out of the woods. They fear being labeled as potentially wanting to hurt their children. Who would want that?
Treating Postpartum Depression
Like any other clinical depression, postpartum depression responds well to psychotherapy and medications. It’s generally suggested that you undergo psychotherapy first, before attempting antidepressant drugs. If your PPD doesn’t improve after 8 weeks of starting therapy (12 weeks at the latest), it’s time for you to explore antidepressants.
Psychotherapy is an overarching term for treating mental health problems with a professional, whether it is a psychologist, psychiatrist, or other mental health provider. As with other medical conditions, treating your PPD starts with finding the right therapist.
How do you find the right doctor or therapist? The most important thing is the connection. Your therapist is your confidante, so there must be a certain level of rapport. If you can’t find that with your therapist, it’s perfectly reasonable to move on. You also may want to look for someone who specializes in postpartum depression patients, rather than other issues like alcohol or drug abuse.
There are different kinds of psychotherapy and many therapists use a mix of styles. If you’re looking for a certain style, be sure to ask what your therapist what his/her approach to treatment is.
Here is the overview of different types of psychotherapy used in treating postpartum depression:
Cognitive Behavioral Therapy (CBT): According to the Anxiety and Depression Association of America, this type of therapy works best in treating postpartum OCD, or obsessive-compulsive disorder. Postpartum OCD symptoms may include constantly needing to “do stuff,” whether it’s cleaning the baby, cleaning yourself, or cleaning the house. You may also constantly worry about everything, seeing or hearing threats that don’t exist.
A CBT therapist helps you distinguish realistic and false threats. He/she may use homework, thought stopping, relaxation, and mental imagery to replace your irrational thinking with something more grounded in reality.
Interpersonal Psychotherapy (IPT): IPT is a type of treatment with specific time limit, usually 12 to 16 weeks. It has shown to be at least as effective as using antidepressants when treating postpartum depression. The principle of IPT is that there is a relationship between how people interact with others and their mental health.
IPT’s goal is to reduce depressive symptoms and improve social adjustment. That makes sense since pregnancy, childbirth, and caring for a newborn all bring sudden changes to your body and mind, often at the same time. You may feel unattractive about your body and fear social exclusion and judgment from your peers. IPT addresses these issues, as well as any struggles you may have with your partner.
If you’re suffering from extreme symptoms of PPD bordering on psychosis, IPT alone may not be enough. A combination of medications and hospitalization is considered in this case.
Dialectical Behavior Therapy (DBT): This type of therapy was developed in the 1980s to address personality-related disorders, particularly borderline personality disorder. It has since been expanded to treat other mental health issues, including postpartum depression.
DBT is cognitive-based, which means it works by helping you identify your thoughts and beliefs that contribute to your depression. Then it uses collaborative efforts, often in a group setting, to work on a variety of skills. These skills are: interpersonal effectiveness, distress tolerance, emotional regulation, and mindfulness skills.
Psychodynamic psychotherapy: This is probably what people think of the most when they hear the word “therapy.” It’s based on a belief that your past experiences as a child have a direct impact on your present distress.
One of the risk factors for postpartum depression is a family history of depression. If either of your parents suffered from PPD, this likely spilled over to your upbringing and affected you. Psychodynamic psychotherapy encourages you to go over these experiences, identify beliefs that work against you, and relieve tension that way.
Eye Movement Desensitization and Reprocessing (EMDR): This therapy is geared more towards people suffering from postpartum PTSD, since many women experience trauma while giving birth. EMDR was a controversial method in the past, but since 2004, it has become a recommended treatment by several reputable entities.
Couples Therapy: There are risk factors that make some women more susceptible to postpartum depression than others. Poor marital relationship is one of them. In this case, whether you’re married or in a domestic partnership, you and your partner can benefit from couples therapy.
Maintaining connection and intimacy is particularly challenging after childbirth. Couples therapy will address the changing dynamics post-baby and what partners should expect from each other.
Group Therapy: This type of therapy focuses on building a community. As mentioned earlier, fear of judgment makes women reluctant to seek treatment for postpartum depression. If you’re one of those women, being amongst people who have similar goals – recovering from PPD – will be beneficial.
In some cases, psychotherapy alone doesn’t alleviate symptoms. If your condition doesn’t improve after 8 to 12 weeks, or until you complete your therapy, you’ll want to seek additional treatment. That’s often in the form of antidepressants.
Antidepressants are common but have a negative image. They simply exist to help balance your brain chemistry. There are of course side effects you should be aware of. But in the case of postpartum depression, they’ve proven to be effective, especially in combination with psychotherapy.
You’ll most often be subscribed something from a class of antidepressants called selective serotonin reuptake inhibitor, or SSRIs. SSRIs increase serotonin, one of the “happy” hormones, in your brain. Common SSRI brands are Prozac (fluoxetine), Zoloft (sertraline), Lexapro (escitalopram), and Paxil (paroxetine). There doesn’t seem to be any significant difference among different brands of SSRIs.
If you’re breastfeeding, taking SSRIs may concern you. Your baby might have short-term exposure to the drugs. Despite this, many researchers recommend you stay on your antidepressants. The reason is that you’ll actually have an easier time breastfeeding your baby if you treat your depression.
Tricyclic antidepressants (TCAs) are an older class of drugs. TCAs prevent the absorption of serotonin and norepinephrine, making more of these chemicals available in your brain. Some common TCA brand names are Sinequan (doxepin), Elavil (amitriptyline), and Pamelor (notriptyline).
Unlike SSRIs that are deemed safe for breastfeeding, there are cases against using TCAs if you’re breastfeeding. Doxepin can pass to the child through milk. The American Academy of Pediatrics classifies doxepin as “whose effect on nursing infants is unknown but may be of concern.” As for other TCAs, there has been no study done or the results are inconclusive.
As a breastfeeding mother, you’ll be tempted to lean against taking antidepressants just in case. But it’s important to take a long-term view of what foregoing treatment for your depression can do. In one research, babies with depressed mother scored low on social engagement, fear regulation, and physiological stress reactivity. You’ll have to be the judge of what’s more important.
Psychotherapy on its own or combined with antidepressants will yield best results in treating your postpartum depression, but there’re many things you can do on your own to improve your symptoms.
Joining a support group is highly effective in keeping your PPD in check. You’ll be amongst like-minded individuals who share the same condition and can understand what you’re going through. You’ll be in an environment free of judgment, particularly helpful if you’re dealing with a lot of judgment from your friends and family.
Regular exercise is another helpful option. It’s logistically hard, since you’ll be watching a newborn that needs care 24/7. Enlisting your spouse’s help is critical for this method to succeed. Exercise increases your feel-good hormones, like endorphins and serotonin. Your sleep quality will improve as well as your cognitive ability.
Many ailments in life can benefit from eating well, getting rest, and moderate exercise. Postpartum depression is no exception. Although these tips are obvious, they take a lot of effort to follow. You’ll often feel you lack time or motivation to stick to a diet or exercise. And sleep? What’s that? Sleeping when the baby sleeps is easier said than done. All you can do is try your best.
As a new mother, the faster you recognize there are unrealistic expectations about motherhood, the better. You can’t do it all, contrary to what some people think. There’s no shame in asking for help in doing chores, preparing meals, or caring for the baby.
It’s also important to recognize that while the methods above are good lifestyle habits to have in general, they don’t substitute medical intervention. PPD is a real illness that can’t be treated on your own. For faster recovery, you can combine psychotherapy, medication, and good daily habits, but habits alone won’t make your symptoms go away.
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