Baby Blues or Post Partum Depression? When and What to Do?
By Dr. Cathy Moser
Although there is much information indicating that men also suffer from Paternal Postpartum Depression (PPPD), this article will focus on women (sorry guys - I don't mean to diss you..... if you would like to hear more about PPPD - send in your request to our fearless and fantastic publisher, Susan Rykiss, and I will oblige!)
In the past years, there have been some very high profile cases of women with Postpartum Depression (PPD) that have had very tragic outcomes. This is a terrifying thought for pregnant women - but don't panic.
While the very mild and transient form of the baby blues are very common (50% - 60% of women), Postpartum Depression only occurs in about 10% - 15% of the population, and the type of Psychotic Postpartum Depression that reflect the high profile cases occurs in only 0.1% to 0.2%. In the most severe cases of PPD, we have heard of mothers who have harmed their children or themselves. These cases most likely reflected very extreme cases of untreated or poorly treated PPD that evolved into a Psychotic Depression. Psychosis is a condition where individuals experience hallucinations and/or delusions that they believe are real - sometimes acting upon 'voices' that tell them to engage in harmful behaviour. You may wonder how this could possibly happen - how a woman who is so much looking forward to the most exciting event of her life could possibly have malevolent thoughts about such an innocent, beautiful, and completely vulnerable and innocent little being.
Our thoughts (both real and delusional) are regulated by neurotransmitters. These are substances in our brain (like serotonin and dopamine) that transmit messages from one cell to another. Having a baby throws our bodies and our lives off balance (at least temporarily) and this imbalance can wreak havoc with the biochemistry of our brains. Depression (and in the extreme cases, psychotic thoughts) can result from a state of neurotransmitter imbalance. Unfortunately, from a biological perspective, the postpartum period is a perfect storm for some women. The following are the risk factors that make up the storm - accompanied by a very basic prevention strategy:
- First - hormones. For women who are the biological mothers of their children - their bodies go through cataclysmic hormonal tsunamis from the moment of conception through birth/nursing/return to menstrual cycles - and beyond. Women who have children through adoption can also go through biological changes and Depression - but the mechanisms are a little different. Hormones hugely affect neurotransmitters and can throw the balance off in a flash - which is why females are most prone to Depression around the time of puberty, childbirth, and menopause (times of significant hormonal flux). IMPORTANT TO KNOW - check your family history to see if there is a history of Depression, and know that you may be vulnerable if there is a strong history. Preventive Practice: knowing your vulnerability factors makes it more likely that you will be prepared to recognize and appropriately treat PPD if it occurs. It is important to talk to your partner and your loved ones about the way you feel. If the baby blues continues too long or is too intense, it is critical to discuss treatment options with your Physician.
- Second - sleep deprivation throws off the neurotransmitter balance in both women and men - regardless of childbirth. Typically, the downside of sleep deprivation is offset by the excitement (and adrenaline production) of having a new baby. However, with ongoing deprivation and maybe adding in a colicky child, family stress, etc. - the teeter-totter can plummet and hit rock bottom quickly. Preventive Practice: Make sleep a priority! Do everything you can to get as much sleep as possible. Give up all expectations of yourself beyond basic care for you and your child. It's a perfect time to tell all of the people that deplete you that you need to take a break and to ask those that nurture for support. Open your home to friends and allow them to cook for you, take care of the baby in the morning, shop for you - whatever. It is not a sign of weakness and you are not imposing! Your friends will love to hold the baby - in fact, if you need a babysitter for your infant - give me a call. I love babies! If you can't sleep because your body won't let you - consult with your Physician.
- Third - having to care for other children. Often, after the birth of the first child, PPD is mild and is thought of as a slight case of the baby blues. However, the combination of the hormonal changes and the stress of meeting the needs of your other children, family, etc. can be overwhelming. Add in a little self-doubt and insecurity, some guilt because you cannot completely meet your younger child's needs, and the fact that there is no time to replenish yourself - and the perfect storm erupts. In fact, often, you wind up cutting out those replenishing activities that are best for restoring biological balance (e.g., exercise, yoga, meditation, sitting by yourself without little people poking you, screaming babies, and a partner that looks at you helplessly like they just wandered in from the twilight zone). PPD is often first noticed after a second child - and retroactively diagnosed because it was mild with child number one.
- Preventive Practice: Call in the troops - friends and family to transport your older child to their activities and to take them out to fun events (they're having fun - you don't have to feel guilty!). Try to remember that at some point in time, one child will accuse you of favoring the other child REGARDLESS of how amazingly wonderful a parent you are. So you might as well let go of the guilt now. REPEAT AFTER ME: I am doing the best I can at this moment in time. Let it go!
WHAT TO DO IF THE PREVENTION PRACTICES ARE NOT ENOUGH?
It is not unusual to feel exhausted, vulnerable, a little anxious, sad, and to even cry occasionally in the days and weeks after you have a baby. Talk to you loved ones about the way you feel. If the feelings persist and you feel detached from your baby- then it is time to consult with your Physician and another mental health professional (like a Counselor, Social Worker, or Psychologist). If you have suicidal thoughts, it is critical to call the crisis line (204-786-8686) or 911.
If you are a friend or family member who notices the baby blues - be there, listen, take away the guilt, step up the support, and monitor closely. If there is a significant change in mom's well-being, it is important to be assertive, and if necessary, to take over (insist on getting help and monitoring the situation 24/7). Signs that you must step in include finding your loved one crying frequently throughout the day, disoriented, confused, unkempt, seemingly detached from the baby. And, if crisis proportions are reached - it is important to take more substantive action - like calling the Mobile Crisis Unit or taking mom to the Crisis Response Centre at 817 Bannatyne Ave (204) 940-1781.
As I said in the beginning, though - if PPD is recognized and treated properly when it starts, crisis is completely avoidable.
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