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What is PPD by Tascheleia Marangoni, Founder & Project Manager for PPDA

posted Jan 24, 2011, 4:06 PM by Tascheleia Marangoni   [ updated Jan 25, 2011, 2:05 AM ]

Rather than give an exact text book defintion of what postpartum depression is, what I want to do here is talk about the subject in it's entirety. First off, postpartum depression is not really the correct term. Postpartum depression is one type of Postpartum Mood Disorder that individuals can suffer from in the postpartum period. Others include: postpartum anxiety/panic, postpartum obsessive compulsive disorder and in extreme cases postpartum psychosis. We can define postpartum mood disorders as mood changes that occur following the birth of a baby. They can be anywhere form mild to severe in nature.

Sypmtoms vary greatly and can seem to come out of nowhere. All of a sudden a woman may feel unlike herself: she may have trouble getting out of bed and performing normal daily tasks; her appetite and sleep habits may change; she may experience feelings of sadness, depression, hopelessness, worthlessness, agitation, anxiety and panic; she may have obsessive thoughts and experience abrupt changes in mood and energy level. Sometimes Moms find they feel quite irratible, have difficulty concetrating, making decisions and even suffer confusion at times. Other things are affected as well such as libido. New fears may come into play as well such as: fear of being left alone, fear of impending disaster, fear of hurting oneself or the baby. A common reaction is for a Mom to experience either a lack of interest in the baby or extreme overprotectiveness of the infant. She may have a lack of interest in activities she normally enjoys, a powerful desire to run away, or feel that her life is spinning out of control.

One of the biggest issues with postpartum mood disorders is recognizing them. Not only are they difficult for professionals to diagnose but they are even more difficult for Moms to recognize. For this reason, Women who are expecting and are aware of PPD sometimes worry they might unknowingly develop it. Everyone is suceptable to postpartum mood disorders but some face a higher than average risk of developing one if:
-there is a family history of mood disorders or more specifically postpartum mood disorders
-the individual has experienced depression or other mood disorders in the past
-there is a history of hormonal problems (with PMS for example)
-the individual is a first time mother and/or is quite young
-the baby was delivered prematurely and/or by cesarean or if there were any other complications during the pregnancy and/or delivery
-the new Mom has multiples
-the individual experienced fertility problems prior to conceiving
-the new Mom and her partner are having relationship problems
-the new Mom is experiencing financial stress
-the new Mom is not used to spending a lot of time at home or ends up spending a lot of time alone
-there is a lack of family support or community

Another very important question is why does PPD develop? Aside from some of the risk factors listed above, what can bring on a postpartum mood disorder?
-Hormonal changes after delivery is probably one of the biggest factors. It is interesting that some are susceptable to these changes and others are not; just like some Moms experience awful morning sickness, some just a little and others none at all - everyone has different ranges of sensitivity.
-Sleep deprivation and exhaustion is probably the second biggest cause. It takes awhile just to recover from the sometimes days spent in labour and delivering. After that, it does not matter how good the little bundle of joy is, he/she will inevitably disrupt his Mom's sleep schedule. Plus I think a lot of Moms do not realize how tiring it is simply looking after a little person day in and day out. All of these factors add up to fatigue and sometimes exhaustion.
-Depletion of nutrients can also be another contributing factor. Maybe not enough to cause a problem on it's on but in combination with other things, if a new Mom's nutrient stores have run low in some areas this can have big affects on her mood.
-Feelings of overwhelment due to new responsibilities of Motherhood. Most of us do our best to prepare for the arrival of our new baby based on what we have read, advice from family and friends and our own personal experiences in life. At the same time, there is only so much preparing one can do for such an enormous life event. I have three children myself and with each child, no matter my experience, it was a big adjustment.
-Expectations play a very large role in how someone will adjust to being a new Mom, whether it is the first time or the fitth time. The unrealistic expectations Mothers place on themselves, the sometimes outdated, unrealistic expectations society places on Moms, the expectations Moms place on eachother through competitiveness and how society thinks of PPD are all factors that require change. For more information on this subject please see my article entitled Expectations.

If you are a new Mom or Dad and are feeling unlike yourself or displaying any of the symptoms listed in this article it is a good idea to talk to someone. Talk to your spouse, a friend or a relative but most importantly book an appointment with your family doctor. Even more importantly, remember you are the expert on yourself, if you don't get the help you think you need from one professional or resource, get a second opinion or try something else. Often postpartum depression requires more than one kind of help and time, don't think that one doctor appointment or prescription will solve the problem.

So what are some of the options that can help with postpartum mood disorders?
-Support Groups are an excellant resource. They may not always be easy to find but they are a great place to start if you need some help. Often when a person is suffering from some type of mood disorder they feel very isolated, alone and like they are the only person going through what they are going through. Meeting other individuals dealing with similar problems and knowing that you are not alone makes a world of difference. For similar reasons Moms groups are also a very good resource as meeting other Moms and discussing similar topics of interest can really boost ones mood as well. Of course for someone that is severely depressed, getting out of the house alone can be difficult never mind joining a moms group so take baby steps - you will get there!
-Nutrition and Holistic Health is a worthwhile place to do some researching. There are so many options here for a new Mom such as seeing a dietitian for nutritional changes that can be made to help mood to seeing a holistic practitioner to learn more about supplements. Acupuncture, acupressure and massage are used to help Moms during the postpartum period as well. Just looking after yourself and making sure you eat healthy, drink lots of water and rest when you can makes a big difference. Of course I know from personal experience that this can be much easier said than done; Especially if you are not feeling like yourself or are depressed it seems impossible to do the very things you need. So please reach out and get help from wherever you can.
-Exercise is another part of looking after yourself, especially exercise geared toward the postpartum period. Exercise is also considered to be really good for depression partly due to the endorphins released in the body during exercise.
-Hiring a postpartum doula is another fabulous option if you would like a little extra help at home; that extra help could be all you need!
-Making an appointment to see a Psychologist is also a step in the right direction. Psychologists are very resourceful and compassionate. Sometimes all a person needs is someone to talk to. Psychologists offer not only talk therapy but have many resources at their finger tips and can help to point individuals in the right direction.
-Psychiatrists differ from Psychologists in that they are more like medical doctors, but for the mind and have the ability to presicribe medication. Generally if one sees a Psychiatrist, it is for a shorter period of time and the goal is usually to obtain a prescription for some type of antidepressant. Antidepressants can be helpful when nothing else seems to help and in severe cases of postpartum mood disorders but sometimes simply mask the problem rather than curing it.
-Publications, Books & Websites are very helpful as well in that they are self-help and can be used at home. Publications from your city geared towards Moms and families are filled with all kinds of resources that can be helpful. Books on the topics of pregnancy, postpartum health and postpartum mood disorders are great for those of us who like to research and get to the bottom of things. Websites too can offer a wide variety of resources and information.

Often a combination of the above suggestions will have a new Mom feeling like herself again in a matter of time. Eating healthy, getting rest and exercise, supplements, maybe a few acupressure appointments and a visit to a Psychologist will really help. In more extreme cases however if you are really struggling and are not feeling better over time then please make sure you examine other options. Talk to a Psychologist or Naturopath or book an appointment with a Psychiatrist.

I want to summarize a little bit about the different kinds of postpartum mood disorders:

1. Baby Blues
Something I have not yet discussed in this article as most people are pretty familiar with this concept. Baby blues are for the most part a normal part of the adjustment period after having a baby. Just as the body needs to heal so does all of you. Feeling a bit down or overly emotional or exhausted is to be expected in the first couple of weeks after childbirth. Approximately 80% of new Moms experience Baby Blues within 2 to 6 weeks after having their baby. After the 6 week period it is generally considered to be PPD rather than baby blues.
Symptoms include: mild mood swings including tolerable/manageable anxiety and depression

2. Postpartum Mood Disorders
Depression
Symptoms include: changes in sleep pattern, forgetfulness, changes in appetite, crying spells, unrealistic complaints, loss of interest in favourite activities, tendency to be withdrawn ro uncommunicative, tendency to feel overwhelmed quickly, feeling fearful, low self-esteem, not feeling better when reassured.
Anxiety & Panic
Symptoms include: intense feelings of fear, heart palpitations, fear of heart attack, hyperventalation, chest pains and indigestion, numbing or tingling sensation in hands and feet.
Obsessive Compulsive Disorder
Symptoms include: Obsessive worries about health of the baby and your own health, preoccupation with cleanliness and germs, overprotectiveness of baby, fear of being alone with the baby due to concern of hurting him/her, repetitive/obsessive thoughts.

3. Postpartum Psychosis
Postpartum psychosis is very rare, experienced by less than 1% of new Mothers. It is the most extreme form of postpartum mood disorders and can begin only days after delivery. Postpartum psychosis can display similar symptoms to PPD as well as the following
Sypmtoms include: Hallucinations, manic episodes, disconection between actual and perceived events.

Another condition that can sometimes arise after childbirth is Postpartum Post-Traumatic Stress Disorder. Sometimes what transpires during labour and delivery has been so traumatic for the new Mom that she experiences post-traumatic disorder just as a person might after any other traumatic event such asa a car accident or war.
Symptoms include: flashbacks to event, nightmares, feelings of helplessness, feelings of fear, panic attacks.

Other terms used to refer to postpartum mood disorders or postpartum depresison include: Postnatal depression, perinatal depression, postpartum adjustment, postpartum exhaustion.

So in knowing all of this, how do we prevent postpartum mood disorders? Can we? I am far from an expert but I don't think we can prevent them entirely, we can however lessen their effects if they do occur. By being aware, informed and living a healthy lifestyle I think we can stay on top of PPD. Awareness and information is really the key so that other new Moms and young Moms can be much more prepared for PPD should it happen.

Tascheleia Marangoni

References

How to Make a New Mother Happy
A Doctor's Guide to Solving Her Most Common Problems - Quicly and Effectively
by Uzzi Reiss, M.D., OB/GYN & Yfat M. Reiss

The Mother of All Pregnancy Books
by Ann Douglas

Internet Research.

My own personal experiences with PPD.

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