Postpartum Mood Disorders (PPMD)EI Training May 7, 2012

Karen Fairchild,

LCSW

Postpartum Depression in Women “I have trouble eating and sleeping. I

feel lonely, sad, and don’t have the energy to get things done. Sometimes I don’t even want to hold my baby. If this supposed to be the happiest time of my life, why does everything feel so wrong?”

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Postpartum Depression in Men? Yes! 10.4% of men between the first

trimester of their wife’s pregnancy and the child’s first birthday (about twice the general rate)

Testosterone drops in men Loss of sleep Added responsibilities Economic stressors Depressed wife

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Mild, Moderate, Severe Baby Blues Postpartum Depression Postpartum Psychosis Can occur up to two years following

childbirth

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Baby BluesUp to 85% of women

Occurs during the first few weeks following birth

It is normal but often unexpected Caused by hormonal shifts May not feel bonded to baby Typically begins 2-3 days following

birth

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Fluctuation of mood Lack of concentration Fatigue Teary spells Anxiety Woman feels down, irritable, or just off “Hassles Intensity”—Arnold Lazarus

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Postpartum DepressionUp to 27% of women

Onset often gradual; can occur anytime during first year

Qualify for diagnosis of Major Depressive Disorder (with Postpartum onset)

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DSM-IV Symptoms of Major Depressive Disorder with postpartum

onset

Must have 5 or more symptoms in a two week period, a distinct change from previous functioning and must include either symptom 1 or 2

1.Depressed mood most of the day/irritable

2.Markedly diminished interest or pleasure in previously enjoyed activities

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3. Significant weight loss or weight gain4. Insomnia or hypersomnia5. Psychomotor agitation or retardation6. Fatigue or loss of energy7. Feelings of worthlessness or

excessive or inappropriate guilt

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8. Diminished ability to think or concentrate, indecisiveness

9. Recurrent thoughts of death

Important to note that the depressed person may or may not recognize the symptoms

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“I was so excited I decorated the nursery months before the baby arrived. But when she came, it was not a dream. I had no energy to smile or even to cry. I didn’t even want to pick her up. This was not how I thought it was going to be, and I was ashamed of how I felt.”

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Postpartum PsychosisOne or two in 1000

Extreme confusion Hopelessness Cannot sleep Distrusting of people (paranoia) Seeing things or hearing voices that

are not there Thoughts of hurting themselves, the

baby, or others12

This is a medical emergency and requires urgent care!

Suicide rates increase 44% in the postpartum year

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Other Common Mood Disorders and Factors Anxiety/Panic Disorder/OCD Manic/Bipolar Phases Progressive Postpartum Depression Excessive Guilt Shame Child Abuse

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What causes it? Hormonal Changes Other body changes Sleep Deprivation Being overwhelmed by baby Lifestyle change Pressure to be perfect Increased conflict in marriage

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Increased Risk Factors

A traumatic or disappointing pregnancy or birth experience

A history of mental illness or previous PPMD

Medical problems with mom or baby Social isolation and stress Sleep difficulties

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Poor support system Relationship difficulties Changes in job, financial income, a

recent move History of eating disorders Thyroid disease Contraception and depression history

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Multiples Unresolved losses History of sexual or physical

abuse or neglect Perfectionistic personality Challenging baby

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What are the effects on the baby? Babies born to depressed moms have a

greater chance of arriving too small and too early.

Depressed parents are less successful at reading their baby’s cues. This leads to withdrawal or overstimulation in the baby.

Babies can lose sense of wonder and curiosity.

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Less ability to sustain attention in joint play

Less responsive and lack joy The babies don’t explore their

environment as much or experience new events with delight

At three months, baby’s brain waves match depressed mom’s

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What are the long term effects on children? Greater chance of learning disabilities as

they grow older Increased chance of developmental

delays Less ability to self-soothe Lower scores in intellectual development Male children may be more vulnerable to

the effects—Gottman

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What can be done about it?

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Tips for Moms Find someone to talk to about their

feelings Attend a support group Talk with their health care provider Medication Ask for help with caring for the baby

(family, friends, neighbors)

Sleep when baby sleeps, or get someone to watch the baby so they can sleep

Exercise (just getting fresh air while walking with baby is great)

Good nutrition, even if they don’t feel like eating

Relaxation or meditation Get a massage (15 min. from partner)

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Tips to help Baby Get help for mom Care from a non-depressed

caregiver can reverse effects Massage

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How others can help Encourage mom to seek help Offer support and encouragement Listen Allow mom to focus on her own

needs Understand that dad is probably

distressed as well

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Support for Parents

•Parent Support Group, Wednesdays at KOTM, 11:30am-1pm

•Postpartum Support International •1-800-404-7763•www.ppmdsupport.com

•Contacts for Utah

References John Gottman—Bringing Baby Home

Couples Workshop Heidi Koss-Nobel—Executive Director

of Postpartum Support International US Department of Health and Human

Services—Booklet on Depression During and After Pregnancy

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