STORY BYAn obstetrician and psychiatrist discuss the rollercoaster ride of new motherhood.
The progression from depression during pregnancy to baby blues and then postpartum depression is part of a continuum, says Dr. Rahn K. Bailey. Postpartum depression may be triggered by plummeting hormones after the baby is born, but anxiety and sleep deprivation fuel the condition and create a serious mental and physical health problem. As the hormones drop, there is also a decrease in serotonin, a chemical in the brain that acts as a messenger and affects mood.
“What happens to women postpartum is a form of clinical depression and results from the stressors in a woman's life during pregnancy that are beyond her ability to handle,” explains Bailey, a clinical assistant professor in the Department of Psychiatry and Behavioral Sciences at The University of Texas Health Science Center at Houston (in 2003). He is also a staff physician at the Harris County Psychiatric Center (HCPC). “The depression becomes worse after delivery if appropriate measures are not taken to address them as well as the complications.”
Stressors can include the new mother seeing the baby as another job added to her already long list of chores. Having a non-supportive spouse or significant other who makes many demands of her and views the baby as “woman’s work” can be a major stressor. The new mother may have financial demands and needs to return to work sooner than she wants to because the money is needed for food and rent.
Symptoms of postpartum depression include constant fatigue, lack of joy in life, withdrawal from family and friends, severe insomnia, excessive concern for the baby, severe mood swings, and loss of sexual interest.
“After the delivery, the new mother may experience some changes she had not expected. She may experience fatigue, exhaustion and lack the energy to accomplish the tasks she was doing before the pregnancy. If this is the case, she will begin to have a lower self-esteem about her abilities,” observes Bailey, who is the director of UT-Houston’s program on Law and Psychiatry.
This feeling of depression and hopelessness could be worsened if the baby needs to be held or cries more, has colic or needs more breastfeeding. If these stresses on the mother go on, her postpartum depression could develop into a psychosis.
A psychiatric illness often begins with a mild anxiety resulting from the stressors. If this mood continues, the next level is depression, during which women do not sleep or eat and may cry a lot. A third level is volatile swings of emotion or manic depression. The woman uses poor judgment and tries to do many things at once, none of them successfully.
The fourth level is psychoticism, characterized by totally inconsistent thoughts and actions as well as hearing voices. Andrea Yates, the mother who drowned her five children, is an example of this conflicted thinking. She had reached the worst form of psychoticism – when the patient, through reasoning that is illogical to everyone else, believes she has to kill herself or somebody else.
Symptoms of postpartum psychosis, which can begin days or weeks after childbirth, include severe depression, acute anxiety, fear of harming yourself or your baby, hallucinations, paranoia, hysteria, and irrational thoughts.
When a patient comes in with anxiety, the
psychiatrist begins with the belief that this condition will be short-term
and temporary and will require mild management. “I spend time
talking to patients first. Medications are worked out carefully because
there are some that, if taken long-term, the patient will become
dependent. I might treat a patient with a medication for two weeks
or maybe 30 days to decrease the anxiety,” he says.
There are 20-25 anti-depressant medications on
the market. Many have been around for years. Then 15 years ago, the
SSRIs (Selective Serotonin Reuptake Inhibitors, such as Prozac, Paxil,
Zoloft, among others) came along. They work in the brain by regulating
the amount of serotonin, among other brain chemicals that circulate
too much or too little.
Rapid recovery from postpartum depression depends on early intervention. Treatment
varies according to individual needs but includes individual counseling, anti-depressant
medication for anxiety, and hormone therapy.
Bailey tells his pregnant patients and their families about baby blues and postpartum
depression. He challenges the attitude that a woman should be able to perform
all the tasks she did before the pregnancy as well as care for the baby. He believes
that the time he spends educating his patients as well as others is very important.
UPDATED: 7-28-2003
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For women who want to attend a support group in Houston, Tx, there is a Mom-To-Mom Group that meets every 3rd Thursday at the Columbia-Clear Lake Regional Medical Center, call 281.332.2229.
For information on the Postpartum Adjustment Support Group that meets weekly at Women’s Hospital of Texas, call 713.791.7593.
Make an appointment
with your stress—
and keep it!
Set aside a specified time of day, say 3:00 to 3:20 P.M. Keep this appointment with yourself—make it as important as a client or a child’s reading time.
Now, let the stress pour out of you, all the worry, guilt, what-ifs, if-onlys. Hold nothing back. Imagine every possible scenario that intrudes on you, day and night. Funnel it into that 20-minute period.
When the bell goes off, you are done, finished, until your next appointment with yourself.
When you’re tempted to let stressful thoughts crawl across your mind, remind yourself that you have 20 minutes to address them—tomorrow.
