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?” 2

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 3

Mild, Moderate, Severe Baby Blues Postpartum Depression Postpartum Psychosis Can occur up to two years following childbirth 4

Baby Blues Up 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 5

Fluctuation of mood Lack of concentration Fatigue Teary spells Anxiety Woman feels down, irritable, or just off “Hassles Intensity”—Arnold Lazarus 6

Postpartum Depression Up to 27% of women Onset often gradual; can occur anytime during first year Qualify for diagnosis of Major Depressive Disorder (with Postpartum onset) 7

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 8

3. Significant weight loss or weight gain 4. Insomnia or hypersomnia 5. Psychomotor agitation or retardation 6. Fatigue or loss of energy 7. Feelings of worthlessness or excessive or inappropriate guilt 9

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 10

“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.” 11

Postpartum Psychosis One 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 others 12

This is a medical emergency and requires urgent care! Suicide rates increase 44% in the postpartum year 13

Other Common Mood Disorders and Factors Anxiety/Panic Disorder/OCD Manic/Bipolar Phases Progressive Postpartum Depression Excessive Guilt Shame Child Abuse 14

What causes it? Hormonal Changes Other body changes Sleep Deprivation Being overwhelmed by baby Lifestyle change Pressure to be perfect Increased conflict in marriage 15

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 16

Poor support system Relationship difficulties Changes in job, financial income, a recent move History of eating disorders Thyroid disease Contraception and depression history 17

Multiples Unresolved losses History of sexual or physical abuse or neglect Perfectionistic personality Challenging baby 18

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. 19

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 20

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 21

What can be done about it? 22 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) 23

Tips to help Baby Get help for mom Care from a non-depressed caregiver can reverse effects Massage 24

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 25

26 Support for Parents Parent Support Group, Wednesdays at KOTM, 11:30am- 1pm Postpartum Support International 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 27