Maternal depression, also referred to as perinatal depression, affects many mothers. With the establishment of National Maternal Depression Awareness Month in May, mothers are expected to receive more attention for this mental health issue.
There are four recognized types of maternal depression: prenatal depression, “baby blues,” postpartum depression and postpartum psychosis, according to a fact sheet by the New York State Department of Health and Office of Mental Health. Although all types have similar symptoms, the prevalence rates, some symptoms and time frame of the depressions differ. Some studies also explore postpartum major depression, which is similar to major depression except after pregnancy.
For example, “baby blues” is the least severe, and usually lasts only about two weeks maximum after delivery. It is the most common, and as many as 80 percent of new mothers suffer from “baby blues,” according to the fact sheet. Some symptoms include exhaustion, crying, sleep problems, anxiety and mood fluctuations.
Postpartum depression is becoming more well-known, and it affects 10 to 20 percent of new mothers, according to the fact sheet. Symptoms must last more than two weeks to be considered PPD and not just “baby blues.” There are also more symptoms associated with PPD, such as feeling inadequate or guilty, feeling sad constantly, feeling suicidal, not attaching or bonding to the baby, overly worrying about the baby or not being interested at all in the baby.
Lucy Puryear, a psychiatrist in private practice who specializes in reproductive mental health, is president of Postpartum Support International. She said in an email that the organization officially started the awareness month for the first time this year, and it’s the first time this type of month has been declared by a national organization. The campaign for the month is “Speak Up When You’re Down.”
“We want women who are feeling depressed, blue, or ‘down’ to have the courage and support to let someone know,” Puryear said. “There is help and lots of support out there. Maternal depression does not have to be a silent illness.”
She said the term “maternal depression” was used instead of “perinatal depression” because it’s easier to understand.
“We wanted to use the term maternal depression, because the medically accurate term is ‘perinatal’ but many may not know what that means,” Puryear said. “In medical terms it includes during and after pregnancy. There is a whole spectrum of mood and anxiety disorders that fall under the term ‘perinatal mental health,’ but depression is the illness most commonly talked about and recognized by the public.”
The first step to treating or preventing maternal depression is to tell someone, like a family member, friend or health care professional.
“They can talk with you about what you’re experiencing and refer you to the appropriate professional,” Puryear said. “Support groups, therapy, exercise, good nutrition, adequate rest, and sometimes medication are all useful treatments for maternal depression.”
Although new mothers might feel guilty about maternal depression, she said they have to realize they are not alone and there is help available to treat the depression. There is stigma associated with maternal depression, but the depression is not the mother’s fault.
“Any mental illness is terribly stigmatized, but especially for a new mother, not feeling on top of the world after you’ve had a beautiful baby carries a lot of shame and guilt,” Puryear said. “Women don’t want to admit they’re not feeling as happy as others believe they must be. It can feel terribly isolating to keep the secret that you are feeling bad after you’ve had a baby. Women need to realize depression is not a weakness or a character flaw, it a biological illness that can be treated and it is not something they’ve done that has caused it.”
Diane Sanford, a clinical psychologist specializing in pregnancy and postpartum mental health and other areas, is also the president of Women’s Healthcare Partnership and the co-author of the book “Life Will Never Be The Same: The Real Mom’s Postpartum Survival Guide.” She is the clinical adviser for Mother to Mother, a Missouri phone support program for mothers.
“I think it’s important to have a month devoted to the issue of maternal emotional health because how moms fare emotionally has such a significant impact on their children and families, and if we have to start by focusing on depression, that’s OK,” Sanford said.
She said one way to prevent maternal depression is to monitor stress levels.
“To prevent maternal depression, the first thing is to manage stress wisely, so be aware of when and how stress is affecting you,” Sanford said. “If you start having changes in sleeping, appetite, energy, things like that, irritability, little things bother you … we know that when you get rundown physically, emotionally and mentally, you’re more prone to an episode of depression.”
Self-care is also important in maternal depression prevention, besides self-educating about depression signs and symptoms.
“Self-care includes everything from eating at regular intervals, to getting enough sleep at night, to having social support, to having an opportunity to express positive and negative feelings,” Sanford said. “It’s kind of your whole way of taking care of yourself, body, mind, heart and soul.”
Prevention could include counseling, support, self-care, or even medication.
“The sooner you get treatment, the less severe your depression gets, and the sooner you’ll get better,” Sanford said.
If mothers are clinically depressed, seeking proper treatment is crucial. This may include cognitive behavioral therapy.
“Make certain that again they’re not just treating the chemical part of the depression, but also get help with counseling and what needs to be different in your life, or in how you regard yourself and your life,” Sanford said.
Social support is key to prevention and recovery.
“You also need to make certain that you’ve got adequate social support both in terms of emotional support, but also if you’re like a mom who’s struggling because you’re trying to take care of a newborn, manage your house, make things nice for your partner, you need to reach out to other friends and family that can help you do things as well as support you emotionally,” Sanford said.
Social support, counseling and medication are the main forms of treatment, but mothers also shouldn’t be afraid to ask or look for other help.
“If you don’t think you’re getting the help you need … look at other resources or talk to a different health provider or talk to a different counselor,” she said.
Sanford’s book explains the important of self-care and outlines a program, as well as what to do and how to treat depression.
“Our book is really about preventing and then if you do have depression, what you can do about it, but mostly it’s about staying well, which is really the first step in preventing depression, practicing self-care,” she said.
She first started getting interested in these issues and wrote her book because of her experiences working with mothers through a psychiatrist who had postpartum depression. She also had her own children.
“After I had my first baby, I had some mild depression because I exhausted myself and tried to do too much,” Sanford said. “After that, when I had my second baby, I followed the advice of practicing self-care and making my emotional health a priority, I had no problems, I had a great adjustment to motherhood, I had a wonderful experience, and it convinced me that women need to make their emotional health a priority and practice self-care so they can adjust to the different changes they go through in their lives, including having a baby.”
She said that women are more vulnerable for depression during pregnancy, and it’s even a greater vulnerability if they’ve already had depression prior to pregnancy.
“There is a vulnerability that’s just associated with pregnancy and post-birth because of the hormonal, situational, psychological changes,” Sanford said.
Like Puryear mentioned, there is still a stigma associated with maternal depression.
“We still have women tell us all the time that they didn’t go for care or call their health provider because they feel that the depression reflects negatively on them, and they should be feeling happy, and everybody else is handling it so why can’t I, and I must be a bad mom,” Sanford said. “And they start telling themselves all sorts of things about themselves as people, and how they’re lacking, rather than the fact that they have, because of a change in hormones, psychological changes and relationship/situational changes, developed what we’re calling now clinical condition.”
Maternal depression should be taken seriously because of the impact it can have on mothers and their children.
“Women should know that maternal depression has a far-reaching impact on the health and well-being of their children and families,” Sanford said. “We know maternal depression is tied to problems with social development, cognitive development, motor development in children. Just like women do everything they can during pregnancy, taking their vitamins, getting exercise, not drinking, not smoking, to make certain that they ensure the health of their baby ... they have to start taking care of their emotional health equally because this is as critical if not more critical a factor in the health and well-being of their children.”
Reviewed May 18, 2011
Edited by Alison Stanton
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