[dropcap]T[/dropcap]he transition to becoming a mother is not always easy. New mothers have to learn to care for their little ones, learn to breastfeed, function with little sleep, and integrate the little one into their lives among other new tasks – all of these can be quite challenging. The adaptation to motherhood can be especially difficult for those women who struggle with depression in the postpartum. At Sunnybrook, the Women’s Mood and Anxiety Clinic: Reproductive Transitions assesses and treats women, in pregnancy and during the postpartum, struggling with such issues. Below, we dispel some commonly held myths about postpartum depression.
Myth: All women feel happy during pregnancy.
Pregnancy is often perceived to be a time of happiness and joy. However the idea that pregnancy protects women from the onset of mood symptoms is false. Nearly 13% of women experience a major depression while pregnant, and up to about 18% will experience a depressive disorder of any kind. It is important to identify and treat women in pregnancy as depression in pregnancy is a significant risk factor for postpartum depression.
Myth: “I am the only one who feels this way.”
Postpartum depression is common with about 15% of women experiencing it. Furthermore depression often co-occurs with anxiety, which is actually more prevalent in the postpartum.
Myth: Postpartum depression begins in the first few weeks after birth.
The first few weeks and months after birth are a period of risk for the onset of postpartum depression due to many factors such as hormonal changes, sleep deprivation, caring for a newborn and the psychological adjustment to becoming a mother. Different studies have given us various estimates yet clinical depression can occur really at any point in the first year postpartum. The Diagnostic and Statistical Manual of Mental Disorders (5th Edition) specifies an episode as postpartum when it occurs within the first 4 weeks postpartum. Breastfeeding is not protective against postpartum depression. As well, a mother who did not have postpartum depression after her first child could still develop symptoms after a subsequent delivery. When a woman has had one episode of depression in the postpartum, the risk of future postpartum episodes is about 50%.
Myth: “Feeling depressed and anxious is just a normal part of motherhood.”
While it may take time to develop confidence with a new baby, feeling depressed and very anxious is not a normal part of motherhood. Up to 80% of mothers will experience the “baby blues” in the first 2 weeks postpartum; this is the time when women have much emotional sensitivity, irritability, fluctuating mood and anxiety. However these symptoms should not persist. A mother with a major depressive episode in the postpartum will experience either depressed mood or lack of interest. Other symptoms may include sleep disturbance, low energy, change in appetite, guilt, feelings of worthlessness and poor concentration. Anxiety is often prominent. Thoughts of wishing one were dead or suicide always warrants an assessment by a physician. The bonding or emotional connection with the baby can, but is not always, affected. It is important to distinguish depression from postpartum psychosis, which occurs in 1 of 1000 births. Postpartum psychosis is a psychiatric emergency and requires urgent medical assessment as it can involve symptoms such as agitation, irritability, confusion, hearing voices, paranoia, unusual thoughts and thoughts of harm to one’s infant.
Myth: “It’s just hormones, it will go away on its own.”
Depression in the postpartum can last for many months or longer. Although sensitivity to the drop in hormones after delivery may be one contributing factor, there are many others. A past history of a mood or anxiety disorder, family history, symptoms in pregnancy, social stressors, sleep deprivation, relationship problems, difficulty breastfeeding, infant health problems and few supports are some of many potential risk factors. Treatment of a major depressive episode in the postpartum involves psychotherapy, medication or both. Other important strategies include ensuring adequate sleep, nutrition, self care, time to self, education of the partner and family, and increased support. It is important that women with postpartum depression get adequate support and treatment to minimize impact on mother and child.
Myth: “I can’t take medication because I am breastfeeding.”
The class of medication generally used to treat depression in the postpartum is the selective serotonin reuptake inhibitor (SSRI) class of antidepressants. Many women take antidepressants while pregnant or breastfeeding but it is a very individualized decision taking into account many factors including severity of illness, the impact of illness on the mother, infant and family as well as medication effects. Women considering medication during pregnancy or breastfeeding should speak to their physician. When selecting an antidepressant in breastfeeding, the percentage that passes into the milk, the mother’s past response, impact on the infant, and the side effects are all considered carefully. Psychotherapy can be an alternative or in addition to medication. Evidence based treatments include cognitive behavioural therapy, which involves challenging depressive thought patterns, or interpersonal therapy, which is focused on relationships. Other approaches that can provide benefit include mindfulness, couples therapy, postpartum support groups and mother-infant therapy.
