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Definition, Symptoms, Causes & Treatment

Postpartum Depression message board, open discussion, and online support group.

Definition, Symptoms, Causes & Treatment

Postby Butterfly Faerie » Sat Aug 26, 2006 7:21 pm

Definition
The term Postpartum Depressiondescribes the range of physical, emotional, and behavioral changes that many new mothers experience following the delivery of their babies. Symptoms of this condition can range from mild to severe. A new mother's depression may be a mild, brief bout of "baby blues"; or she may suffer from postpartum depression, a much more serious condition. In some cases, new mothers may have postpartum psychosis, a relatively rare but severe and incapacitating illness.



Symptoms
The mildest and most frequent form of Post Postpartum Depression is commonly referred to as the “Baby Blues” and is occurs in 40 to 85 percent of deliveries. Symptoms arise spontaneously during the first ten days postpartum, and tend to peak around 3 to 5 days. Although symptoms are distressing, they are transient and are resolved within 24 to 72 hours. Typical symptoms are depressed mood, anxiety, excessive worry, irritability, confusion, crying spells, sleep and appetite disturbances and lack of feeling for the baby.

The onset of postpartum depression frequently begins within 4 weeks after delivery but can occur several months later. Symptoms must be present for at least 2 weeks and must affect the mother’s ability to function in order to be so diagnosed. Postpartum Depression occurs in 10 to 15 percent of all deliveries and in 26 to 32 percent of adolescent deliveries. The majority of patients still suffer from symptoms 6 months after onset and when untreated up to 25 percent of patients are depressed one year later.


Events that predispose a woman to postpartum depression are:
Previous episode of postpartum depression. One incidence of postpartum depression may increase the risk of reoccurrence by up to 70 percent.
Depression unrelated to pregnancy. A prior episode of depression may increase the risk by up to 30 percent.
Severe premenstrual syndrome (PMS)
Stressful marital, family, vocational or financial conditions
Ambivalent feeling about the pregnancy or the pregnancy is unwanted.
Symptoms reported for postpartum depression are:
Depressed mood for most of the day and nearly every day
Loss of interest in activities that were previously experienced as pleasurable
Hopelessness and despair
Thoughts of suicide and or infanticide
Fears of harming the baby
No concern or over concern for the baby
Feeling of inadequacy, guilt and worthlessness
Poor concentration and impaired memory
Bizarre and strange thoughts
Hallucinations
Nightmares
Panic attacks
Agitated or lethargic

Postpartum or puerperal psychosis occurs in at a rate of 1-2 out every 1000 deliveries. Symptoms usually occur within the first 4 weeks postpartum but can manifest anytime up to the 90 days after delivery. It is characterized by a rapid and severe onset. Women with this disorder are severely impaired and suffer from delusions and hallucinations and are at risk for suicide and/or infanticide.

Symptoms manifested are:


Refusal to eat
Frantic energy and activity
Incoherence
Loss of memory and extreme confusion
Bizarre hallucinations
Irrational and suspicious behavior




Causes
While several possible biological, psycho social and cultural theories have been investigated the exact causes of Postpartum Depression are unknown.

Biological

Postpartum dysregulation of the thyroid gland has been considered as another possible cause of depression. This condition is also linked to fatigue. The thyroid gland regulates several hormones and drops production dramatically after birth. It returns to normal functioning in three sequential stages. The first stage, which can last from 3 to 6 months, is hyperthyroidism where the thyroid goes into overdrive and results in anxiety and insomnia. The second phase is hypothyroidism where production is slowed. During this phase a woman experience lethargy and weight gain. The final stage in recovery is when output reaches prepregnant levels. Investigations into the relationship between thyroid dysregulation and postpartum depression have yielded contradictory results and no firm link between the two has been demonstrated. As a result, treatment is considered only when symptoms are severe enough to interfere with daily living

The role that specific hormones may play in the development of postpartum depression has attracted considerable scientific research. Hormones levels change dramatically during pregnancy, delivery and the postpartum period. Researchers are examining a possible relationship between sudden shifts in the levels of these hormones and postpartum depression.

The absence of any clear link between hormones and postpartum depression have led some researchers to conclude that causality may be found in social or psychological factors.


Psychosocial

Psychosocial and emotional factors seem to be related to postpartum depression to the extent that they act as stressors and impact a woman’s self-esteem. New mothers are concerned about levels of support and prolonged postpartum depression is linked to lack of social support.

Lack of sleep and fatigue are common complaints made by new mothers. Giving birth is an arduous process that taxes a woman’s strength. It can take several weeks for the mother to regain normal strength. A cesarean delivery is major surgery and requires even longer recovery time. Add to these the responsibility of caring for a baby around the clock, as well as attending to other household duties, make it almost impossible for a woman to get adequate rest. The resulting fatigue may increase a woman’s vulnerability and be an added risk factor for depression.

A major factor in postpartum depression is lack of support from others. A new mother need comfort and support during pregnancy and after delivery. She also needs help with household chores and with childcare. Such support may be lacking for a single mother or for a woman whose family lives far away.

The changes in the role for women and mothers may be related to the sense of “inadequacy” reported by new mothers. There is some evidence that women with depression view these changes differently than do non-depressed women.

The mother’s attitude towards her pregnancy may be important when evaluating risk. It is common for a woman to feel doubt about the pregnancy. This may be particularly so when the pregnancy is unplanned. A greater incidence of depression is reported among women who were ambivalent about the pregnancy.

Weight gain during pregnancy affects both self-esteem and risk of depression. It can cause a new mother to doubt her physical attractiveness and sex appeal.

Mixed feelings sometimes arise from a woman's past. She may have lost her own mother early or had a poor relationship with her. This might cause her to be unsure about her feelings toward her new baby. She may fear that caring for the child will lead to pain, disappointment or loss.

Feelings of loss, such as loss of freedom and control over her life are common after having a baby and can add to depression.

Breast-feeding problems can make a new mother feel depressed. New mothers need not feel guilty if they cannot breast-feed or if they decide to stop. The baby can be well nourished with formula.

Women who have their babies by cesarean birth are likely to feel more depressed and have lower self-esteem than women who had spontaneous vaginal deliveries.

Mothers with pre-term babies often become depressed. An early birth results in unexpected changes in home and work routines and is an added stressor.

The birth of a child with a birth defect makes adjustment even more difficult for the parents.

The length of time the mother spends in hospital may be related to her emotional well-being. There is evidence that early discharge increases the risk of developing postpartum depression.

The birth of first child is a particularly stressful event for the new mother and seems to have a greater relationship to depression than do the birth of a second or third child.


Cultural Aspects

Cross-cultural studies indicates that the incidence of postpartum depression but not psychosis is much lower in non-western cultures. These cultures seem to provide the new mother with a level of emotional and physical support that is largely absent in western society. In the more traditional cultures there is greater recognition of the demands of motherhood and it provides the new mother with assistance and support. Thus, the new mother gets assured that the discomfort that she is experiencing will pass and that she will not have to face those feelings alone. In contrast, several researchers have reported on the absence of such support in America. One study reported that only 18 percent of new mothers receive more than two weeks assistance with house work and 20 percent reported help with child care beyond the first week.



Treatment
Postpartum depression is treated much like other types of depression. The most common treatments for depression are antidepressant medication, psychotherapy, and participation in a support group, or a combination of these treatments.

Medications

There are several types of antidepressant medications used to treat depressive disorders. These include newer medications—chiefly the selective serotonin reuptake inhibitors (SSRIs)—the tricyclics, and the monoamine oxidase inhibitors (MAOIs). The MAOIs are generally not prescribed for postpartum depression. The SSRIs, and other newer medications that affect neurotransmitters such as dopamine or norepinephrine, generally have fewer side effects than tricyclics. Sometimes the doctor will try a variety of antidepressants before finding the most effective medication or combination of medications. Sometimes the dosage must be increased to be effective. Although some improvements may be seen in the first few weeks, antidepressant medications must be taken regularly for 3 to 4 weeks (in some cases, as many as 8 weeks) before the full therapeutic effect occurs.

Patients often are tempted to stop medication too soon. They may feel better and think they no longer need the medication. Or they may think the medication isn't helping at all. It is important to keep taking medication until it has a chance to work, though side effects may appear before antidepressant activity does. Once the individual is feeling better, it is important to continue the medication for 4 to 9 months to prevent a recurrence of the depression. Some medications must be stopped gradually to give the body time to adjust, and many can produce withdrawal symptoms if discontinued abruptly. For individuals with bipolar disorder and those with chronic or recurrent major depression, medication may have to be maintained indefinitely.

Antidepressant drugs are not habit-forming. However, as is the case with any type of medication prescribed for more than a few days, antidepressants have to be carefully monitored to see if the correct dosage is being given. The doctor will check the dosage and its effectiveness regularly.

Some antidepressants can contaminate breast milk. Women who breast-feed should talk to their doctors to determine the most suitable treatment option.


Side Effects

Antidepressants may cause mild and, usually, temporary side effects (sometimes referred to as adverse effects) in some people. Typically these are annoying, but not serious. However, any unusual reactions or side effects or those that interfere with functioning should be reported to the doctor immediately. The most common side effects of tricyclic antidepressants, and ways to deal with them, are:

Dry mouth—it is helpful to drink sips of water; chew sugarless gum clean teeth daily.
Constipation—bran cereals, prunes, fruit, and vegetables should be in the diet.
Bladder problems—emptying the bladder may be trouble-some, and the urine stream may not be as strong as usual; the doctor should be notified if there is marked difficulty or pain.
Sexual problems—sexual functioning may change; if worrisome, it should be discussed with the doctor.
Blurred vision—this will pass soon and will not usually necessitate new glasses.
Dizziness—rising from the bed or chair slowly is helpful.
Drowsiness as a daytime problem—this usually passes soon. A person feeling drowsy or sedated should not drive or operate heavy equipment. The more sedating antidepressants are generally taken at bedtime to help sleep and minimize daytime drowsiness.
The newer antidepressants have different types of side effects:
Headache-this will usually go away.
Nausea—this is also temporary, but even when it occurs, it is transient after each dose.
Nervousness and insomnia (trouble falling asleep or waking often during the night)—these may occur during the first few weeks; dosage reductions or time will usually resolve them.
Agitation (feeling jittery)—if this happens for the first time after the drug is taken and is more than transient, the doctor should be notified.
Sexual problems—the doctor should be consulted if the problem is persistent or worrisome.


Psychotherapies

Many forms of psychotherapy, including some short-term (10-20 week) therapies, can help depressed individuals. "Talking" therapies help patients gain insight into and resolve their problems through verbal exchange with the therapist, sometimes combined with "homework" assignments between sessions. "Behavioral" therapists help patients learn how to obtain more satisfaction and rewards through their own actions and how to unlearn the behavioral patterns that contribute to or result from their depression.

Two effective short-term psychotherapies are interpersonal and cognitive/behavioral therapies. Interpersonal therapists focus on the patient's disturbed personal relationships that both cause and exacerbate (or increase) the depression. Cognitive/behavioral therapists help patient’s change the negative styles of thinking and behaving often associated with depression.

Psychodynamic therapies, which are sometimes used to treat depressed persons, focus on resolving the patient's conflicted feelings. These therapies are often reserved until the depressive symptoms are significantly improved. In general, severe depressive illnesses, particularly those that are recurrent, will require medication (or ECT under special conditions) along with, or preceding, psychotherapy for the best outcome.


Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is useful, particularly for individuals whose depression is severe or life threatening or who cannot take antidepressant medication (Frank, Karp & Rush, 1993). ECT often is effective in cases where antidepressant medications do not provide sufficient relief of symptoms. In recent years, ECT has been much improved. A muscle relaxant is given before treatment, which is done under brief anesthesia. Electrodes are placed at precise locations on the head to deliver electrical impulses. The stimulation causes a brief (about 30 seconds) seizure within the brain. The person receiving ECT does not consciously experience the electrical stimulus. For full therapeutic benefit, at least several sessions of ECT, typically at the rate of three per week are required.
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Re: Definition, Symptoms, Causes & Treatment

Postby clinton.booze » Tue Jan 17, 2012 8:28 am

too long post..here is a shorter version of the above post...it is to the point... http://www.depressionsymptomsguide.com/ ... ssion.html
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