Your baby is finally here, but something is very wrong. Instead of feeling joy and happiness, you'd rather curl up in a corner and cry. Getting to sleep is difficult, and it's not because of the baby: your emotions fluctuate between feelings of despair, worthlessness, anger and guilt. And on some days you have trouble remembering where even the most basic things are located, and even have difficulty concentrating on your favorite TV sitcom. Is this what motherhood is supposed to be like?
Mild sadness and anxiety, often called the "baby blues," is experienced by about two-thirds of new mothers. It occurs for a number of reasons. For first time moms, the experience of motherhood can be most disorienting. Hormones may also play a role: immediately following delivery, the high levels of certain hormones, which have been circulating in a woman's blood throughout her pregnancy, decrease dramatically, creating an abrupt change in the physiological state of her body.
For some women, the "baby blues" evolve into postpartum depression, a condition that affects between 10 to 15 percent of all new mothers; and some estimates run even higher. Symptoms range from moderate to debilitating, and they can begin within a few days after giving birth, or not be experienced until several months have passed.
It wasn't until the last decade or so that postpartum depression received any sort of attention and even so, many professionals still don't take it seriously. "Women's mental health issues have been overlooked and labeled in the past as hysteria, not worthy of concern," says Laurence Kruckman, PhD, a professor of anthropology at Indiana University of Pennsylvania, an expert on postpartum depression and one of the pioneers in the use of social support groups to prevent postpartum disorders. "The American Psychiatric Association's diagnostic manual (DSM IV) has never fully acknowledged the presence of postpartum illness, and as a result, doctors have not been educated about it nor has reliable data has not been obtained".
Dr. Kruckman also points out that we live in a culture with values that stress individualism and toughing things out alone. so many mothers do not even seek help or discuss their concerns. "And unlike 30 years ago," he says, "Mothers often go home from the hospital within 24 hours. Most postpartum psychoses, blues and some depression occur within three to 14 days following birth. So the mothers are already at home and not screened by professionals who know the symptoms".
The duration of a postpartum depression will depend upon how quickly the condition was recognized and the treatment given, but a full recovery can be expected. For some women, the depression is short lived and will clear up on its own. But if symptoms continue after two or three weeks, it is time to seek some type of professional help.
"And if a woman starts having symptoms of psychosis-- such as if she is experiencing hallucinations, self-destructive thoughts, or feelings of being outside (her)self, she needs to seek help immediately," says Dr. Kruckman.
Joining a support group is one option, especially if the depression is mild to moderate. Many new mothers find it reassuring to know that other women are experiencing the same things. If you can't find one, ask your health care provider or the hospital where you delivered.
While a support group may help tremendously, some women need further assistance in working through their depression. "Recent research shows that a combination of both talk therapy and antidepressants is best," says Dr. Kruckman. "But the therapist must know about postpartum illness and use a cognitive/behavioral approach, which is dealing with the present issues. For example, to probe your past relationships with your parents would be counter productive".
Some women may be hesitant to use antidepressants because of a fear that the drug may end up in their milk supply and hurt the baby. This fear is not completely unfounded because traces of some antidepressants do find their way into breast milk. However, it varies from drug to drug. A recent study from researchers at Emory University School of Medicine found that the antidepressant drug Paxil left no detectable traces of the medication in the blood of breastfed infants, and they experienced no adverse effects of the drug. Prozac, a member of the class of drugs known as SSRI's, is excreted in human milk, and there have been cases of infants developing problems such as sleep disturbances and watery stools.
"The jury is still out on this one," says Kruckman. "What it comes down to is weighing the benefits against possible side effects. Most practitioners will recommend an SSRI rather than leave a depressed mother care for her baby and I agree," he says.
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