Postpartum Parent Wellness: New Information and Interventions

bySara Markese, Ph.D.

It is not surprising that many mothers and fathers experience low mood and high anxiety as they cope with the transition to parenting their new baby. During this time, just as infants are going through the process of acclimating to their new surroundings, mothers are going through physical, emotional and biological changes of their own. While a new baby brings excitement, the new birth also brings the whole family, father included, through a time of intense change and imbalance.

This article will describe some basic symptoms of the “baby blues” versus postpartum depression, offer information and resources for parents who know someone or are themselves experiencing challenges following the birth of their baby, as well as describing a new program at Family Compass, The Postpartum Wellness Program.

Postpartum Mood Disorders: Recent Findings

For women, postpartum changes are biological/neurochemical, hormonal, and physical as well as psychological. Interestingly, researchers are finding that men with new babies are also affected by mood and anxiety symptoms. Furthermore, they also often experience sleep deprivation and even hormone changes themselves (Paulson, 2010).

We are now aware that as many as one in five new mothers may suffer from some depression postpartum, and that postpartum depression and anxiety affects families, with up to as many as 10 to 14 percent of new fathers possibly experiencing some form of postpartum distress, now termed Paternal Postnatal Depression or PPND.

With increasing awareness of postpartum depression, attention is now turning to the impact of a new infant on parental anxiety levels, and the potential for anxiety disorders arising in the postpartum period. Importantly, researchers now know that anxiety disorders, post-traumatic stress disorder, and even obsessive-compulsive disorder can all have postpartum onset, and new assessment tools and interventions are being designed to address this need.

The “Baby Blues” versus Postpartum Depression (PPD):

When people refer to the “baby blues,” they are referring to the common experience that women have post-birth of feeling anxious, sad, lonely, and tired with increased emotionality and mood changes. These symptoms are thought to be caused by the stress on the body of the pregnancy and the hormonal changes caused by the process of giving birth and the body’s acclimation after.

Postpartum depression, on the other hand, is an episode of major depressive disorder occurring in the postpartum period, and is the most prevalent serious complication of pregnancy. Symptoms of PPD generally occur within the first 4 weeks after delivery, however, depressive symptoms may emerge days, several months, or even up to a year after delivery. Unlike the baby blues, PPD does not resolve itself, and can last for weeks, months or even years if left untreated.

Some defining symptoms of Postpartum Depression include; feelings of sadness, loneliness and/or depression the majority of the time, loss of appetite, insomnia, or fatigue, and feeling unfulfilled with usual activities and relationships. For a full list of symptoms, and for more information, see www.apa.org.

Risk Factors for PPD:

PPD can affect any woman, whether it is a first birth or not, and regardless of the type of pregnancy and the woman’s personal life circumstances. Some risk factors, however, have been identified and are helpful to keep in mind.

Women with a previous history of depression and anxiety, before or during their pregnancy, or who have a history of depression or mood disorders in their families, are at greater risk for PPD. Acute stressors may also impact maternal mood in the postpartum period. These include loss of a job, major life or family changes, family illness, or losses during pregnancy which may all put women at increased risk of experiencing postpartum depression symptoms (Pearlstein et al., 2009).

Other risk factors are connected with reproductive hormone levels. Specifically, women who have had negative mood reactions to birth control pills in the past, or who show a decline or fluctuation in reproductive hormones (such as estrogen and progesterone) may be more at risk for depression postpartum (Pearlstein et al., 2009).

New research has revealed genetic contributions to PPD, showing that women with specific estrogen receptor genes are more susceptible (Mehta et al., 2014). Other current research has found a biological link, identifying that specific hormonal change patterns during pregnancy may indicate whether women are likely to develop depression after their babies are born (Yim et al., 2009). These researchers are continuing their work by looking at the effects of stress during pregnancy on these hormone levels, as well as the reparative effects of relaxation techniques such as yoga that might protect pregnant mothers from a rise in these hormones.

Interventions for PPD: The Postpartum Wellness Program at Family Compass

Several interventions have been shown to help women with PPD, including psychotherapy, both individual and group, alone or in combination with antidepressant drug therapy, hormone therapy, or other alternative therapies such as acupuncture, light and massage therapy and vitamin supplement treatment. (Gjerdingen, 2003).

At Family Compass, we have developed the Postpartum Wellness Program, designed to treat all mothers who identify anxiety and depression in the postpartum period and seek support to alleviate their symptoms, and to develop coping methods to better care for themselves and their infants and families.

We work in collaboration with Ob-Gyns and pediatricians, and with mother who self-refer to screen for symptoms of PPD in the initial consultation phase. We take a supportive, individual approach to therapy, working with mothers and their partners / co-parents to promote family wellness. Sessions with Drs. Sara Markese and Kristin Swanson offer education about the post-partum period, its impact on emotional functioning, and possible adjunct treatment options, with the overall goal to help mothers address and cope with their symptoms and to feel more effective as parents.

In family sessions, therapists work with mothers and their spouses, to better understand and cope with anxiety and depression symptoms within their individual family. Over time, as mothers go through individual therapy, supportive group sessions may become available which will continue the goals of the individual sessions in the context of meeting and sharing with others with similar concerns.

Some Additional Resources:

“Beyond the Blues” by S. Bennett and P. Indman (2010), Moodswings Press.

“The Pregnancy and Postpartum Anxiety Workbook” by K. Gyoerkoe and P. Wigartz & (2009) New Harbingers Press.

http://www.ppdsupportpage.com
http://www.1800ppdmoms.org
http://www.postpartum.net
http://www.postpartumprogress.com
http://www.beyondblue.org.au
http://www.postpartumdads.org

References:

Gjerdingen D (2003). The effectiveness of various postpartum depression treatments and the impact of antidepressant drugs on nursing infants. Journal of the American Board of Family Practice.

Mehta1 D, Newport DJ, Frishman G, Kraus L, Rex-Haffner M, Ritchie JC, Lori A, Knight BT, Stagnaro E, Ruepp A, Stowe ZN and Binder EB (2014). Early predictive biomarkers for postpartum depression point to a role for estrogen receptor signaling. Psychological Medicine, 1-14.

Paulson J and Bazemore, S.D. (2010) Prenatal and postpartum depression in fathers and its association with maternal depression. Journal of the American Medical Association, 303, 1961-1969.

Pearlstein T, Howard M, Salisbury A, Zlotnick C. (2009) Postpartum depression. The American Journal of Obstetrics and Gynecology. 200(4):357-64.

Yim I, Glynn L, Dunkel Schetter C, Hobel C, Chicz-DeMet A, Sandman C (2009). Elevated Corticotropin-Releasing Hormone in Human Pregnancy Increases the Risk of Postpartum Depressive Symptoms. The Archives of General Psychiatry 66(2): 162-169.

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