Understanding Postpartum Psychiatric Issues

Spring is soon to arrive, with it new beginnings. A time of birth and rebirth. A time associ­ated with joy but also a time to be mindful of other forces.

Women have the unique quality of carrying and giving birth to the new hopes and dreams of the human species. This is a time that has both great expectations of hope and bounti­ful joy for all. These expectations however may be altered or only briefly experienced. The postpar­tum period may be influenced by several psychiatric issues. These include: “Baby Blues”, postpartum depression and post­partum psychosis.

During the postpartum peri­od up to 85% of women experi­ence some form of mood dis­order. 10-15% of these women experience a more disabling and persistent form of mood disorder called postpartum depression or even psychosis.

The mildest form of postpar­tum dysfunction is the so called “Baby Blues”. These generally consist of a week long period of mood lability with heightened irritability, anxiety and tearful­ness. Symptoms tend to peak around day 4 or 5 postpartum and gradually remit. This does not usually interfere with child­care, maternal bonding or harm to the newborn.

Of a more serious nature is postpartum depression. This occurs in 10-15% of the general population.

The principal phenomeno­logical symptoms of this include: a depressed mood as manifested by: hopelessness, lack of interest or joy- especially in areas to do with daily activities of childcare; feelings of emptiness, height­ened anxiety, which may include obsessional concerns about the baby’s health and well-being.

A prior history of depression, genetic predisposition towards depression, prior postpartum issues or those who experience depression during pregnancy represent those with the highest risk.

The risk of most concern is the mother’s loss of any inter­est in daily child care activities which may progress to having negative feelings towards the newborn. If this continues it may progress to having negative or intrusive thoughts and fears about harming herself, her child or both. These tend to be more obsessional than actual urges to do real harm.

Other negative and qualita­tive changes may occur- i.e., increased or decreased sleep and energy, worthlessness and guilt without adequate reason, appetite variations up or down, significant decreases in concen­tration and restlessness.

The other principal area of postpartum concern is much less common, but much more serious – Postpartum psychosis. Although some research shows that this can occur up to one year postpartum, most cases occur within a 2 week and up to 3 month postpartum period. This illness presents with the potential for many psychotic symptoms, i.e. hallucinations of any sensory organ, delusional mistaken beliefs or illogical thoughts, sleep and appetite dis­turbance, agitation or anxiety to very heightened levels, episodic mania or delirium, suicidal or homicidal thoughts or actions.

Women at greatest risk are those that have a prior history of schizophrenia, bipolar disorder, other psychotic disorders or a history of a prior episode of the illness with another child.

Occasionally women with postpartum psychosis, like other forms of psychotic disease are not always the first ones to notice it or may be unable or unwilling to communicate their experiences or fears. The need for help may need to be communicated by a support – i.e. fam­ily, friend or professional. This help must be via a trained professional.

What needs to be done?

Q. What causes post­partum depres­sion?

A. Like other forms of depres­sion, there is no single cause, but rather a combination of fac­tors. These include genetic family histories, structural and chemical changes in brain function lead­ing to endocrine (hormonal) and immunological alterations. Significant increases of estrogen and progesterone during preg­nancy are precipitously followed by significant decreases in about 24hrs. postpartum. A clear depressive factor. Thyroid hor­mones follow this pattern also. Life events experienced as stress­ors combine to cause symptoms and illness.

Q. What about the demands of motherhood itself?

A. These can clearly contribute. For instance: postpartum physical fatigue from the delivery itself as well as sleep interrup­tion or deprivation caring for the newborn; stressors about being a “good mother”, loss of who or what you did or thought of your­self before, feeling less attractive, lack of free time and simply over­whelmed with all the challenges of a new baby or babies. Women who are depressed during preg­nancy have a far greater risk of depression after giving birth.

Q. Can one just wait it out and let it pass?

A. Definitely not. Postpartum depression and certainly psy­chosis are very serious psychiatric disorders requiring psychiatric treatment as soon as possible. Some women are embarrassed or ashamed to feel these things at a time when they’re supposed to feel happy. How will they be perceived- as unfit parents perhaps? Denial may occur.

Q. What can happen if women don’t seek treatment?

A. Nothing good- either for mother or child, i.e. Poor birth weight or prematurity, rest­lessness for both, poor sleep for both, missed pre and post natal care, substance abuse, poor bond­ing of mother-child and simply not being able to meet the needs of your child. In psychosis, sui­cide/homicide risks can occur.

Treatment for these issues are available by competent, experi­enced physicians. Medication is generally helpful and required. If these are needed during pregnan­cy, the salient risks and benefits are assessed and weighed. Several modalities of psychotherapy and support groups are also very helpful. Rarely, hospitalization may be necessary. These interven­tions may be life saving for both mother and child.

All children should have the benefit of a healthy caring mother. All mothers deserve the opportunity to have rewarding pregnancies, births and maternal experiences. These illnesses can insidiously deprive both mother and child and do serious harm. If there are concerns, symptoms or caring observations of trouble, seek trained psychiatric care at once. Don’t struggle alone in fear, shame or silence.