Trillian's Depression Page
(cont.)
Postpartum Disorders
The cause of all the post-partum emotional reactions remains
unclear, but scientists cite several contributing factors. One is stress.
Motherhood is most disorienting for first-time moms. Not surprisingly, they are
at unusually high risk of post-partum emotional problems. Other kinds of stress
that might lead to depression are an unhappy marriage, obstetric complications,
or a baby who is temperamentally difficult. Sometimes a woman in a shaky
marriage hopes the child will cement her bond with her husband and becomes
depressed when that expectation is disappointed. For women who already tend to
feel inadequate and incompetent, difficulties in caring for the child may
confirm their poor opinion of themselves. The mood of some women is disturbed
by the change in their relationship with their husbands and the start of a new
relationship with the baby. The situation becomes worse if they lack intimate
friends to share their secrets and troubles. The universal expectation that a
new mother should be happy further contributes to guilt and depression.
Hormones also play a role. High levels of female sex hormones
circulate in expectant mothers' blood, but drop precipitously within hours of
delivery, contributing to biochemical depression. Pregnancy also increases
levels of endorphins, the body's feel-good chemicals. Endorphin levels fall
abruptly after delivery, adding to risk of depression. Hormone levels stabilize
in almost all women, including those who become depressed, two weeks after
delivery; but it is possible that in some women who are highly susceptible to
the effects of changing hormone levels shortly after delivery, the mood deepens
and persists because of other past and present circumstances.
A history of depression increases risk. One-third of women with
previous depression experience it post-partum.Women with postpartum depression
are more likely to have had previous mental illnesses, depression during
pregnancy, and a family history of mood disorders, especially bipolar disorder.
They are also sometimes said to have a certain "attributional style"
-- believing that their own actions cannot affect their lives much. Some
authorities believe that postpartum depression is more likely if a woman is in
conflict with her mother and dissatisfied with the care she received as a
child. According to this account, a woman who feels deprived by her own mother
and rejects her as a model may find that becoming a mother herself evokes
disturbing memories, makes her resent her husband and child, and heightens her
sense of being ill-prepared for the new role.
Like biological explanations for postpartum disorders, these
psychological and social explanations remain uncertain, since it can be hard to
tell what is cause and what is effect. A woman may remember her childhood as
deprived or think of herself as friendless simply because she is depressed.
Postpartum depression has not been proved to be correlated with the size of a
woman's social network or the number of her close friends. There is no clear
evidence that being single, or poor, or young, or relatively old, or having a
first child raises the risk for postpartum depression. More studies are needed
to clarify these issues.
Some believe that modern Western society promotes postpartum
depression because it has overmedicalized childbirth, deprived women of the
support of extended families, given them too little time for seclusion and
rest, and eliminated the rituals of transition that relieve the anxiety of
adopting a new social role. Others point out that Hippocrates described
postpartum disorders in ancient Greece, and recent studies in rural Africa have
found a rate of postpartum depression just as high as that of the industrial
West.
Oddly, until recently, mental health professionals have paid
scant attention to post-partum depression. The American Psychiatric Association
didn't even officially recognize the condition until the 1994 edition of the
organization's Diagnostic and Statistical Manual of Mental Disorders.
But today, post-partum depression is much better publicized. It
should become even more so in the future. New York state now requires hospitals
to give new mothers information about their risk of the condition before
leaving maternity wards.
Specific measures to prevent postpartum depression or psychosis are
difficult, since these reactions are so hard to anticipate, but new mothers can
be told about the baby blues and reassured that they are a common and temporary
condition. Women with more serious symptoms may feel ashamed of them and avoid
seeking help because they fear that they are not 'normal' and will be judged to
be bad mothers. They too need to be reassured. Individual psychotherapy, family
therapy, relaxation training, and behavioral modification to improve child care
have all been used. For severe postpartum reactions, antidepressant and
antipsychotic drugs can be helpful, but women are usually advised not to breast
feed while taking these drugs, since they can be secreted into the breast milk
and might affect the baby. Electroconvulsive therapy (ECT) is highly effective
and can be used safely as soon as a week after delivery. Another important
resource is mutual aid groups providing advice and comfort to women with
postpartum problems. An umbrella organization for these groups is Postpartum
Support International
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