POSTPARTUM DEPRESSION

Postpartum Depression (PDD) is a mood disorder that can arise for both mothers and fathers after childbirth. PDD can begin during pregnancy and may persist for up to 14 months after birth.[1] Although this disorder is most prevalent among women, men can also experience PDD.[2]

 

Some of the Symptoms of PDD include:

  • Anxiety1
  • Guilt1
  • Negative attitude towards child1
  • Doubting parental abilities1
  • Withdrawn parental behaviour1

There are a variety of factors that may make individuals more susceptible to experiencing PDD:

  • Symptoms of depression during pregnancy[3]
  • History of depression3
  • Low self-esteem3
  • Negative thinking style3
  • Lack of social support3
  • History of childhood sexual abuse3
  • Low income3
  • Low level of education3

While PDD can drastically affect the lives of mothers and fathers, it can also impact the lives of their families and children. The symptoms of PDD can become so severe that it may begin to interfere with a person’s ability to properly care for him/herself and the family. Additionally, PDD can interfere with the mother-infant relationship and may lead to attachment issues and even child abuse.[4] In fathers, PDD can lead to fewer enrichment activities with the child, such as reading, singing songs, and telling stories.[5]

Canadian Statistics

  • According to a 2011 survey, national rates of minor PDD were 8.46% and 8.69% for major PDD.1
  • Two of the factors that were the most directly related to PDD were stress during pregnancy and lack of support after childbirth.1
  • Immigrants were more likely to experience PDD.1
  • In 2006, 15.5% of women were either diagnosed with depression or treated with antidepressants before their pregnancies.[6]
  • In the 12 months before childbirth, 12.5% of women reported that the majority of their days were stressful.6
  • Thirteen percent of women reported that they had little or no support during their pregnancies, which is a risk factor for PDD.6
  • Approximately 10% of fathers experience PDD within a year of the birth of their child.[7]

Behaviours associated with Postpartum Depression:

  • Showing minimal affection to the child7
  • Discontinuing breastfeeding6
  • Arguing regularly with a spouse about how the infant should be cared for6
  • Spanking or hitting the child6
  • Speaking to the child less often or more slowly7
  • Withdrawing from one’s partner7

Feelings associated with Postpartum Depression:

  • Anxiety1
  • Guilt1
  • Fear[8]
  • Hopelessness8
  • Panic8
  • Depression8

Thoughts associated with Postpartum Depression:

  • “This baby is driving me crazy! I might as well just let it cry, there’s nothing I can do.”
  • “I am never going to be able to care for this child.”
  • “I wish I could turn back time.”
  • “I can’t stand another day of being alone with this child. I just want to run away.”

Postpartum Depression and the Body:

PDD can cause physical symptoms, including:

  • Fatigue[9]
  • Headaches[10]
  • Slowed movements11
  • Loss of appetite or overeating[11]
  • Difficulty sleeping or oversleeping10

Postpartum Depression and the Brain:

There is a link between PDD, hormones, and the brain. After childbirth, levels of progesterone and estrogen rapidly decrease. Lower progesterone and estrogen levels have been linked to the onset of Depressive symptoms and can lead to PDD.[12]

Disregulation in the Hypothalamic-Pituitary-Adrenal (HPA) axis has been linked to higher chances of a woman developing PDD.12 The HPA axis is responsible for responding to stress and regulating levels of stress hormones. Disregulation in the HPA axis has been observed in people with Major Depressive Disorder, and has been increasingly linked to PDD.12 During and after pregnancy, HPA disregulation can be caused by the multiple changes that occur in the female hormone system.12 The development of the placenta during pregnancy is partially responsible for the disregulation of the HPA axis; the hormones that cause placental development can increase the sensitivity of the pituitary to stress hormones.[13] Increased stress levels have been linked to the development of PDD.13

Does Psychology Work?

Research has shown that many women are reluctant to take antidepressant medications during and after childbirth.10 The need for non-pharmaceutical interventions for PDD is necessary, particularly for women who are breastfeeding. Several types of psychotherapy have proven to be effective for the treatment of PDD.

  • Cognitive Behavioural Therapy (CBT): CBT is a type of psychological therapy that aims to change people’s feelings by changing their thoughts and behaviours. Oftentimes, people who feel depressed think negative thoughts and behave in ways that worsen their depression (isolation). CBT teaches people to develop a more balanced mindset and to behave in ways that are more beneficial to their well-being. According to research, CBT is one of the most regularly used and effective treatments for PDD.[14] In one study, researchers found that CBT plus a placebo (fake) pill reduced PDD as successfully as CBT plus medication.[15] Other studies have backed up the claim that CBT works as well as pharmaceutical interventions.[16]
  • Emotionally Focused Therapy (EFT): EFT allows couples to explore their internal experiences while considering how it affects their interactions with their partner. PDD is known to negatively affect the quality of spousal relationships. The less support a parent has from his/her social support network, the worse his/her depressive symptoms are likely to become.[17] Researchers have found that partner relationships are the most significant aspect of social support, and EFT can help reduce depression as strongly as certain antidepressants.18 Marital distress and Depression have a negative reciprocal relationship whereby the more that one partner feels depression, the more the relationship is distressed and the more the relationship is in distress, the greater the depression.[18]
  • Interpersonal Therapy (IPT): IPT is a type of psychotherapy that focuses on improving people’s interpersonal relationships and improving attachments to others.[19] IPT has repeatedly proven to be an effective treatment for mild to moderate PDD.[20] According to research, IPT can reduce depressive symptoms and improve social interactions. In other studies, IPT has performed better at reducing the symptoms of PDD than CBT.[21] Research has also shown that more women with PDD chose IPT therapy over antidepressant medication and that it works as well as medication for reducing PDD symptoms.

Tips to Manage PDD!

  • Gentle Yoga: Preliminary studies have shown that gentle yoga can help reduce symptoms of PDD.[22] In one study, women with PDD who participated in an 8-week yoga regimen lowered their Depression scores and reported an improved perception of their physical and emotional well-being.22 The idea of pursuing yoga may seem daunting, but there are certain types of yoga that require minimal movement and promote relaxation. If going to a class it too overwhelming, there are easily accessible online videos.
  • Celebrate Small Accomplishments: When people are feeling depressed, they often have negative self-talk, which aggravates depressed symptoms. Self-defeating thoughts that may come up are “I’m not good enough” or “everything I do is pointless.” A way to combat these negative thoughts is to mindfully recognize and appreciate your accomplishments. By shifting the focus to accomplishments (such as washing the dishes, changing the baby’s diaper), you are less focused on self-defeating thoughts.
  • Take Walks with the Baby: Research has shown that mothers with PDD who engage in “pram walking” experience reduced depressive symptoms.[23] Pram walking refers to pushing a child in a stroller or carriage while on a walk. Research also indicates that going on pram walks with other parents is especially beneficial.23

Being a parent is difficult enough, however, parenting while experiencing Postpartum Depression is much more difficult. One of the most important parts of PDD recovery is having social support. Therapy can serve as a vital part of that support network. If you are experiencing PDD, know that you are not the only one and reach out for help. No two parents experience PDD in the same way. At Hopewell Psychological, we offer a variety of treatment options so we can find the best fit for you. We create personalized treatment plans and are skilled at treating people who experience co-occurring disorders, such as PDD and Postpartum Anxiety. We want to help you improve every aspect of your life, and offer group, couples, and family therapies to improve interpersonal relationships. If individual therapy is a better option for you, we offer a supportive, understanding and caring environment with one of our expert therapists. There is hope if you are struggling with PDD and Hopewell Psychological can offer you help and guidance towards greater happiness and pleasure in your life.

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*Psychologists are covered under Insurance Companies in Canada. You will need to check with your insurance company about the specific details regarding your coverage.

References

[1] Lanes, Andrea, et al. “Prevalence and characteristics of Postpartum Depression symptomatology among Canadian women: A cross-sectional study.” Public Health 11 (2011): 1-9.

[2] Paulson, J. F., and Bazemore, S. D. “Prenatal and Postpartum Depression in Fathers and its association with maternal depression: A meta-analysis.” Jama 303.19 (2010): 1961-1969.

[3] Leigh, Bronwyn, and Jeannette Milgrom. “Risk factors for antenatal depression, postnatal depression and parenting stress.” BMC psychiatry 8.1 (2008): 24.

[4] Brummelte, S., and Galea, L. A. “Depression during pregnancy and postpartum: Contribution of stress and ovarian hormones.” Progress in Neuro-Psychopharmacology and Biological Psychiatry 34 (2010): 766-776.

[5] Paulson, J. F., et al. “Individual and Combined Effects of Postpartum Depression in Mothers and Fathers on Parenting Behavior.” Pediatrics 118.2 (2006).

[6] “Pregnancy and Women’s Mental Health in Canada.” Government of Canada. Government of Canada, 17 May 2016. Web. 6 May 2017.

[7] Letourneau, Nicole Lyn, et al. “Postpartum Depression is a family affair: Addressing the impact on mothers, fathers, and children.” Issues in mental health nursing 33.7 (2012): 445-457.

[8] Matthey, Stephen, et al. “Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety?” Journal of affective disorders 74.2 (2003): 139-147.

[9] Rich-Edwards, Janet W., et al. “Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice.” Journal of Epidemiology & Community Health 60.3 (2006): 221-227.

[10] Dennis, C.L., and Leinic, C.L. “Postpartum depression help‐seeking barriers and maternal treatment preferences: A qualitative systematic review.” Birth 33.4 (2006): 323-331.

[11] Sit, D. K., & Wisner, K. L. “The Identification of Postpartum Depression.” Clinical Obstetrics and Gynecology 52.3 (2009): 456–468.

[12] Skalkidou, Alkistis, et al. “Biological aspects of postpartum depression.” Women’s health 8.6 (2012): 659-672.

[13] Glynn, L. M., et al. “New insights into the role of perinatal HPA-axis dysregulation in postpartum depression.” Neuropeptides 47.6 (2013): 373-370.

[14] Patel, Milapkumar, et al. “Postpartum Depression: A Review.” Journal of Healthcare for the Poor and Underserved 23.2 (2012): 534-542.

[15] Fitelson, E., et al. “Treatment of postpartum depression: Clinical, psychological and pharmacological options.” International Journal of Women’s Health 3 (2011): 1-14.

[16] Dennis, Cindy‐Lee, and Ellen D. Hodnett. “Psychosocial and psychological interventions for treating Postpartum Depression.” The Cochrane Library (2007).

[17] Blanchard, Amy, et al. “Understanding social support and the couple’s relationship among women with depressive symptoms in pregnancy.” Issues in Mental Health Nursing 30 (2009): 764-776.

[18] Wittenborn, A. K., et al. “Treating Depression in Men: The role of Emotionally Focused Couple Therapy.” Contemporary Family Therapy 34 (2012): 89-103.

[19] Ravitz, Paula, Robert Maunder, and Carolina McBride. “Attachment, contemporary interpersonal theory and IPT: An integration of theoretical, clinical, and empirical perspectives.” Journal of Contemporary Psychotherapy 38.1 (2008): 11-21.

[20] Grigoriadis, S., and Ravitz, P. “An approach to interpersonal psychotherapy for postpartum depression.” Canadian Family Physician 53.1 (2007): 1469-1475.

[21] Stuart, S. “Interpersonal Psychotherapy for Postpartum Depression.” Clinical Psychology & Psychotherapy 19.2 (2012): 134-140.

[22] Buttner, M. M. “Efficacy of yoga for depressed postpartum women: A randomized controlled trial.” Complementary Therapies in Clinical Practice 21.2 (2015): 94-100.

[23] Daley, A. J., et al. “The role of exercise in treating Postpartum Depression: A review of the literature.” Journal of Midwifery & Women’s Health 52.1 (2007): 56-62.

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