Sarah L. Schleifer, MSSW, LCSW
   
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QUESTIONS AND ANSWERS

 What is Postpartum Depression?
Depression can be described as feeling sad, blue, unhappy, miserable or down in the dumps.  Most of us feel this way at one time or another at some point in time. Depression is a disorder of ones mood – in which feelings of sadness, anger, frustration, persist over time. Even more distressing may be fears and worries that surface about things that usually were of no concern.

When does it start?
The word Postpartum means after the baby is born. But over ½ the women who become depressed after the baby is born actually start having signs of it during the pregnancy.  For others, it can start within a few days  or weeks of birth and even as long as a year later.  For some women who are breastfeeding,  they might become depressed when they are weaning the baby.

How is it different from the normal overwhelmed and stressed feelings after childbirth?
If the feelings are related to being overwhelmed – than by getting help in the house, getting help from your family and husband should help you feel better.  If reducing the stress doesn’t help – it might be time to consider follow up.

What is ‘Baby blues”? 
Most women – 85% of new mothers – experience what is called ‘baby blues’ – Baby blues start within a few days or up to a week of birth. The mother may feel moody, overly sensitive, and cries easily. These symptoms will pass over the first two weeks.  If these signs continue and worsen – it may be time to follow up.

What are the symptoms of Depression?    The things to look for are:
  1. feelings of exhaustion,
  2. sadness or crying
  3. Feeling hopeless or helpless
  4. difficulty concentrating or remembering things
  5. difficulty sleeping even when tired or falling asleep and waking in a few hours,
  6. change in eating habits ( loss of appetite or urging to eat), 
  7. thoughts that come out of nowhere of harm coming to the baby,
  8. Thoughts coming out of nowhere  of harming yourself – or wishing you could go to sleep and not wake up.
  9. While some of these are common for every new mother - it’s the intensity of these feelings and how distressing they are to the mother that suggests the need for follow up.

What causes PPD? 
There are many reasons why a woman gets depressed – it can be a combination of factors and not one thing by itself. .  Hormone changes or a stressful life event, such as illness in the family or financial difficulties can cause chemical changes in the brain that lead to depression. Depression is also an illness that runs in some families so there is a genetic factor involved.  Other times, its not clear what causes depression. But depression is not a weakness of will or character or lack of faith.  The shame and guilt that is felt is a symptom of the depression.  

What are the risk factors?  How do I know if I am at risk?
A past history of depression or anxiety or a family history of depression or anxiety are the strongest predictors for depression.  But other risk factors include:  lack of social support or social isolation, death in the family, financial difficulties,  difficult pregnancy or difficult delivery, and history of childhood abuse.

If someone in your family has had depression it increases the chances for depression.  But it certainly doesn’t determine that you will get it.  ( The risk goes from 15% to 30% which certainly doesn’t assure that you will get it.)
     
What can I do to prevent it now  if I have already had it in the past?

Planning, planning, and planning.  Arranging for help in the house, cooking in advance to have meals prepared for the family, discussing possibility of husband or family member  helping out in the first few weeks after birth may help reduce the stress immediately following delivery.  Calls to Aim V’Yeled and Yad Rochel can bring additional support and assistance.  Consider the possibility of using a Dulah for the birth to  provide  skilled support during labor and delivery.   

Can I have another baby?  Will I become depressed again?

Depression should not be a reason not to have a baby. However,  if the mother is on medication –  a thorough discussion with the physician will provide information about how to manage.  Some women will be able to go off medication for the time of the pregnancy, others may do well with the dosage being reduced.  Having one depressive episode doesn’t guarantee that you will have another – but the risk is about 50%.  Since stress is a factor that can increase the risk for depression, it may be helpful to have a plan to reduce work hours or stop working, get extra help in the house or enlist neighbors to help in the first few weeks following delivery.  Remember an investment in planning may result in a lower risk for depression or even if it occurs – a less severe experience.   

In addition, its been found that specific coping skills – Cognitive Behavior Techniques – can be learned that help address the negative thoughts that begin to surface in a woman as she is beginning to become depressed.  Through practice , the woman can learn to catch the negative thoughts and change them before they cause a negative change in her mood. These skills can be learned at any time – you don’t have to be depressed to find them useful.