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Section 20
PPD: Common yet Undertreated

Question 20 | Test | Table of Contents

Depression is treatable, during and after pregnancy.
Everything seemed normal during Sherryl Hartman's pregnancy and labor five years ago. Her son was born healthy, and she had plenty of support from family and friends in her town of Elkridge, Md. A few days after delivery, however, the then 26-year-old Hartman began to feel depressed. "I just started bawling like a baby," she says. Late-night panic attacks soon followed: Hartman's heart would race and she would feel anxious and overwhelmingly emotional. It was difficult to control her strong urge to leave the house--and her newborn.

Hartman called her midwife and explained what was happening. "She said it was just the baby blues. She told me to find a hobby and I'd feel fine," Hartman says. But it wasn't simply the blues. Hartman had a severe case of postpartum depression (PPD).

Her crying jags and panic attacks continued. Soon she began to self-inflict pain by hitting herself on the head. Visits to her doctors and a psychological counselor at her local hospital brought no solutions.

Finally, Hartman found a psychiatrist who prescribed both an anti-depressant and an anti-anxiety drug in addition to weekly visits with a psychologist. After two months of the combination therapy, her depression lifted, but she looks back at those first months after her son's birth and feels a sense of loss. "Things were supposed to be so happy with a new baby in the house," she says, "and I feel like I missed it."

PPD: Common yet Undertreated
Other symptoms of postpartum depression include irritability, apathy, lack of appetite, insomnia, irrational behavior, fear of hurting oneself or one's baby and an inability to make decisions or to concentrate, according to the American College of Obstetricians and Gynecologists. And it is far more prevalent than most people realize, says psychologist Margaret Howard, Ph.D., clinical assistant professor at Brown University in Providence and director of the Day Hospital at Women and Infants Hospital of Rhode Island.

"The women who have PPD think they're the only ones, but 10 to 20 percent of women get it," Howard says. "It's vastly under-recognized, and as a result, it's vastly undertreated." But PPD can be treated with psychotherapy and antidepressant medications such as Zoloft and Paxil. Studies suggest that babies of moms who breastfeed while taking Zoloft or Paxil do not behave or develop any differently than babies who are breastfed by unmedicated moms.

Patients at the Day Hospital, a specialized treatment facility for pregnant and postpartum women who are suffering from depression, anxiety or other mood disorders, can receive group and individual therapy, lactation consultation, drug therapy and more without ever having to disrupt breastfeeding or separate from their newborn.

However, new mothers may be afraid to admit that they are depressed and seek treatment, says Ronald Rosenberg, M.D., a psychiatrist and OB-GYN on the faculty of Wayne State University School of Medicine in Detroit and coauthor of Conquering Postpartum Depression (Da Capo, 2004). "There's guilt, there's shame, there's a feeling that the baby will be taken away from them," Rosenberg says.

Despite the self-imposed stigma, PPD can strike any woman, regardless of her age, economic status or cultural background. However, your risk might be elevated if you have a personal or family history of depression, anxiety or depression during pregnancy, a more difficult than usual labor, little or no social support, marital problems or a baby with a birth defect or disability.

Depression can hit before delivery
Depression after pregnancy is getting more attention lately as several celebrities, including Brooke Shields and Marie Osmond, are coming forward and telling their stories. But some women find they are getting depressed before they give birth.

It's common to feel mildly blue sometimes during pregnancy. But when the blues turn into depression, it's time to seek help. Prenatal depression is more likely to strike when you have a history of depression, if your pregnancy is unplanned, mistimed or marked by complications or if you are experiencing marital problems, says Victoria Hendrick, M.D., associate professor at the University of California, Los Angeles, Neuropsychiatric Institute and Olive View-UCLA Medical Center. Some 10 percent of pregnant women suffer from it.

Depression during pregnancy can be alleviated with psychotherapy, group therapy, couples counseling, medication or a combination of these treatments. Pregnant women may naturally worry about taking anti-depressants. Although there are medications that appear to be safe for the fetus, research shows that some babies born to mothers who take full doses of anti-depressants during the third trimester are born with respiratory distress, jitteriness and hypoglycemia (low blood sugar). These symptoms disappear within two to five days. However, a new study shows that baby mice given the anti-depressant Prozac early in life display more depression-like behaviors in adulthood, although it's unknown whether human fetuses exposed to anti-depressants in the third trimester might suffer similar effects later on. For this reason, nonmedicinal approaches usually are tried first. But if anti-depressants are prescribed, complications can be avoided if your doctor starts tapering your dosage during the third trimester.

Don't postpone treatment
If prenatal depression is not treated, it can affect the baby. That's because when pregnant women are depressed, they are less likely to eat properly, get enough sleep and take prenatal Vitamins, Howard says. They're also more likely to use alcohol, tobacco or drugs, all of which increase the risk of birth defects.

Pregnant women and new mothers can benefit from talk therapy or programs like those offered at the Day Hospital in Providence. Many new moms feel overwhelmed because they think they have to be perfect mothers, and therapy can help them develop more realistic expectations. That was the case with Hartman, who was able to work through her feelings of inadequacy and her tendency to be a perfectionist.

About 10 months after her son was born, Hartman no longer needed medication. She was worried that her depression would prevent her son from bonding with her, but it turned out not to be the case. Today, she says, "My son and I couldn't be any closer."
- Kelly, Alice Lesch; When Mama Sings the Blues; Fit Pregnancy; Apr/May 2005; Vol.12, Issue 1.

Postpartum period: three distinct but continuous phases

- Romano, M., Cacciatore, A., Giordano, R., & La Rosa, B. (2010). Postpartum period: three distinct but continuous phases. Journal of prenatal medicine, 4(2), 22–25.

Personal Reflection Exercise #6
The preceding section contained information regarding common issues of PPD. Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Update
Improving front-line clinician capacity to address depression and bipolar disorder among perinatal individuals: a longitudinal analysis of the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms

Masters, G. A., Yuan, Y., Li, N. C., Straus, J., Moore Simas, T. A., & Byatt, N. (2023). Improving front-line clinician capacity to address depression and bipolar disorder among perinatal individuals: a longitudinal analysis of the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms. Archives of women's mental health, 26(3), 401–410. https://doi.org/10.1007/s00737-023-01324-1

Peer-Reviewed Journal Article References:
Swami, V., Vintila, M., Goian, C., Tudorel, O., & Bucur, V. (2020). Mental health literacy of maternal and paternal postnatal depression in a community sample of Romanian adults. International Perspectives in Psychology: Research, Practice, Consultation, 9(3), 147–158.

Tomfohr-Madsen, L., Cameron, E. E., Dunkel Schetter, C., Campbell, T., O'Beirne, M., Letourneau, N., & Giesbrecht, G. F. (2019). Pregnancy anxiety and preterm birth: The moderating role of sleep. Health Psychology, 38(11), 1025–1035. 

van Scheppingen, M. A., Denissen, J. J. A., Chung, J. M., Tambs, K., & Bleidorn, W. (2018). Self-esteem and relationship satisfaction during the transition to motherhood. Journal of Personality and Social Psychology, 114(6), 973–991. 

QUESTION 20
What are 4 treatment methods mentioned for pregnant women suffering from depression? To select and enter your answer go to Test.