However, between 15- 20% of women experience a more prolonged and debilitating period of clinical depression or Post Partum Depression (PPD), which robs them of pleasure, fills them with self-doubt about their ability to care for their infant, reduces them to frequent tears, and instils feelings of hopelessness and guilt. Sleep and appetite are also disrupted but this is often confused with the disruptive impact of life with a new baby.

PPD often has a gradual insidious onset, following an initial period of elation, and occurs within four weeks of childbirth. Women are often reluctant to share how they are truly feeling because it is out of keeping with “how it’s supposed to be”. This can mean that serious symptoms are ignored or overlooked until the depression is deeply entrenched and more difficult to treat.

Postpartum mania includes a heightened and inappropriate feeling of well being, excitability, irritation, and grandiosity. The mother’s sleep is markedly reduced without any complaint of fatigue. The mother may forget her child or have delusional ideas about its importance or identity (i.e. the baby is the son of God). The lack of insight and awareness that anything is wrong complicates getting help.

However, getting treatment is essential not only for the health of the mother but also for the infant as well. Although rare, some women may develop a psychotic depression (false fixed beliefs) with hallucinations that can encourage the mother to take her life and the life of her child or delusions about the infant being dead or defective, excessive concerns about the baby's health or have impulses to hurt the baby.

A previous history of depression or manic depression can increase a women’s risk of developing PPD after childbirth. If you have a personal or family history of mood disorders then getting good prenatal care to addresses this risk and develop an appropriate treatment plan is vitally important.

The clinical presentation of PPD is similar to that of major depression or manic depression.

What causes PPD?

No one is 100% sure what causes some mother to develop PPD. Researchers are exploring the role that hormones play in searching for causes of pregnancy and postpartum mood and anxiety disorders. It is believed that the rapid changes in levels of hormones that accompany pregnancy and delivery such as estrogen, progesterone and thyroid have a strong effect on women's moods. . (Hyperlink to causes of depression)

The Common symptoms of PPD include:

• Depressed mood or mood swings with exaggerated highs and lows.
• Uncontrolled crying and irritability.
• Loss of interest in usually pleasurable activities.
• Lack of interest in sex.
• Difficulty with memory, concentrating, and making decisions.
• Psychomotor agitation or retardation.
• Fatigue, sluggishness, and feeling exhausted.
• Changes in appetite or sleep. Insomnia.
• Recurrent thoughts of death/suicide.
• Intrusive unwanted thoughts.
• Feelings of worthlessness or guilt, especially failure at motherhood.
• Lack of interest in the baby.
• Excessive anxiety over child's health.

The treatment of PPD is highly successful but can be complicated because:

• Breast-feeding can reduce the number of treatment options available particularly regarding the use of medications.
• Women need to continue to care for an infant at a time when all her resources may be needed to look after herself. Seeking extra help from family or professional services is essential to help the mother cope and increase the opportunity for a good mother - infant bond.

The most common treatment approaches include:

Treatment for Postpartum Depression can be as varied as the symptoms. Common approaches include:

• Medications to stabilize mood and treat depression.
• Psychotherapy and psychosocial supports to help the mother adjust and cope with new responsibilities and infant care.
• Hospitalization may be required to provide a safe and supportive environment for mother and child.
• Electro convulsive therapy when medications cannot be used or are not effective.

Build in additional supports:

• Creating a supportive environment, which nurtures both the mother and infant and encourages mom’s self-care. Ask for help from family and friends for both infant care and managing daily tasks such as cooking, shopping chores.
• Build a support network of care providers. Speak with your doctor about additional resources in your community i.e. Public Health Nurses, Home Care Service.
• Keep connected with friends. You may feel a desire to pull back and hide what is happening. Friends can add support and give you a break from the all-compelling task of providing infant care.
• Seek out the support and reassurance of other new moms by joining a self-help group.
• Seek out the support of other more experienced moms. It can help to normalize your experience. There is nothing like the wisdom of experience to help a mother cope.
• Learn as much as you can about PPD so that you can understand what is going on and plan your care and make informed treatment decisions.

What can fathers do to help?

For many women the period following childbirth is extremely demanding. This is greatly exaggerated when PPD is part of the experience. You can play an important role in helping your wife and infant by:

• Encourage her to share her thoughts and feelings and show her you understand. Reassure her that she is loved and valued.
• If possible take some time from work in the early days to help with infant care and allow your partner to rest and care for herself.
• Ask family and friends to help with chores.
• Avoid minimizing or dismissing her experience. If you have concerns about how your partner is coping, go with her to the doctor and share your concerns.
• Look after your own needs. Find someone you can talk to. Being a new father is demanding for you, particularly if it is a first child. Speaking with others who have ‘been there’ can provide you with reassurance and support.
• Continue to participate and enjoy with personal interests and activities.

http://www.mooddisorderscanada.ca/depression/ppd.htm

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