By Kathy P. Behan
Susan Kushner Resnick knew she was in trouble when her infant son started to sleep through the night at four months, and yet she wasn’t able to. Along with insomnia, she also experienced crippling anxiety attacks, a loss of appetite and episodes of compulsive behavior — repeatedly straightening bed sheets and making detailed lists.
Resnick was suffering from a classic case of postpartum depression (PPD), but she didn’t know it. “I really didn’t feel sad,” she said. “I thought that’s what depression was — feeling sad. I just felt frenzied and out of control.”
Resnick gradually started to feel better, mainly due to the help of a nurse psychotherapist, who prescribed an antidepressant and medication to help her sleep. She also joined a Depression After Delivery support group, and enlisted the aid of her husband, who would come home early from work to take care of their baby and 3-year-old daughter.
Prompted partly by frustration, Resnick wrote a book about her experiences. “I wrote ‘Sleepless Days’ because it was the book I needed to read,” she said. “When I was feeling so badly, I thought l’ll be OK if I read someone else’s story and find out that they lived through this.’ There were no books like that.”
Postpartum mood disorders are common, and yet as Resnick found out, information on the topic is surprisingly sparse. Ruta Nonacs, M.D., Ph.D., a staff psychiatrist at Massachusetts General Hospital, an instructor at Harvard Medical School and a new mother explained: “People have known that depression has existed for a long, long time but post-partum depression has only been recognized in the last hundred years, and studied more closely for the last 20.”
The good news is that even though experts still aren’t exactly sure what causes PPD — hormones, stress or a combination of the two — the condition is finally being taken seriously. “People are seeing this as a real entity, that it really does exist, and it can be quite severe,” says Nonacs.
Why has PPD been overlooked? Nonacs speculates that one reason may be because new motherhood has always been viewed as one of the happiest times in a woman’s life.
“It’s kind of a taboo in our culture,” agrees Resnick. “Motherhood is supposed to be so beautiful and fulfilling. If you say that many women are miserable after having a baby, it’s bad PR.”
This may explain why so many new mothers are reluctant to admit they’re having problems, and seek professional help. The problem is often compounded by loneliness. “I think the new mother is particularly isolated,” said Nonacs. “She’s at home. She’s not in the work force. She can manage to take care of her child, but some other things might be falling by the wayside, but there’s nobody there to see it.”
Isolation is something that Carol, a Metrowest mother of four, knows all too well. Even though she keeps in close touch with her sister in Oklahoma, she has few local companions.
“My husband’s never home,” she said. “I’d just love somebody to talk to.” Carol’s baby is almost 6 months old, and Carol says she’s never felt worse. Her profile is typical of a PPD sufferer: Carol worries incessantly, mostly about her kids; she doesn’t get more than four hours of sleep a night; she’s very tearful; she’s “cranky” with her other children; and she’s eating more than she normally does but she’s still hungry all the time. In addition, she lives under a cloud of stress — she has no one to help her with the children; two of her sons have significant learning problems; her parents are recovering from life-threatening ailments; and her baby is plagued by non-stop ear infections.
Yet Carol’s not convinced she has PPD. “I’ve always had stress, but I’ve always been pretty resilient,” she said. “I still don’t really think of myself as depressed, I just need some sleep, and somebody to talk to.”
“PPD often goes untreated,” Nonacs said. “There’s a lack of knowledge in the general population so these women are reassured that things will get better. They’re told this is a phase and it will pass, or that they’re simply not getting enough sleep. Symptoms get minimized.”
Recovery is important not only for the mother’s well-being, but also for her child’s. “PPD can have a significant impact on a baby,” Nonacs said. “Even mild depression can affect how a mother interacts with her child. We have a lot of data that shows that kids who have depressed moms will have more behavioral problems, and they’ll be slower to develop both in terms of interpersonal skills, as well as their motor coordination.”
The good news is that all kinds of help is available. Some studies suggest taking part in parenting or support groups during pregnancy and in the postpartum period can actually ward off PPD. Even when a mother becomes depressed, joining this type of group may also offer significant relief. “These gatherings provide a woman with an extra layer of support in a community where she can talk about issues,” Nonacs said.
Women should contact their ob/gyn or primary care physician for referrals. A mother may need individual therapy, and possibly sleep and antidepressant medications. Other resources include: Depression after Delivery (800-944-4PPD); Jewish Family & Children’s Services (617-558-1278); Postpartum Support International (805-967-7636); the Perinatal Psychiatry Program at Mass General (617-724-6540) or the Hestia Institute in Wellesley (781-431-1275).
Postpartum mood disorders generally fall within the following three categories:
BABY (OR POSTPARTUM) BLUES
• Onset: Usually about three days after delivery.
• Duration: Less than two weeks.
• How common: Affects 50-85 percent of new mothers.
• Symptoms: Mood swings; irritability; tearfulness; generalized anxiety; mild sleep; and appetite disturbances.
• Treatment: None — resolves on its own.
POSTPARTUM DEPRESSION (RANGES FROM MILD TO SEVERE)
• Onset: Late in pregnancy, or within the first few months after delivery.
• Duration: Without treatment, may last up to a year.
• How common: Affects 10-15 percent of new mothers.
• Symptoms: Depressed mood; feelings of guilt; exhaustion; hopelessness; significant appetite and sleep disturbances; poor concentration; memory loss; over-concern for the baby; uncontrollable crying; irritability; intense anxiety; and intrusive, repetitive thoughts.
• Treatment: Group psychotherapy; support groups; individual psychotherapy; and sleep and antidepressant medication.
POSTPARTUM (OR PUERPERAL) PSYCHOSIS
• Onset: Usually within two weeks of delivery.
• Duration: Resolves within weeks with medication.
• How common: Rare — approximately one out of every 1,000 women.
• Symptoms: Restlessness; agitation; irritability; sleep disturbances; confusion; hyperactivity; disorganized behavior; delusions and hallucinations, possibly of a religious nature; and rapid speech or mania.
• Treatment: Mood stabilizers, antipsychotic medication and hospitalization.