| |||||||||||||
|
Home
|
June 26, 2006
Postpartum depression affects a significant portion of the population, yet it remains in the shadows. A recent bill passed in New Jersey mandates that healthcare professionals discuss the disorder with all new mothers. In recent months, postpartum depression (PPD) has been in the headlines everywhere from Hollywood to national courtrooms. Women such as Brooke Shields, former first lady of New Jersey Mary Jo Codey, and Andrea Yates are shaping the American public’s understanding and view of PPD. As with all mental illnesses, depression carries a certain stigma that creates shame and embarrassment for those who need the most help. However, through educational initiatives such as New Jersey’s “Speak Up When You’re Down,” and the recent passing of mandatory screening for PPD in all women who have given birth in the Garden State, it appears that depression and mental illness are becoming as talked about as high blood pressure. Up to 80% of women suffer from some form of depression, sometimes referred to as “the blues,” following the birth of their child. “Women will often have the blues the first week postpartum due to the large fluctuation in their hormones,” says Jennifer L. Ashton, MD, a gynecologist/obstetrician in Englewood Cliffs, N.J. PPD is a more severe form of depression that lasts beyond the first week and can make it increasingly difficult for the woman to cope with her situation and feelings. One in 10 women will suffer from PPD, and it can start anywhere from the first week through the first year but is most likely to occur within the first three months, according to Ashton. PPD is not discussed often enough and women need to know about the disorder and its implications if they are at risk for developing it, says Codey, who suffered from a severe case of PPD 21 years ago with the birth of her first son, Kevin. “Women need not suffer from postpartum depression unnecessarily. It is a treatable disorder, but if women do not ask for help or discuss their feelings with their doctors, they are not going to get the help that they need,” she says. When a woman is diagnosed with PPD, medical intervention is necessary to help her cope with the feelings and symptoms. “She could be suffering from lack of sleep not related to normal wakings by the baby to feelings of being trapped or feelings of hurting the baby,” says Ashton. “PPD and depression in general have a stigma attached to them because of the feelings of loss of control, but women should not be embarrassed to come forward and speak with their doctors. Someone with high blood pressure would not feel ashamed and nor should the woman suffering from PPD.” On April 13, New Jersey Gov John Corzine signed a bill making it mandatory for all healthcare professionals providing prenatal and postnatal care to educate women and their families about the disorder. The bill stems from the efforts of former governor Richard J. Codey and his wife, Mary Jo, who created greater awareness of mental illness, says Celeste Andriot-Wood, assistant commissioner of the state of New Jersey. “While the program is still in its infancy, it is our intention to have all healthcare providers familiar with the screening program by the six-month mark,” says Andriot-Wood. The state has already convened a working committee to develop and implement the particulars of the program. But, some hospital systems such as Virtua Health in Voorhees already have an entire women’s health program, including screening for PPD, up and running, she adds. Currently, only New York and New Jersey have mandates requiring physicians and nurses to educate women and their families about PPD. Mary Jo Codey When Kevin was 3 months old, Codey and her psychiatrist decided she needed more help than what medications were providing. “When I told my family and friends that I had PPD, they were in disbelief. They could not believe that I was depressed; they thought I should be so happy because I had the baby I always wanted. I was happy to have Kevin, but I was suffering from depression and I needed help,” she explains. Complicating the situation was the fact that depression is easy to hide, says Codey. In 1985, depression and mental illness were often taboo subjects. Codey searched numerous books on pregnancy and child rearing to find more information about what she was feeling and how she could help herself. She found one reference to PPD and wanted to know more about what it is, what causes it, and what to do if you become depressed. After a series of different medications, Codey eventually found the correct dosage to help relieve her symptoms. Despite the hardships, Codey knew she wanted another child. “The fear I had when I got pregnant the second time was similar to the feelings I had following Kevin’s birth. I had to get off my medications and I again began to become depressed. I turned to shock therapy in my eighth month to help with the symptoms I was having on hurting my toddler,” she says. In all, Codey endured 11 shock therapy treatments to alleviate her pain. She was fearful of the birth of her second child and was dreading dealing with the thoughts she had when Kevin was born. Fortunately for the Codeys, Mary Jo did not suffer from PPD with her second child and once she returned to her medication after the second birth she was, and still is, fine. Approximately 20 years later, following the resignation of James McGreevy, New Jersey Senate president Richard J. Codey was sworn in as interim governor in November 2004. Mary Jo Codey knew then that she was in the unique position to share her story to bring attention to the effects of mental illness and PPD. She and her husband created an extensive media campaign that included a Web site and a call center to educate New Jersey residents about the disorders. Educating Women About PPD “Postpartum depression is discussed early on in the woman’s pregnancy at Virtua,” says Powell. In some classes offered at Virtua, PPD’s warning signs are discussed to inform moms of its existence and comfort them at a later date if they begin to suffer from the disorder. By bringing it up while the woman is pregnant, “we are removing the ‘whispering’ of depression,” says Powell. The symptoms of depression vary from woman to woman and in their intensity, but, according to the National Mental Health Association (NMHA), the following are general signs of PPD: Emotional: • Hopelessness and sadness • Uncontrollable mood swings • Feeling overwhelmed or unable to cope • Fear of harming the baby, her partner, or herself • Fear of being alone Behavioral: • Poor self-care • Loss of interest or pleasure in activities • Decreased energy and motivation • Withdrawal or isolation from friends and family • Inability to think clearly or make decisions Physical: • Sleep and appetite disturbances not related to the care of the baby • Headaches, chest pains, hyperventilation, heart palpitations “Some women may have one or all of these symptoms, but the important thing is to know that she has someone to talk to and somewhere to go to get help,” Ashton says. While some women are at greater risk for developing PPD based on previous mental illness, the disorder is far-reaching. Women who are young and unmarried have just as much of a chance of developing PPD as does the older, more established woman. “At Virtua, we have noticed that a lot of women who are developing PPD are older and have more established marriages and careers. It is difficult for these women to transition into motherhood so smoothly because there is a great loss of control and independence,” says Powell. For these women, knowing they are not alone in their feelings and there is help in dealing with their emotions is a great source of comfort, she adds. According to the NMHA, other risk factors for developing PPD include: use of fertility treatments; complications in giving birth or with the newborn following delivery; giving birth to multiples; having PPD with a previous pregnancy; a limited support system; ambivalence toward the pregnancy and impending birth; marital or relationship difficulties; and a family history of depression. Treating PPD Once the patient has been diagnosed with PPD and assessed with a treatment plan, the next step involves the start of antidepressant medication therapy. “Today’s antidepressants are very different from those of years ago,” says Thomas Kay, MD, chair of obstetrics and gynecology at Virtua Health. “Selective serotonin reuptake inhibitors [SSRIs] are a new breed of antidepressants that work to correct the chemical imbalance in the brain associated with high levels of serotonin. The one drawback of these drugs is that they can take anywhere from three to six weeks to reach their full effectiveness. It is because of this that I recommend taking the medication at the onset of symptoms, even if this means while the woman is pregnant. SSRIs have not been found to transfer any significant amount of the drug through breast milk and they are fine to take while nursing.” In addition to being on medication, speaking to a mental health professional is prescribed and encouraged, says Ashton. “Talk therapy is an excellent supplement to an SSRI. Most women see marked improvement in their symptoms within one year of starting the medication and meeting with a psychiatrist,” she says. Having someone to talk to about the feelings and emotions associated with PPD can be as effective—if not more effective—than taking the medication alone, she adds. “Looking back, I wish I had known about postpartum depression,” says Mary Jo Codey. “I wish I knew that other women had it and how to treat it effectively. My goal is to educate women that they are not alone. That PPD is treatable and that she must speak up if she needs help.” — Kim M. Norton is a freelance writer/journalist.
National Mental Health Association, www.nmha.org New Jersey Department of Health and Senior Services, www.state.nj.us/health/fhs/ppd/home.shtml
During the test, the mother answers a series of 10 questions to describe her feelings over the past week. “The validation study showed that mothers who scored above threshold 92.3% were likely to be suffering from a depressive illness of varying severity,” according to the EPDS’ authors. The authors also advise that the questionnaire should not override clinical judgment and should be followed by a thorough clinical assessment to confirm the diagnosis. To evaluate the woman’s responses, the categories are scored 0, 1, 2, and 3, according to increased severity of the symptom for questions one and two. Questions three through 10 are reverse scored (ie, 3, 2, 1, 0), according to the authors. “A score of 12+ indicates the likelihood of depression but not of its severity. The EPDS score is designed to assist—not replace—clinical judgment. The woman should be further assessed before deciding on treatment,” the authors say. The EPDS is as follows: As you have recently had a baby, we would like to know how you are feeling. Please UNDERLINE the answer that comes closest to how you have felt IN THE PAST 7 DAYS, not just how you feel today. 1. I have been able to laugh and see the funny side
of things. 2. I have looked forward with enjoyment to things. 3. I have blamed myself unnecessarily when things went
wrong. 4. I have been anxious or worried for no good reason.
5. I have felt scared or panicky for no very good reason.
6. Things have been getting on top of me. 7. I have been so unhappy that I have had difficulty
sleeping. 8. I have felt sad or miserable. 9. I have been so unhappy that I have been crying. 10. The thought of harming myself has occurred to me.
Resource
|
3801 Schuylkill Rd • Spring City, PA 19475 Publishers of For the Record All rights reserved. |