What is PPD and how is it different from regular depression?
Postpartum Depression (PPD) is an illness a mother may experience after the birth of a baby. It can present in a number of ways. PPD is typically an agitated depression with symptoms of both depression and anxiety.
While PPD is technically depression with a postpartum onset, it is also incredibly different from the standard diagnosis of depression we see in the DSM. This is because of the simultaneous experience of life’s greatest gift (a baby) and one of life’s hardest illnesses (depression).
I most appreciate the analogy of this difference as it is presented in the book, This Isn’t what I Expected:
“Imagine two women going in for operations, one to have a kidney removed, one to have a breast removed. In both cases, the women will experience many similar things; they will both will undergo anxiety, surgery, pain, recovery, and the loss of a body part. But in addition, the woman who loses her breast will experience feelings and changes related to sexuality, self-esteem and identity.”
How Prevalent is PPD in the United States?
Every year, more than 400,000 infants are born to mothers who are depressed, which makes perinatal depression the most under diagnosed obstetric complication in America.
At least 1 in 7 women suffer from postpartum depression or anxiety.
Postpartum depression is considered the number one complication of childbirth.
Suicide accounts for up to 20% of postpartum deaths and is the second leading cause of mortality in postpartum women.
In Colorado, self-harm is the #1 cause of death in new mothers.
Is this just an American Epidemic?
Based on research conducted worldwide, even the cultures with healthy, holistic, mother-baby-centered postpartum practices reflect levels of perinatal mood disorders.
According to the World Health Organization, about 10% of pregnant women and 13% of postpartum women experience a mental disorder globally. In developing countries, this statistic is higher: nearly 16% during pregnancy and 20% of women during the postpartum period.
A snapshot of prevalence of PPD in other countries:
(Country: % of birthing women suffering from PPD)
India: 23% (16% in rural south India)
To consult a more thorough list of statistics per country, please visit this website
Snapshot data from (http://www.postpartumprogress.com/is-postpartum-depression-non-existent-in-other-cultures-the-facts)
WHO thorough report: (http://apps.who.int/iris/bitstream/10665/43846/1/9789241563567_eng.pdf)
Are perinatal mood disorders a new phenomenon?
Perinatal mood disorders were first studied by Hippocrates in 460BC. Later, Louis Victor Marcé, a French psychiatrist, wrote about postpartum health in 1858.
Between 1858 and the 1900s, research seems to have dropped off.
James A. Hamilton, MD, PhD, became the Father of Postpartum Psychiatric Illness and was the forerunner of resurgence and support for perinatal mental health.
DSM-4 (Diagnostic Statistic Manual) included a specifier for the illness starting in 1994.
How does one develop a perinatal mood disorder?
All women are at risk for mental disorders during pregnancy and throughout the postpartum period, including when she weans her baby, even if that is over a year after delivery. The causes are multifaceted.
Poverty, stress, having multiples, exposure to violence, high conflict environments, natural disasters, having a baby with a difficult temperament or health condition, and low social support generally increase risk for these disorders.
Other contributors to developing PPD include psychological challenges associated with attachment, feeding, loss of freedom and control, birth trauma, physical healing from labor/delivery, insecurities about parenting, identity changes, social adjustments, body image issues, and financial pressures.
Nine personality traits have been linked to predictors of PPD, as well. These nine traits include neuroticism, high worry and low self-confidence, mistrust, high introversion/low extraversion, perfectionism, harm avoidance, interpersonal sensitivity, body image dissatisfaction, high trait anger and personal distress empathy.
PPD has a strong biological component and individuals who have a personal or family history of depression or mental illness are more likely to experience PPD.
Research indicates a strong connection between these disorders and biochemical changes during pregnancy and following delivery. The sudden shift of hormones within a woman during this period of time can have physical and mental ramifications.
The washing of these hormones over the brain during this time can result in a bit of re-shaping of various cerebral components anatomically. The results can manifest in a mood disorder.
Research shows that sleep deprivation can, indeed, trigger disorders that were laying dormant, particularly Bipolar I and depression.
Is Postpartum Depression Preventable?
The studies are mixed.
The most effective methods of prevention include:
~Sleep: The most critical method of prevention and intervention is sleep, however she can acquire it. Many doctors and psychiatrists recommend a sleep aid to help her get the rest she needs in order for therapeutic interventions to be effective. Mothers may opt for natural sleep aids using dietary changes, supplements, and aromatherapy rather than medication. Regardless of the remedy she chooses, it must result in her sleeping.
~ Medication: it is advised if mothers were diagnosed with PPD in one pregnancy, they are put on an anti-depressant during subsequent pregnancies. The dose is sometimes increased during the third trimester and always increased immediately after birth to offset hormonal shifts.
~ Psychotherapy: Preventative cognitive behavioral therapy and a sort of prenatal survival skills support group or class is recommended. Not just a birthing class, but a course that offers practical skills to offset challenges of new parenthood.
~ Nutrition: She must be eating a well-rounded, healthy diet. This is not necessarily paleo or carb-free. There have been some studies that indicate a connection between a low carbohydrate diet and increased occurrences of depression. Ultimately, she needs to eat healthy foods that her body digests well.
~ Social Support
*There is currently no scientific studies that can demonstrate a connection between placenta consumption and PPD prevention. There are a couple studies currently open, but none have been conclusive.