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Postpartum Depression
CBS CARES: What is postpartum depression and what physical and psychological factors cause it?
DR. WEISSMAN: Well, postpartum depression is usually depression that occurs during the postpartum period, which begins at the point of delivery and lasts up to six months after. One can make a case for different biological and psycho-social factors that are going on that can contribute to it. And probably everything is correct. If you think about it, babies take time and keep families up at night, causing a lot of sleep deprivation.
Factors include all of the changes that come with having a baby, such as the reorientation of roles in the family. Taking care of a small child is very demanding, and that can have an impact on the spouse and also other family members. Usually, if there are other children, they're not always happy about the new baby. They may be happy about having a sibling, but they're not so happy about having some of the attention of their parents divided. And, of course, if there's a broken family, and single mother or marital problems, you can imagine all the things that occur that can be very stress producing.
Added to that is just the physical labor of pregnancy and labor which is exhausting. Then there are the enormous hormonal changes, which occur after birth. And, of course, if there's a previous history of depression, then the mother is more vulnerable.
All of those factors can contribute to postpartum depression, even if this is a baby that's highly wanted, highly desired and a marriage that's wonderful and just waiting for this child to be delivered.
CBS CARES: What are the symptoms of postpartum depression?
DR. WEISSMAN: They include feeling sad, blue, emotional, loss of appetite, having difficulty sleeping, although that's hard to discern because babies keep mothers and families up. Sometimes, women with postpartum depression feel life is not worth living or feel suicidal. Some can even, in a very small number of cases, have negative feelings towards the baby.
CBS CARES: Which women are at higher risk of developing postpartum depression?
DR. WEISSMAN: Women who had a previous history of depression or bipolar disorder are at high risk. Also, a woman who does not have a lot of social support is more vulnerable, whether there's marital conflict or no marriage.
CBS CARES: Can it actually begin during pregnancy...is there such a thing as prepartum depression?
DR. WEISSMAN: Yes. Pregnancy was always defined as the period of great happiness and maternal pride and satisfaction. But there are depressions that can occur during pregnancy, although the postpartum period is a much more vulnerable period. Lots of physical changes occur during pregnancy aside from weight gain. There are also job orientations and career orientations that might change. There are so many things that go on. It's a period of great joy for many women, but also a period of great change and depression can occur.
CBS CARES: Don't most mothers experience the blues after giving birth? If so, how long do those symptoms usually last?
DR. WEISSMAN: No, those figures vary. They say that postpartum blues are so common as to be considered normal. I've seen figures that have ranged from 20 percent to 80 percent. I don't think we really know what the figures are, but they are high. Also, rather than just new baby blues, there are mood swings. There are some women who experience euphoria. Those are usually transient, and they go away within six weeks.
However, there can be symptoms that persist and begin to impair one's life. The woman can't take care of the child. She can't or doesn't want to go out. She has all the classic symptoms of depression. They're not just fleeting.
The very typical thing is a woman who after birth, is euphoric at the attention, euphoric at having produced an infant. That's a very heady experience. And then there is being kept up at night, and the child is cranky and can't be soothed. That can be very stressful and can produce problems in the family.
CBS CARES: What percentage of new mothers experience postpartum depression?
DR. WEISSMAN: About 10 percent of women will suffer from depression. And a much smaller number will have very serious depression.
CBS CARES: If a woman experiences postpartum depression with her first child will she necessarily experience it after having a second or third child?
DR. WEISSMAN: Not necessarily, but if she has a previous history of postpartum depression, she's at higher risk.
CBS CARES: Is there a related form of postpartum depression experienced by some fathers?
DR. WEISSMAN: That's a good question. I wouldn't be surprised, because depression occurs during periods of change and transition. Those are the associated factors. Pregnancy and delivery produce transitions and can produce disputes. If a man is feeling left out, neglected and no longer the center of the woman's emotional life, he might not be happy about it.
CBS CARES: Is there a form of postpartum depression for the baby? ?There you are, a newborn baby, plucked from the cozy comfort of the womb and suddenly in the outside world with people shouting in a strange language at each other...and, where, after delivery you're prodded and processed...could birth and the time soon after affect babies psychologically?
DR. WEISSMAN: Otto Rank actually had a theory of birth-trauma many years ago. But, he never had any scientific data to back it up and no one has studied it since. Early after delivery, most babies are just sleeping. They want to eat and they are really programmed to do very well with this experience. Mothers, too, are geared to be warm and nurturing at this time and it is important to hold the baby close after birth.
CBS CARES: How does a mother's postpartum depression affect the baby...now and later in life?
DR. WEISSMAN: If the mother is depressed and there's no one else around that can take over that maternal role, there can be an effect on the child. Children lose their appetite, and their cycles of sleep and eating become more unregulated. In these cases, postpartum depression can have an effect on the baby.
We've studied the effects of parental depression on the offspring of the depressed mothers or fathers. In a study of three generations, we have shown that the children of depressed parents have high rates of anxiety disorders and depression. These persist. They're recurring. They're impairing. And they often occur cross the generation.
CBS CARES: How does a mother's postpartum depression affect the father?
DR. WEISSMAN: Well, he can't be happy. It's very hard to live with a depressed person because you want to help. And it's hard to know how to help.
CBS CARES: What advice can you give new fathers on how best to help their partner who is going through postpartum depression?
DR. WEISSMAN: Be loving, supporting and pitch in and help with the baby in a meaningful way. Don't blame or judge your partner for being depressed-facilitate them getting professional help.
CBS CARES: Does the treatment for postpartum depression differ in any way from treatment for regular depression?
DR. WEISSMAN: Only to the extent that if you use medication and the woman is nursing, these medications do get into breast milk. You can ask the woman to stop breast-feeding.
The treatment of postpartum depression has to deal with the transition and the disputes that occur around the entrance of the baby into the house, as well as the physiologic problems that are associated with depression and the eating problems. If a woman is nursing and she's depressed and she can't eat, that's a real problem. If a woman has trouble sleeping and then her sleep gets interrupted every three hours by a baby who is colicky and screams all the time, that needs to be dealt with.
I think the more resources there to help the woman to get through this period when she can at least get some good rest is very important. Not many people have that luxury.
CBS CARES: What do you have to say to those, such as Tom Cruise, who criticize women with postpartum depression for undergoing antidepressant drug treatment?
DR. WEISSMAN: What is his evidence? I think that the evidence is very strong that the antidepressant medications and psychotherapy help depression. For many women, psychotherapy alone may not work.
And why would one advocate against woman getting the best help for depression available? Why shouldn't women have all the available treatments that have been shown to be effective? The only caution about medication is breast-feeding. But other than that it should work. And usually, some kind of psychological intervention is necessary.
CBS CARES: Are there some specific psychotherapies that are better?
DR. WEISSMAN: Well, there are two therapies that have been used for postpartum depression and that have been shown to be effective in clinical trials. That doesn't mean there aren't others that might be effective, but they just haven't been studied.
There's interpersonal psychotherapy, which is something I developed with my late husband, Gerald Klesman. It has been modified for use during pregnancy and the postpartum period. The structure of interpersonal psychotherapy dealing with transition and dispute associated with the onset of depression fits in very well with the issues that women have postpartum. Delivery, the entrance of a baby into a home is a big transition and then, of course, there are disputes that are going to occur as a result. Interpersonal psychotherapists are helping mothers deal with those issues.
Another is cognitive therapy, which deals with thinking. It deals with the negative thoughts of a depressed person and helps to reorientate the thinking about the situation.
CBS CARES: Are there support groups for mothers with postpartum depression? How can postpartum mothers tap into such support groups? What about those without insurance or who cannot afford healthcare?
DR. WEISSMAN: Well lack of insurance is a real problem for everybody. There are groups that are doing work on trying to help depressed people. There's the National Depression & Bipolar Organization. They do have support groups, although it's not specifically for pregnant women.
CBS CARES: How do you know when a mother who may have harmed her child and pleads postpartum depression as defense really has postpartum depression? How can/do psychiatrists determine a legitimate case of postpartum depression versus where someone feigns it...
DR. WEISSMAN: Well, that's a difficult question. There are a very small number of women who become hostile and aggressive to the point of being psychotically depressed and hurting their children. They become delusional. We've just seen cases of this.
I think there are cases where these women have been put in jail for many, many years when it seems so clear it's postpartum depression. Now I think it's the courts that have to decide whether this is real or unreal. One can't do that in the abstract. On the other hand, I think that there needs to be a real recognition of the fact that this is a clinical syndrome that's been documented for decades.
CBS CARES: What do you have to say to women who think they're suffering from postpartum depression?
DR. WEISSMAN: It's a real condition. It's not because you're a bad mother. You need to get some sleep, find support within your family and get help?.for your own sake, for the sake of your baby and the family.
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