# Presentation: 470182

## Understanding Perinatal Mood Disorders: 
An overview 

- <date/time>

- Understanding Perinatal Mood Disorders:
- An overview

**Notes:**
Public Policy, Children, Youth and Families
Thank you for having me with you tonight.  It is a pleasure to be at .... and to share my knowledge about a neglected women’s health issue called  “Postpartum Mood Disorders”.  The first part of my talk will be general information about the topic. 
Babies...aren’t they adorable??!! This particular photo was taken at a mother’s support group in Canada.  It is a reminder that society usually is focused on the baby and rarely on the MOTHER.  Tonight’s discussion will do just the opposite.  I do love children but I’m far more interested in their mothers because I was a mom who suffered from this neglected disorder.

## Postpartum Support Internationalwww.postpartum.net

- 927 N. Kellogg Avenue
- Santa Barbara, CA 93111
- 805 967-7636

## Jane I. Honikman, M.S.

- Founding Director
- Postpartum Support International

## Slide 4

## General Facts About Depression In Women

- Over the life-span 21 % of women will experience a depression vs. 13% of men
- The rates of depression rise rapidly after puberty in girls
- There is an increased prevalence of depression during the reproductive years;
- There is an increased risk of recurrence in the perimenopausal years between ages 45 – 50
- And finally, the rates of depression decrease after menopause

## Issues Affecting Pregnancy and Postpartum Psychological Outcome:

- Previous history of personal and/or family psychiatric problems
- History of sexual abuse or trauma;
- Fertility problems
- Pregnancy losses
- A previous experience of pregnancy, birth, and/or postpartum difficulties

## Why Do We Want to Recognize, Diagnose, and Treat PPD?  

- Increased incidence of childhood psychiatric disturbances
- Impaired cognitive and language development in children
- Potential for child abuse (infanticide, being the most extreme example) and failure to thrive through neglect
- Impacts marital, family, and ALL relationships
- Chronic illness in the mother, particularly bipolar disorder and major depression

## Depression in Pregnancy

- About 10% of women experience depression in pregnancy
- 50 - 75% relapse after discontinuing medication when pregnant
- Over 40% resume medication during pregnancy

## Depression/Anxiety in Pregnancy

- Depression in pregnancy associated with:
- Low birth weight (under 2500 grams)
- Preterm delivery (less than 37 weeks)
- Severe anxiety in pregnancy associated with:
- Constriction in placental blood supply
- Heightened startle response

## Treatment in Pregnancy

- No increased risk of malformations, miscarriage, neonatal complications or neurobehavioral developmental problems
- Lithium has under 1% risk of Ebstein’s anomaly in 1st trimester. Best choice for bipolar disorders
- Prozac, Zoloft, Paxil, Celexa, and TCA’s

## Association for Postnatal Illness in England was founded in 1979.Cathy Hamlin, shown here with her children, is just one of many APNI volunteers.

## Postpartum Blues

- Occurs in 50-80% of postpartum women
- Onset usually between day 3 and day 14 postpartum
- Symptoms may persist from several days to a few weeks

## Symptoms of the “Blues”

- Mood instability
- Weepiness
- Sadness
- Anxiety
- Lack of concentration/ability to carry out activities of daily living
- Feelings of dependency

## Etiology of the “Blues”

- Rapid hormonal changes
- Physical and emotional stress of birthing
- Physical discomforts
- Emotional letdown after pregnancy & birth
- Awareness and anxiety about increased responsibility
- Fatigue and sleep deprivation
- Disappointments about the birth, spousal support, nursing, the baby, etc.

## Postpartum Depression/Anxiety

- Occurs in 8-20%; 20% of those with “postpartum blues” develop depression
- Onset is usually insidious although it can be rapid, and can occur any time in the first year
-  May last from 3 to 14 months
- Most recover within one year
- Can become chronic

## Symptoms of PPD:

- Sad mood, feelings of guilt, phobias
- Sleep problems, often insomnia
- Physical symptoms or complaints in excess of or without physical cause
- Marked fear of criticism of mothering skills;
- Excessive fear about baby’s health or well-being
- Excessive worry or fatigue
- Infant’s failure to thrive
- Loss of focus/concentration; loss of interest or pleasure;Appetite/weight changes

## Risk Factors for PPD

- 50-80% risk if previous postpartum depression
- Depression or anxiety during pregnancy
- Personal or family psychiatric disorder (especially depression)
- Severe PMS (premenstrual dysphoric disorder)
- Social isolation/poor support system

## Treatment for Postpartum Depression/Anxiety

- Individual and/or couple therapy
- Group support
- Antidepressant and/or anti-anxiety medication, if necessary
- Medication for sleep, if necessary
- Treat thyroiditis
- Inadequate treatment can lead to chronic depression and relapse

## Postpartum Obsessive-Compulsive Disorder

- 3% - 5% of new mothers may develop obsessive symptoms

## Symptoms of Obsessive-Compulsive Disorder

- Intrusive repetitive and persistent thoughts or mental pictures
- Thoughts often are about hurting or killing the baby
- Tremendous sense of horror and disgust about these thoughts (ego alien)
- Thoughts may be accompanied by behaviors to reduce the anxiety (hiding knives)

## Risk Factors for Obsessive-Compulsive Disorder

- Personal or family history of OCD

## Treatment for OCD

- Psychotherapy
- Medications

## Postpartum Panic Disorder

- May occur in up to 10% of postpartum women

## Symptoms of Panic Disorder

- Episodes of extreme anxiety, excessive worry or fears
- Shortness of breath, chest pain, sensations of choking or smothering, dizziness
- Hot or cold flashes, trembling, palpitations, numbness or tingling sensations
- Restlessness, agitation, or irritability
- During attack may fear she is going crazy, dying, or loosing control
- May awaken from sleep; often no trigger

## Risk Factors for Panic Disorder

- Previous history of anxiety or panic disorder
- Thyroid dysfunction

## Treatment for Postpartum Panic Disorder

- Psychotherapy
- Medications

## Bernadette Brennan Founded Post Natal Distress Support Group in Dublin, Ireland After Her Recovery From Postpartum Psychosis in 1986

## Postpartum Psychosis

- Occurs 1-2/1000
- 5% suicide and 4% infanticide rate
- Requires immediate hospitalization

## Symptoms of Postpartum Psychosis

- Usually begins about 3 days postpartum
- Fatigue
- Tearfulness
- Mood instability
- Confusion,suspiciousness, and obsessive concern about baby
- Delusional thinking (infant death, denial of birth, need to kill baby)

## Risk Factors for Postpartum Psychosis

- History of psychosis or bipolar disorder
- Family history of mental illness
- Difficult labor
- Possible other factors include:
- First child
- Perinatal death
- Advanced maternal age
- Premature delivery
- Low birth weight
- Unmarried mother

## <footer>

- <date/time>

## Postpartum Support International

- Self-Help, Social Support
- and Perinatal Mood Disorders

## Our Motto:Mothering the Mother

- Every mother needs a mother
- If a mother is not well, her family is not well
- Mothers deserve care and are worthy of being the focus of society’s attention

## Universal Message

- 1.  You are not alone.
- 2.  You are not to blame.
- 3.  You will be well.  Your experience is real and there is help.

## The Myth of Motherhood

- Motherhood is instinctive and you’ll know just what to do.
- You will have a perfect baby.
- You will be the perfect mother and partner.

**Notes:**
There are many social barriers to getting women and their families the help they need.  The primary one is the Myth of Motherhood.  The most heart-wrenching discovery that you are not OK, when you are SUPPOSED to be happy.  This is where the STIGMA of mental illness collides with the mythology surrounding motherhood and fatherhood.

## The Needs of Childbearing Women:

- A companion or spokesperson to provide support during pregnancy, birth, and the first year postpartum
- Supportive professionals who are knowledgeable about mental health and who will access for mood disorders
- Time and place to talk about the pregnancy, the birth, and the continuing postpartum experience

**Notes:**
Support must be available without judgements from the listener.
Women deserve to be Acknowledged, Reassured, and Validated about their experiences.

## Skills Required for All Family Members, Friends, and Professionals:

- The ability to actively listen to what women are saying
- Respectfully respond to what she is saying without passing judgements
- Suggest options without giving ADVICE
- Counsel decisions without taking control away from her

## Volunteers

- Self-help volunteers and supporters provide EMPATHY. They have “been there” and are well
- Volunteers are role models, living proof that women can and do get well
- They represent the path that getting well takes
- Volunteers provide a realistic view of the road to wellness

## Key Points to Prevention and Intervention

- Education is essential
- Continuity of health care
- Social support is critical.  Social isolation is devastating
- Preparation for parenthood
- A plan of action
- Referral to additional resources

**Notes:**
Continuity of Health Care, from conception through the first year postpartum and throughout the woman’s childbearing period
Social Support is critical.  Social isolation is devastating.
Preparation for parenthood can help with expectations  and the reality of life with a new baby
A Plan of Action is very important.  This includes but is not limited to stress management and problem solving techniques
Referral to additional resources means that there needs to be a NETWORK in each community around the world.  Resources include trained professionals and self-help telephone and group support volunteers.
Education is essential.  In fact there are only TWO true barriers from being well. These are DENIAL and IGNORANCE.  Knowledge is power.  One loses control while depressed.  Education is the key to regaining that control.  It is a priority to getting well

The rates of pregnancy and postpartum depression remain at 10% throughout the world, in all settings. Complete Prevention may not be possible. However, if a mood disorder begins then the SOONER we can intervene then the better the outcome for the entire family.  This is done with the following 6 key POINTS.

## Strategies to Increase Diagnosis Include:

- Education during pregnancy
- Obstetrical and midwifery risk assessment. Pregnancy is the window of opportunity for prevention, early intervention and referral to treatment
- Pediatricians can and should screen new mothers for depression and anxiety

## Characteristics of Self-help Groups and Support Networks:

- People are helping people where they pool a common knowledge, share experiences, reinforce hope, and join their efforts to be well
- Postpartum depression becomes a shared problem
- This is not therapy, there is little if any fee involved
- The group or network is in control of itself, not dominated by any profession or institution

## Social Support in Group Settings:

- Provides freedom for women to disclose their feelings
- Reduces the impact of postpartum depression on self-esteem
- Provides a safe place and opportunity for the woman to share her worst fears
- Allows mothers to acknowledge intrusive thoughts and suicide plans
- Give mothers a chance to deal with the feelings of grief, loss and mourning of the woman she used to be

## Social Support on the Phone

- Mothering the new mother
- The universal message
- Steps to wellness
- Developing a plan of action

## Tips for Providing Support

- 1. Know your facts. Be up-to-date on current research and options.
- 2. Know your community resources for appropriate referrals.
- 3. Be comfortable with the topic of mental illness.
- 4. Listen actively, do not judge.
- 5. Offer accurate written materials.
- 6. Follow-up to know that the woman and her family’s needs have been met.

## Steps to Wellness

- Education
- Sleep
- Nutrition
- Exercise and time for myself
- Sharing non-judgmentally
- Emotional support
- Physical help
- Referrals to others
- Developing a plan of action

## Social Support and Self-help in the Prevention, Intervention, and Treatment of Childbearing Mood Disorders Offer:

- VALIDATION that the woman is not crazy,
- REASSURANCE that she has found non-judgmental help, and
- The HOPE that she will be well.

## I’m ListeningA Guide to Supporting Postpartum Families

- By Jane I. Honikman, M.S.
- 2002

## Steps To Wellness

*Providing telephone social support*

## Step 1:  Education

- This Isn’t What I Expected
- Karen Kleiman and Valerie Raskin
- The Postpartum Survival Guide
- Ann Dunwood and Diane Sanford
- Shouldn’t I Be Happy?
- Shaila Misri
- Overcoming Postpartum Depression and Anxiety
- Linda Sebastion
- The Postpartum Husband
- Karen Kleiman
- When Words are Not Enough
- Valerie Raskin

## Step 2: Sleep

- “Given the opportunity to sleep, can you sleep?”
- Sleep is critical to being well.
- Callers may need help with overnight feedings.

## Step 3:  Nutrition

- Majority of callers are eating poorly; some are malnourished and starving themselves.
- “Do you have an appetite?”
- “What are you eating?”
- “What have you eaten today?”
- “What’s in the fridge?”
- Emphasize complex carbohydrates and protein; discourage caffeine and sugars.

## Step 4: Exercise and Time for Myself

- “You are worthy and deserving of being alone.”
- Deconstruct the myths of motherhood by making connections to diverse cultures which provide vital time and support to new mothers.

## Step 5:  Sharing With Non-judgmental Listeners

- “Who can you talk to about your feelings?”
- Husbands/partners
- Mothers
- Friends
- Other relatives
- Verbalization is as therapeutic as medication.

## Step 6:  Emotional Support

- “You need and deserve emotional support from your friends and family in order to heal.”

## Step 7:  Practical Support

- “You also need and deserve physical help with the childcare, cooking, and housework”

## Step 8: Referrals to Professionals

- Psychiatrists
- Therapy: psychologists; counselors; social workers
- Interpersonal therapy
- Cognitive therapy
- Support groups and self-help

## Plan of Action

- “Look back over your list.  What are you doing well and what could you be doing better?”
- “What are you going to do when we get off the phone?”

## June 25, 1987First PSI Meeting