Summary: PostPartum Depression Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director: AllCEUs.com Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Objectives ~ Define postpartum depression ~ Identify signs of postpartum psychosis ~ Identify Risk factors of PPD ~ Identify screening tools and protocols ~ Discuss the impact of PPD on the mother, child and family ~ Identify the cause of PPD ~ Explore current biopsychosocial interventions for PPD ~ Postpartum depression usually occurs in the first 4 to 6 weeks after giving birth, and it is unlikely to get better by itself. ~ 50% of patients experienced depression for more than 1 year after childbirth. ~ Women who were not receiving clinical treatment, 30% of women with postpartum depression were still depressed up to 3 years after giving birth Define Postpartum Depression ~ Perinatal mood disorders (20-weeks gestation to 4 weeks of age) ~ According to the Centers for Disease Control and Prevention (CDC), up to 20 percent of new mothers experience symptoms of postpartum depression ~ Postpartum blues is a relatively common emotional disturbance with crying, confusion, mood lability, anxiety and depressed mood. ~ The symptoms appear during the first week postpartum, last for a few hours to a few days and have few negative sequelae. ~ At the other end of the spectrum, postpartum psychosis refers to a severe disorder beginning within four weeks postpartum, with delusions, hallucinations and gross impairment in functioning ~ Postpartum depression begins in or extends into the postpartum period and core features include dysphoric mood, fatigue, anorexia, sleep disturbances, anxiety, excessive guilt and suicidal thoughts for at least one month Signs of Postpartum Psychosis ~ Postpartum Psychosis is a rare illness, compared to the rates of postpartum depression or anxiety. It occurs in approximately 1 to 2 out of every 1,000 deliveries, or approximately .1 -.2% of births. The onset is usually sudden, most often within the first 2 weeks postpartum. ~ Symptoms ~ Delusions or strange beliefs which are ego syntonic ~ Hallucinations (seeing or hearing things that aren’t there) ~ Feeling very irritated ~ Hyperactivity ~ Decreased need for or inability to sleep ~ Paranoia and suspiciousness ~ Rapid mood swings ~ Difficulty communicating at times ~ The most significant risk factors for postpartum psychosis are a personal or family history of bipolar disorder, or a previous psychotic episode. ~ Note: Valproic Acid has a high rate of causing multiple congenital abnormalities as do carbamazepine and lithium (first trimester) Scary Thoughts ~ Scary thoughts are a very common symptom of postpartum depression. ~ Scary thoughts can come in the form of thoughts (“what if I …”) or images (imagining the baby falling off the changing table) ~ Scary thoughts can be indirect or passive (something might happen to the baby) or they can imply intention (thoughts or images of stabbing the child) ~ Scary thoughts are NOT indication of psychosis. ~ Scary thoughts can be part of a postpartum OCD diagnosis or PPD Scary Thoughts Interventions ~ Scary thoughts will make the woman feel like she is a bad mother. ~ They will make her feel guilty and ashamed. ~ It is a good sign if the thoughts are worrisome. ~ Remind her that these thoughts are NOT about who she is or her capability as a mother. Scary Thoughts ~ The nature of these thoughts: ~ Scary thoughts typically focus on the baby, but can also center on thoughts about you, or your partner. ~ Scary thoughts can be intermittent or constant. ~ They may be accompanied by compulsive behaviors (e.g. checking) ~ Some examples of scary thoughts: ~ “I’m afraid I might take one of the knives in my kitchen and stab the baby” ~ “I can picture myself driving off the road with my baby in the car” ~ “I think my family would be better off without me” ~ “I’m having sexual thoughts about my baby.” ~ “I can see terrible graphic violent things happening to my baby.” Scar
