Feelings of sadness, anxiety, and exhaustion in new parents are common, and typically subside after a few weeks. However, if those emotions last much longer, and are more pervasive, this may be postpartum depression (PPD), a very serious mental health condition that requires immediate intervention by a team of medical professionals.
What is Postpartum Depression?
According to the American Psychiatric Association (APA), PPD is major depressive disorder with peripartum onset (either during pregnancy, or within 4 weeks after childbirth). Some mothers report the appearance of symptoms up to a year after giving birth.
According to the Centers for Disease Control and Prevention (CDC), as many as one in nine women suffer from this condition, while other research findings indicate that number may be higher – up to 20%. PPD can occur for the first time in first time moms, or in women who have had children previously with no issues with mental health.
Symptoms of Postpartum Depression
Beyond the proverbial “baby blues”, an individual must display 5 out of 9 diagnostic criteria, or symptoms, for postpartum depression (PPD) in order to be officially suffering from the illness.
These occur throughout the entire day, and include being in a depressed mood, an inability to experience pleasure in everyday activities, a complete loss of interest in previously enjoyed interests, feelings of worthlessness or guilt, disruptions in sleep patterns, difficulty with attention, concentration, memory or decision making, a lack of energy or motivation, fluctuations in weight, problems with motor control, suicidal thoughts, and/or anger directed at the child.
Feeling anger toward her baby is one of the most troubling symptoms of PPD, and moms may feel resentment about becoming pregnant. They often do not engage in basic care, or even talk about harming the baby.
The most severe type of PPD is postpartum psychosis. It is rare, and is characterized by a very dramatic onset of symptoms, as early as 48 – 72 hours following delivery. This a bi-polar disorder, with episodes of mania interspersed with periods of depression.
Delusional beliefs, typically centred on the newborn, are cause for great concern, as are hallucinations. The likelihood of suicide, and infanticide, is significant, and requires immediate intervention.
Every individual will display different symptoms, and a personalized treatment plan is essential, usually involving a combination of counselling, therapy and/or medication. If the new mother is suffering from postpartum psychosis, hospitalization is strongly indicated.
Group therapy has proven to be effective with postpartum depression. Knowing that she is not alone, or the only one experiencing what she is feeling, can be extremely helpful for new moms. Though sharing, and listening to the stories of other parents can seem daunting at first, it can be incredibly healing.
There are several types of medication used to treat this mental health disorder, and they can be extremely effective in managing symptoms, particularly those that put the mother, and new baby, at the greatest risk.
Many factors go into the decision about which medications should be used, including family and medical history, as well as whether or not the mother is breastfeeding. The wrong prescription drugs can be very harmful, so it may be dangerous to take medication without the direct supervision of a health care provider.
It is equally risky to treat PPD with over the counter medications, illicit drugs, or alcohol.
Substance Abuse and Postpartum Depression
Substance Abuse and Mental Health Services Administration (SAMHSA) reports that there are several factors that are indicators for both substance abuse and mental illness. There is a direct correlation between both conditions.
Genetics, neurobiological characteristics, environmental factors such as a history of abuse, and a susceptibility to mental health disorders, increases the likelihood of developing other psychiatric disorders, including addiction.
This is also the case for postpartum depression. 14.9% of pregnant women aged 15-44 reported binge alcohol use during their postpartum period, and 8.5% reported illicit drug use. This rate of consumption was much higher than women that age who were not pregnant, or postpartum.
Women diagnosed with PPD are at significantly greater risk of developing a substance use disorder than those who do not experience depressive symptoms while pregnant, or following the birth of a child. Research findings indicate much higher levels of alcohol or drug use among new moms with postpartum depression, compared to those without it.
New mothers with postpartum depression are frequently experiencing these feelings, and associated symptoms, for the first time, and may not realize that they are suffering from a very serious illness. They may assume that what is happening is normal, and will subside.
Statistically, these women are very unlikely to seek treatment from a medical professional. According to the CDC, many cases go undiagnosed completely, while as few as 15% of women with PPD ask for help.
Ultimately, they search out relief elsewhere – from substances.
Treatment Options for Co-occurring Disorders
Suffering from two conditions at the same time, like PPD and addiction, is known as a dual-diagnosis, or co-occurring disorders. When this happens, research findings strongly support an integrated approach that addresses all mental health disorders simultaneously. Failure to do so leaves symptoms untreated, and frequently leads to continued alcohol or drug abuse.
Understanding of mental illness and substance abuse has evolved, and so have treatment options. Rather than having patients complete detox programs, and then enter psychotherapy to address depression symptoms, modern rehab facilities offer a more integrated approach.
Teams of medical professionals, across a wide range of disciplines, work with the patient to develop an individualized treatment plan. This includes counselling, therapy, support groups and/or medications specifically selected to address each disorder, without exacerbating either.
Postpartum Depression – The Unseen Illness
Very often, mental illness goes untreated. This may be truer for postpartum depression than for any other condition.
For so many reasons, PPD continues to be misunderstood, and the potential effects grossly underestimated. It is so easy to dismiss its symptoms as normal emotions that will go away.
When feelings of depression are pervasive and do not subside, they put the mother and baby at tremendous risk, especially if there is drug and alcohol abuse.
The appropriate intervention can save lives, and significantly improve quality of life.
The Centre for Addiction and Mental Health (CAMH), Copyright 2019
Substance Abuse During Pregnancy
Centers for Disease Control and Prevention (CDC), Page last reviewed: July 24, 2019
Mayo Clinic, Article Date: September 1, 2018
Substance Abuse and Mental Health Services Administration (SAMHSA), June 8, 2017
American Psychiatric Association (APA), Physician Review: March 2017