Feelings of sadness, anxiety, and exhaustion in new parents are common but typically subside after a few weeks. However, if those emotions do not subside or become pervasive, the parent (usually the mother) may have postpartum depression (PPD), a serious mental health condition that requires immediate intervention by medical professionals. Many women do not understand or recognize that they have developed a treatable mental illness and may begin to self-medicate, which accounts for an association between postpartum depression and alcoholism or substance use disorders.
What Is Postpartum Depression?
According to the American Psychiatric Association (APA), PPD is a major depressive disorder with onset either during pregnancy or within four weeks after childbirth. Some mothers report the appearance of symptoms up to a year after giving birth.
The Centers for Disease Control and Prevention (CDC) report that as many as one in nine women suffer from this condition, while other research indicates that number may be up to 20%. PPD can occur in first-time moms and in women who had previous pregnancies in which they did not experience mental health issues.
What Are the Symptoms of PPD?
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While many women experience the baby blues, PPD is about more than just feeling sad. To make a diagnosis, the health care provider must determine that the patient displays at least five diagnostic criteria, or symptoms, that may include these signs of postpartum depression:
- Depressed mood.
- Loss of interest in activities the person previously enjoyed.
- Inability to take pleasure in daily life.
- Lack of motivation or energy.
- Struggles with decision-making, memory, concentration, or focus.
- Disrupted sleep.
- Feelings of guilt or worthlessness.
- Motor control problems.
- Weight fluctuations.
- Feelings of anger.
- Suicidal thoughts.
Some parents are especially troubled by feelings of anger or resentment toward the baby. They may even experience intrusive thoughts about harming the child or have difficulty caring for the infant.
In rare cases, women may experience a severe form of PPD called postpartum psychosis. This condition manifests with dramatic symptoms within two to three days of delivery and may cause mania, depression, hallucinations, delusional beliefs, and thoughts of harming themselves or others. Suspected postpartum psychosis requires immediate medical intervention.
What Are the Treatment Options for PPD?
Because every individual displays different PPD symptoms, effective treatment requires a personalized plan that typically involves a combination of counselling, therapy, and/or medication. If the new mother is suffering from postpartum psychosis, hospitalization is strongly indicated.
Group therapy has been proven effective for women who have postpartum depression. Knowing that others have the same feelings and they are not alone can be extremely helpful for new moms struggling with PPD. Though sharing her own story and listening to the stories of other parents can seem daunting at first, it can also be incredibly healing.
Medications such as antidepressants have been shown to effectively manage the symptoms of PPD. The mother and her doctor must carefully consider which prescription drug is most appropriate depending on her personal medical history and family history. If she is breastfeeding, some antidepressants may be unsafe to take.
How Does Substance Use Impact Postpartum Depression?
Unfortunately, many women struggling with postpartum depression use substances such as drugs and alcohol to cope with the symptoms of PPD rather than seeking medical attention. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) reports a correlation between substance use and mental illnesses, including PPD.
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. According to SAMHSA research, 14.9% of women aged 15-44 who recently gave birth reported binge drinking alcohol during their postpartum period, and 8.5% reported illicit drug use. This rate of consumption was much higher than women in the same age group who were not postpartum.
New mothers with postpartum depression are often 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 to them is normal and will subside. Statistically, these women are very unlikely to seek treatment from a medical professional. According to the CDC, most PPD cases go undiagnosed completely, while as few as 15% of women with PPD ask for help. These women are much more likely to seek symptom relief from substance use.
When people have a dual diagnosis of mental illness of substance use, research findings strongly support an integrated approach that addresses all co-occurring 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.
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 when drug and alcohol use becomes a factor. The appropriate intervention can save lives and significantly improve quality of life. Families expecting a new addition and their health care providers should be aware of the potential impact of postpartum depression and alcoholism or substance use disorder.
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