Depression After Delivery By Rochelle Nazarian, RN, MSN, FNP, CS, Triplet Mom Originally printed in August 2003 Being pregnant with three or more babies will most likely come with many challenges. Many more challenges will occur once your babies arrive. You will need to take care of yourself as well as your babies. You may experience many different emotions during this time. The following is solely meant to be a guide to help you understand if you are experiencing such feelings. If you find that you are experiencing any of the following symptoms, contact your health care provider. After you have contacted you health care provider, reach out to your support mom or moms at your night outs as we have several moms who have been down this path and are willing to share their experiences. Remember, we are here to support each other. The following information was taken from Depression After Delivery, Inc., Your National Postpartum Depression (PPD) Resource. Depression After Delivery, Inc. is a national, nonprofit organization which provides support for women with ante and postpartum depression. Its focus includes education, information, support groups, telephone support and referrals for women and families coping with mental health issues associated with childbearing, both during pregnancy and postpartum. 1-800-944-4PPD During pregnancy and following the birth of a baby, a wide range of emotions is possible. Often there are the expected feelings of excitement and joy, along with feelings of anxiety and worry. Mothers may also feel overwhelmed, uncertain, and frustrated. Being pregnant can be difficult. Caring for an infant is hard work. Regardless of how prepared you were or how much you looked forward to your pregnancy and your babies' births, this time may include some unexpected "highs" and "lows". Time, patience and support from family and friends are all helpful during this period of adjustment. Sometimes, in spite of help and support, women may feel bewildered and concerned about themselves. WHAT ARE THE BABY BLUES? The "baby blues" is an extremely common reaction occurring in the first few days after delivery, usually appearing suddenly on the third or fourth day. Fifty to 75% of all new mothers experience this feeling of letdown after the emotionally charged experience of birth. Symptoms may include crying for no apparent reason, impatience, irritability, restlessness and anxiety. This is the most common, the least severe, and the most well known of the postpartum reactions. Symptoms of the blues are briefly unpleasant and usually disappear on their own, sometimes as quickly as they came. At least one in 10 new mothers experiences various degrees of postpartum depression. Postpartum complications can occur within days of the delivery or appear gradually, sometimes up to a year or so later. Symptoms may include: ? Sluggishness, fatigue, exhaustion ? Sadness, depression, hopelessness ? Appetite and sleep disturbances ? Poor concentration, confusion ? Memory loss ? Overconcern for the baby ? Uncontrollable crying, irritability ? Guilt, inadequacy, worthlessness ? Lack of interest in the baby ? Fear of harming the baby or yourself ? Fear of losing control or "going crazy" ? Exaggerated highs and/or lows ? Lack of interest in sex ? Insomnia ? Intrusive thoughts WHAT IS POST PARTUM DEPRESSION? A woman suffering from postpartum depression will usually experience several of the above symptoms ranging from mild to severe. She may experience "good" days and alternating "bad" days. Although postpartum depression does not take the same form for every woman, all of the symptoms can be equally distressing and often leave the woman feeling ashamed, guilty and isolated. WHAT IS POSTPARTUM ANXIETY? Some women may not feel depressed, but may feel very anxious. Postpartum anxiety and/or panic disorder is characterized by: ? Intense anxiety and/or fear ? Rapid breathing ? Fast heart rate, palpitations ? Sense of doom ? Hot or cold flashes ? Chest pains or discomfort ? Shaking ? Dizziness ? Insomnia ? Feelings of wanting to "run away" WHAT IS POSTPARTUM OBSESSIVE-COMPULSIVE DISORDER? Symptoms of Postpartum Obsessive-Compulsive Disorder (OCD) can also occur for the first time in women following childbirth. Women may have thoughts that are often scary and perceived as being out of character for the woman experiencing them. These thoughts are symptoms of the illness; things one would never want to happen. In addition, if a woman has a history of OCD, her symptoms may intensify. Symptoms include: ? Intrusive, repetitive thoughts (which may include thoughts of harming the baby or others) ? Obsessive thoughts (i.e., contracting AIDS) ? Avoidance behavior (i.e., avoiding the baby to alleviate intrusive thoughts) ? Anxiety and/or depression ? Fears WHAT IS POSTPARTUM PSYCHOSIS? Postpartum Psychosis (PPP) is the most severe and, fortunately, the rarest postpartum disorder. It occurs in about 1 out of 1000 women who give birth. Onset is sudden and usually occurs within the first 2-3 weeks. Symptoms of PPP are very exaggerated and involve a loss of touch with reality. Symptoms may include: ? Hallucinations ? Delusions (usually religious) ? Severe insomnia ? Extreme anxiety and agitation ? Suicidal or homicidal thoughts ? Bizarre feelings and behavior Postpartum Psychosis is a severe emergency and requires immediate medical attention. Although a postpartum depression usually follows, this disorder is treatable and prognosis is good with early intervention. WHO CAN BE AFFECTED? Any woman who is pregnant, had a baby within the past year or so, miscarried, had an abortion or interrupted pregnancy or recently weaned a child from breast feeding can be affected, regardless of how many previously noncomplicated pregnancies and/or postpartum adjustments she has had. Most women have never experienced anything like this at any other time in their lives. WHAT CAUSES THIS? We are not 100% sure. There are multiple causes for mood and anxiety disorders - hormonal imbalance, alteration in brain chemistry, stress, isolation etc... Currently, hormones are receiving attention in the search for causes of pregnancy and postpartum mood and anxiety disorders. Researchers have suggested that the rapid changes in levels of hormones such as estrogen, progesterone and thyroid appear to have a strong effect on women's moods. Although you may be familiar with terms such as "baby blues" and "postpartum depression" as they apply to the time period after childbirth, some women experience these symptoms not only after childbirth, but sometimes during pregnancy, following a miscarriage, interrupted pregnancy or termination of pregnancy. CAN THIS BE TREATED? Treatment varies for disorders associated with depression after delivery, depending on the type and severity of symptoms. All of the symptoms, from the mild to the most severe, are temporary and treatable with skilled professional help and support. A woman experiencing any of the symptoms described should contact her health care professional. She should have a complete medical evaluation, including a thyroid screening. The "ideal" treatment plan includes: ? Medical evaluation (to eliminate physiological causes, i.e. thyroid) ? Psychiatric evaluation ? Psychotherapy ? Participation in a support group for emotional support and education. Reaching out for the proper help is an important step toward recovery. If you are experiencing the symptoms described, do not continue to suffer in silence. Share your concerns with your health care professional. FREQUENTLY ASKED QUESTIONS Can there be a thyroid connection? Yes. Standard thyroid tests as well as more definitive studies (i.e. TRH Stimulation Study or AMA, Anti-thyroid Microsomal Antibody) may be ordered. It is important to have the results read by a professional who is knowledgeable about Postpartum Thyroiditis. What about PMS and PPD? You may be more at risk for PPD if you have a PMS history. Conversely, it is believed we may be more at risk for PMS if we have had a PPD. Often women with or without a history of PMS will find that as their PPD begins to abate, the symptoms can take on a cyclic pattern related to menses. Can there be symptoms during pregnancy? Antepartum disorders do exist. For many women, the onset of symptoms begins during pregnancy. Some continue into a postpartum disorder and for others it disappears after birth. This can be a very difficult time for the woman and those around her. It is important to note that this can happen and more importantly, you can get help. What about medication? Medications can be very helpful in treating PPD. Women recover more quickly with their use in conjunction with therapy, education, and support. A qualified doctor (usually a Psychiatrist or in some states a Clinical Nurse Specialist) knows which medication would be best for your individual case. It is sometimes very difficult to accept having an illness and the need for medication. As with any other illness requiring medication, it is sometimes necessary for healing. PPD is an illness that can be treated more efficiently and more quickly with appropriate medication. You are worth finding the help you need to get well. Can I breast feed? If you are nursing, you may be able to take some medications. Weaning can be a risky time for some moms due to disruptions in hormonal equilibrium and may precipitate a PPD. It has been suggested that a slow weaning may be helpful. For some women, weaning has no effect. Breast-feeding can be a very important factor for some women and this issue is not to be addressed lightly. The decision to breast-feed or to bottle-feed is a personal decision. Whichever way is chosen, we must feel confidant and supported. Can I have another baby after a PPD? If you have suffered a PPD, you are more at risk for a reoccurrence after a subsequent birth. Reoccurrence can be a frightening subject. However, there are medical and preventative measures now being utilized. Do seek professional assistance. As with any disorder, it may be a smart idea to get a comprehensive evaluation from an expert in this field. With an evaluation, support, and education, specialized care helps you feel validated and supported. Yes, there is life after PPD!