dban asked this question on 5/9/2000:

Does anyone know of any support groups for post-partum depression in the Madison, WI area? Any other support groups for parenting would also be helpful. I am a mother of two that is suffering from post-partum depression for the second time. I have a 10-week old daughter and a 3-year old son. This time around, the depression is 100% worse and I'm scaring myself and others as to how horrible I feel and what I might do or at least think about doing. Medication is just not enough. Any advice would be extremely grateful.

Desertphile gave this response on 5/11/2000:

Hi. I went looking on the WWW to see if I could find a text that addressed your concern. I think I have found one of the better ones (in my opinion--- I am NOT a doctor!), and at the end it provides a short list of resources. You may wish to schedule an hour with a woman psychologist and ask her for advice--- I tend to trust women more when it concerns "women's issues."

Here's the web text I thought was one of the best. All copyrights are still retained by the author.

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http://www.obesity.net/health_library/types/ types_08_postpartum.html

Post-Partum Depression

From the moment Katie Renshoe of Mt. Prospect,

Illinois, delivered her daughter, Sarah, she just didn't feel right. "I thought I'd be happy," the 38-year-old public relations representative recalls, "but I cried constantly and felt terribly anxious. I couldn't sleep, even when Hannah did. And I couldn't make even trivial decisions. Once at Toys R Us, I stood for a half-hour trying to decide which baby bottle to buy. The decision was simply too much for me."

Renshoe had a classic case of post-partum depression, a condition that afflicts 10% to 15% of new mothers, according to Barbara Parry, M.D., an associate professor of psychiatry at the University of California, San Diego, School of Medicine. Symptoms typically appear within a few months of delivery, including: deep sadness, frequent crying, insomnia, lethargy, and irritability.

It Can Happen to Any New Mom

Post-partum depression is a severe form of "baby blues," mild sadness and anxiety that some two-thirds of new mothers experience. A few new moms -- one in 1000 -- suffer a complete break with reality, post-partum psychosis. That's what happened in 1984 to Nancy Berchtold, of Morrisville, Pa., after the birth of her daughter, Alison. Seventeen days post-partum, she became delusional, and had to be hospitalized.

Post-partum depression has been recognized since ancient times. In 460 B.C., Hippocrates described it. Other descriptions have turned up from time to time since then. But the condition has become widely publicized only within the past 15 years.

The cause of all the post-partum emotional reactions remains unclear, but scientists cite several contributing factors. One is stress. "As a new mother, I felt overwhelmed," recalls Jane Honikman, founder of Post-Partum Support International (see Resources at the end of this article). "The first year with each of my three children was very hard. I was exhausted and sleep-deprived. Add a colicky baby, or a lack of emotional support, and you have a one-way ticket to the blues." Motherhood is most disorienting for first-time moms. Not surprisingly, they are at unusually high risk of post-partum emotional problems.

Hormones also play a role. High levels of female sex hormones circulate in expectant mothers' blood, but drop precipitously within hours of delivery, contributing to biochemical depression. Pregnancy also increases levels of endorphins, the body's feel-good chemicals. Endorphin levels fall abruptly after delivery, adding to risk of depression.

Finally, a history of depression increases risk. One-third of women with previous depression experience it post-partum, Dr. Parry says, and half of women who become depressed after one delivery relapse after subsequent births.

Oddly, until recently, mental health professionals have paid scant attention to post-partum depression. Donna Stewart, M.D., a professor of psychiatry at the University of Toronto in Canada, says it's still "vastly underdiagnosed" and unpublicized, leaving many women unaware that it might happen to them. The American Psychiatric Association didn't even officially recognize the condition until the 1994 edition of the organization's Diagnostic and Statistical Manual of Mental Disorders.

But today, post-partum depression is much better publicized. It should become even more so in the future. New York state now requires hospitals to give new mothers information about their risk of the condition before leaving maternity wards.

Many Treatments

Katie Renshoe knew little about post-partum depression until her fourth miserable week post-partum when she stumbled across a book on the subject, This Isn't What I Expected (see Resources). "I read it, and diagnosed myself." You can also be diagnosed by your obstetrician, family physician, or a mental health professional.

To treat mild baby blues and more severe depression, Honikman recommends joining a mothers' group. Renshoe attended a new-mothers' support group three times a month for six months. "It was so reassuring to know that other women were experiencing what I was going through." After Nancy Berchtold overcame her post-partum psychosis, she couldn't find a support group. She placed a newspaper ad, hoping to start one. Her group has since blossomed into Depression After Delivery, with 55 chapters nationwide (see Resources).

Dr. Stewart recommends psychiatric evaluation and possibly antidepressant medication. The psychiatrist Renshoe consulted prescribed Prozac. "It really helped. Pretty quickly I could function again."

Unfortunately, some depressed new mothers shun psychiatrists, fearing that any admission of depression might spur child welfare authorities to snatch their babies from them. "No one is going to take your baby away," says Peggy Filipowicz, R.N., of Michigan City, Ind., who suffered post-partum panic attacks 10 years ago after the birth of her son, Christopher. "If you have that fear, you need professional help."

Other women fear that medication will enter their breast milk and harm the baby. Lithium, prescribed for bipolar women who cycle into mania after delivering a baby, can contaminate breast milk. Therefore, women who take Lithium should not nurse, so that the infant won't develop toxic side-effects from the drug. Low levels of Paxil have also been found in breast milk.

But other antidepressants, notably tricyclic medications (Elavil, Pamelor, Sinequan, Tofranil, etc.), are secreted in only trace amounts, if at all. Researchers at Case-Western Reserve Medical Center in Cleveland have been analyzing the milk of women taking Pamelor (nortriptyline). "Our test detects the drug down to 5 billionths of a gram per milliliter," says Research Director Thomas Gigliotti, M.S.W., "and we've found no trace of it."

Estrogen also helps lift post-partum depression, according to a new British study. Researchers at Salisbury Mental Health Services divided 61 depressed new mothers into two groups. Half wore a skin patch that delivered 200 micrograms of estrogen a day for three months, while half wore a placebo patch. The women on estrogen showed faster and greater relief.

Sometimes post-partum depression is caused by a thyroid disorder. Like sex hormones, thyroid hormones may fall precipitously after delivery and may not return to normal. Any medical workup for post-partum depression should include a thyroid function test. Thyroid abnormalities respond to replacement-hormone medication.

Another reason to seek help is research suggesting that children of mothers with post-partum depression are unusually prone to insecurity, sleep disturbances, impaired cognitive development, and frequent temper tantrums.

[concludes in follow-up]

Desertphile gave this follow-up answer on 5/11/2000:

A woman's post-partum depression can affect her husband as well. Dr. Stewart says education about the condition helps orient most men to their wives' situation. Some men also benefit from counseling.

More than a year after realizing that she had post-partum depression, Rose says, "It took about eight months for me to feel like my old self again. If you feel depressed or anxious, don't be afraid to reach out and get help. You're not alone, and the therapies work. I'm living proof."

Resources, Sources, Links

Post-Partum Support International. 927 North Kellogg Ave., Santa Barbara, CA 932111; (805) 967-7636. Crisis counseling available.

Depression After Delivery. P.O. Box 1282, Morrisville, PA, 19067; (800) 944-4773. Crisis counseling available.

To start your own mothers' group. Contact the American Self-Help Clearinghouse, St. Clares-Riverside Hospital, Denville, NJ 07834; (201) 625-7101. This nonprofit organization tracks self-help and support groups around the U.S. and Canada, helps people start new ones, and can refer to local and regional self-help organizations in your area.

This Isn't What I Expected: Recognizing and Recovering from Depression and Anxiety After Childbirth by Karen R. Kleinman and Valerie D. Raskin, M.D., Bantam, 1994. Includes a valuable chapter about how husbands can help wives overcome post-partum depression.

NIH Depression Awareness, Recognition, and Treatment (D/ART) Program

Leopold, K. and L.B. Zoschnick. "Postpartum Depression," The Female Patient, Sept. 1997. 12-20.

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