Postpartum Depression Guide Review: Support for postpartum mood disorders

Reprinted with permission from the October 2005 issue of Hospital News

Support for postpartum mood disorders

The Centre for Addiction and Mental Health develops guide to address postpartum depression  

By Kristie Jones

Having a baby can be one of the happiest moments in a woman's life. But with a new baby comes challenges, adjustments and rapidly changing hormone levels - it is natural for a new mother to experience mood swings or what is commonly referred to as "the baby blues." However, when the "baby blues" last longer than two weeks, she may be experiencing postpartum depression (PPD).

PPD is defined as a depressive episode diagnosed soon after childbirth, usually within a year of delivery (often detectable within 2-6 weeks of the birth). Ten to 15 per cent of new mothers will be affected by PPD. In 2003, Statistics Canada reported 335,202 births - that means that in 2003 alone, up to 33,520 Canadian women suffered from PPD, making it the most common complication of child-bearing.

In spite of its prevalence, it appears that PPD is widely misunderstood by health-care providers, the general public and even new mothers who may be experiencing it. Often there's a tendency to sensationalize PPD and we hear of mothers with PPD injuring or murdering their child. "Unfortunately, it's the tragic, atypical cases that are brought to the forefront in the media, when the reality of the situation is that most women with PPD do not harm their children and often show very subtle symptoms of the disorder," said Dr. Lori Ross, Research Scientist at the Centre for Addiction and Mental Health (CAMH) and co-author of the guide.

If left untreated PPD can become a serious health issue. It can lead to strains on a new mother's relationship with her partner, other family members and her baby. Untreated PPD may hinder mother-infant attachment which can lead to cognitive and behavioural developmental problems for the baby. Prolonged postpartum depression may leave a mother feeling hopeless, inadequate and unable to cope with normal life.

Barriers to Diagnosing PPD

Many new mothers suffering from PPD don't understand what is happening to them. PPD survivor "Angela" admits that she had no idea what was wrong with her when she started feeling depressed. "I associated PPD with suicide or infanticide and because I didn't have those types of thoughts I had no idea I was experiencing PPD. It's so hard to see it when you are living it. I felt like I was not bonding with my new baby. I was ashamed and felt like the worst mother - how do you tell someone these feelings?"

When "Angela" finally talked to her doctor about the way she was feeling, they tested her thyroid. "I had to convince my doctor that there was something wrong and finally I was referred to someone who could help. For me, the biggest barriers to receiving treatment were my doctor's lack of awareness and my own misconception of PPD," she said. Dr. Lori Ross explains that, "The biggest challenge in diagnosing PPD is that women are having shorter visits with their physicians. PPD is a complex issue that often cannot be detected unless the physician asks a set of carefully directed questions. This challenge is compounded by the reluctance of a new mother to talk about her feelings openly in fear of being stigmatized."

A survey of front-line health and social service providers conducted by CAMH revealed that many health-care providers do feel unprepared to effectively address this significant women's health issue. "We surveyed various types of health and social service professionals who work with families, pregnant women and new moms and their responses strongly indicated a need for a resource on PPD," said Julia Greenbaum, Publishing Developer, Centre for Addiction and Mental Health.

PPD Guide first of its kind

In collaboration with Toronto Public Health, Journey Support Services, the University Health Network and Best Start , CAMH has developed the first Canadian guide to prepare health-care providers to address PPD. This new guide is evidence based, offers practical recommendations and includes the most current studies to date on PPD. It includes information on:

• Risk factors for developing PPD
• Detection and screening for PPD
• Prevention
• Assessment and referral
• Treatment
• Support for family members
• Self-care for Women

The Guide also includes a directory of support groups and programs for mothers suffering from PPD. Any PPD survivor knows the importance of support from others who have experienced it. For "Angela" social support was as important as medication in her recovery. "Support is crucial, I was lucky and got support from my family. My advice to new mothers with PPD is to talk to somebody close to you, be open and honest about your feelings. The longer you wait, the worse it will get," she said.

Next step - develop treatment programs

While part of the problem in treating PPD lies in detecting the disorder, a larger part of the problem is that when women are diagnosed, there are often waiting lists for treatment.

"The next step is to advocate that people direct their available resources to make sure we have effective treatment programs in place to treat women with PPD. There is no point in having a screening process until a treatment system is in place," said Dr. Ross.

Fortunately, PPD is being increasingly recognized as a serious women's health issue and with an increased awareness of this mood disorder, new mothers may no longer have to suffer in silence.

To order a copy of the guide contact: CAMH Publication Services at 416-595-6059 or 1-800-661-1111 or email publications@camh.net.

For more details on this publication visit www.camh.net/publications/

Kristie Jones is a staff writer for  Hospital News. 

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