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Q & A with Perri Shaw Borish on post-partum dedpression

8/10/2014

 
Adapted from an interview on August 7, 2014 at www.wee-wander.com.

Real Talk: Baby Blues and Postpartum Depression A no-b.s. Q&A with Perri Shaw Borish, psychotherapist and perinatal mood disorder specialist. Plus: Local resources for moms by Christy on Aug 7, 2014.

While most of us have at least a baseline understanding of postpartum depression these days (most doctors are doing a good job educating us, no?), it’s also true that the whole world turns upside down in those weeks and months after you give birth. Suddenly, things you might know intellectually don’t necessarily translate into your new reality, and so It’s easy to question your feelings, to feel overwhelmed about reaching out to someone, and to just worry about the logistics of dealing with your own anxiety, depression, or mood issues. In short: There can be so many questions about everything, including your own feelings.

So. We hit up Wee friend, mom of three and psychotherapist Perri Shaw Borish (Perri specializes in anxiety and perinatal mood disorders: you can read about her private practice here), and asked the nitty-gritty detail things that we never really thought to ask until we were moms with new babies. 

***

Q:  I mentioned to my pediatrician that I was a bit more irritable with my husband in the few months after having the baby. She startled me by suggesting I might have been suffering from a bit of postpartum depression. This makes me think that as much as most of us think we know the symptoms, maybe there’s some confusion between baby blues, postpartum depression and postpartum anxiety?
A:  Yes, that is true. The “baby blues” are very common (about 85 percent of women experience them), and it is a temporary state. Symptoms of the “blues” — which might include (but aren’t limited to) weepiness, a lack of energy, negative thoughts, feeling sad — that last longer than 2-3 weeks should be referred to for assessment and treatment.

Postpartum Depression is best defined on a continuum. There is a large spectrum of postpartum mood disorders which range from mild to severe and usually occur within the first year. Some examples of symptoms of PPD might include feelings of anger, sadness, irritability, guilt, lack of interest in baby, changes in eating and sleeping habits, thoughts of hopelessness and even sometimes, thoughts of hurting oneself or the baby.

Symptoms of Postpartum Anxiety usually manifest as extreme worries or fears – often over the health or safety of the baby. Some women have panic attacks, a feeling of loss of control, racing thoughts and often disturbance of sleep.

Q:  If a mom does go to you — or any professional — to deal with anxiety or depression, what does she do with the baby for the duration? I ask this because I think some moms might find trying to find the time and the energy to take care of themselves stressful in a moment when they’re also learning to deal with a new baby.
A:  I always encourage women to bring their babies (up to a certain age). If they have childcare and can come alone, that’s great, but that’s not always possible. Additionally, I really like to see how a woman engages with her baby – it helps give me a better sense of her attachment to the child and therefore where she may be on the continuum.

Q:  Are there long-term effects of not being treated? Do some people just snap out of it?
A:  There can be major risks to the mental health of the mother and the child if Postpartum Depression/Postpartum Anxiety goes untreated. Again, it depends where on the continuum you are. For example, we know that children of depressed mothers have been found to have impaired cognition and emotional abilities, and bonding with the baby can become an issue. Anxiety Disorders that go untreated can lead to impaired functioning, panic and agoraphobia, to name a few. If you feel you may be suffering from some type of Postpartum Depression, the important thing to remember it is not your fault. You are not to blame and with help, you can feel well again. Even if it’s just a mild case, you can still benefit from talking to someone. In fact, mild cases especially are treated quickly once people seek professional help. 

Q:  Is there an alternative to seeing a therapist ? Hotlines? Support groups? Phone calls with a therapist instead of in person visits? I’m just curious if there are varying levels and methods of support for varying levels of need.
A:  There are alternatives to seeing a therapist, and depending on the person’s situation and needs, the alternatives may or may not be recommended … or they may be used as complements to other therapies. It’s best to first at least talk to a qualified therapist or doctor to determine what’s going on. Once that happens, some alternatives to therapy might be medication (prescribed by an M.D., of course), exercise, massage, meditation, good nutrition, adequate rest, and social interaction. (Exercise, massage, meditation, good nutrition, adequate rest, social interaction and support are always recommended, and for some new moms that might be enough, however, for many moms, much more clinical work is needed.) There are also hotlines and support groups (depending where you are – many of the support groups are peer groups run by other moms).

Sometimes these types of alternatives can make a difference, however that’s often not the case, and seeking professional help with a qualified therapist can make a huge difference. Often people don’t seek professional help because they feel ashamed or because they think they should “be able to handle it on their own,” but the quickest way to feel better is to talk to someone. Also, one thing to remember when seeking professional help is that you have the right to ask about the therapist’s qualifications, training, and approach and confidentiality policies. It’s your treatment and you need to be comfortable with whomever is going to treat you.

Q:  Are there any preventative steps a new mom can take so she doesn’t feel anxiety or depression?
A:  Yes, there are lots of preventative steps that may help — although there is a lot we can’t plan for, such as what kind of birth one might have. Working with a therapist trained in Perinatal Mood and Anxiety Disorders before the birth can actually help with this, too. If, for example, you have a lot of worries going into the birth, or there is unresolved trauma or loss (since those things put you at higher risk for PPD), it can be very helpful to process those things before the baby arrives with a therapist. Also if you’ve had any kind of postpartum mood disorder before, going to a therapist when you’re planning for a second child or when you’re pregnant with a second or third child can help tremendously to cut down on potential risk for that postpartum period.

Other examples of preventative steps include working on letting go and being okay with not doing everything perfectly once baby comes home; making sure the lines of communication are open between mom and her partner, or whomever her support people are; working on processing any major losses and any parenting issues before the birth; having a plan in place for taking care of oneself; and divvying up responsibilities once the baby comes home so mom can find pockets of time to rest and nurture herself. Also, have your thyroid checked within first few months postpartum, because thyroid disease often looks like Postpartum Depression. Sometimes OB/GYNs miss it because they often only see a postpartum mother once or twice in first year postpartum.

Q:  Aside from you, any other thoughts on where Philly folks can turn for help, even if it’s just an initial phone call to ask a question? 
A:  Postpartum.net is a really great, free, local resource that includes free weekly chats for moms, and also monthly chats for dads, and they have a map of local coordinators who can help connect women with local resources.

And there’s the Penn Center for Women’s Behavioral Wellness, which is great (215-573-8886), and they take most insurance providers. There are loads more locally; you can also ask your OB/GYN office for a list of local professionals who take your insurance.

There is also the very helpful Postpartum Support International Warm Line: 1-800-944-4773, as well as the suicide prevention hotline: 1-800-273-TALK (8255).

And you might remember the Hall Mercer Parent Child Center, which isn’t specifically for postpartum issues, but they have groups for new moms and their babies, which is a great way to get support in your own community and meet new moms who are potentially going through similar things.

Treating Post-Partum Depression

10/25/2012

 
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Post-Partum Depression by Perri Shaw Borish, MSS, LCSW, BCD 215-840-3554

"The only thing that seems eternal and natural in motherhood is ambivalence.” – Jane Lazarre, novelist.

There is a tremendous societal pressure on mothers to see the period after their child's birth as a time of bliss.  But for many mothers this is not the case. Rather, it is often a time of ambivalence, irritability, anxiety and hopelessness.

“I just want to sleep. I feel terrible and I’m afraid I’m going to drop my baby. Sometimes I imagine my arms may just give out and the baby will fall to the floor. I can’t speak to anyone about this so I pretend that everything is fine but sometimes I wonder if everyone would just be better off if I weren’t here.”

These thoughts are typical among new mothers I have treated.  Many do not realize that they suffer from a common and treatable condition. Postpartum depression may appear to be the baby blues at first -- but the signs and symptoms are more intense and longer lasting, eventually interfering with a mother's ability to function.

Postpartum Depression affects 15-20% of new mothers and ranges in severity from mild anxiety to major depression. Here we will focus on the most common form, that of major depression.

Patients and caregivers often overlook the symptoms of postpartum depression.  Like most types of major depression, postpartum depression is characterized by: depressed mood, irritability, anxiety and loss of interest in general.

In addition, women who suffer from postpartum depression often express ambivalence toward their newborn child and commonly doubt their ability to care for the child.

How should women suffering from Postpartum Depression be cared for?

Ideally, women at risk - those who have been depressed in the past either post partum or otherwise or have a family history of depression - should meet with a therapist to create a wellness plan to be prepared for her child's arrival.

Once a mother shows symptoms of postpartum depression, she and her doctor should review her medical history and consider a physical exam and lab tests to rule out reversible causes of depression such as thyroid dysfunction or anemia. Then they can make a treatment plan based on the severity of the symptoms and the degree of functional impairment experienced by the new mother.

For mild to moderate depression, non-pharmacologic options such as psychotherapy can be helpful.  A healthy diet and plenty of sleep are essential.  The human brain needs continuous sleep to recharge.

Friends and family can lend a hand and offer emotional support and encouragement and provide hands-on help taking care of the baby.

At night, a loved one (partners need to pitch in if there is one) can help feed the newborn with a bottle so the mother can sleep. During the day, a loved one or friend can take the baby for a walk, hold the baby, or do household chores to give the new mother much needed time for herself.

Believing the myth that “new mothers love each and every moment with their babies” can push some mothers to ignore their own needs. When we are depressed it can feel as though the walls are closing in around us. A few minutes of exercise, a short walk outside and a breath of fresh air can go a long way to help the recovery process.

When a mom shows signs of more severe postpartum depression or does not respond to non-psychotropic treatments, antidepressant medications taken along with psychotherapy have been proven to be effective. For nursing mothers, antidepressant medications must be chosen with the safety of the baby in mind. When a mother presents with severe postpartum depression, particularly for patients who are at risk for suicide, inpatient hospitalization may be considered.

Recognize the Symptoms and Know What to Do

New mothers and those who surround them should be made aware not only of the symptoms of postpartum depression but also that it is a common and highly treatable condition.

There is no reason for a new mother to suffer in silence and shame.  Getting help from a trained professional helps develop a game-plan to lessen the depression and anxiety and enable the mother to enjoy this time.

I have found that the simple act of talking about feelings often helps to alleviate symptoms in my patients. As a therapist, often the most important thing I can do for my patients is to listen to them, encourage them, and normalize what a difficult and challenging time this is for new parents. With proper treatment and care, the process of becoming a mother can truly be an exciting time, full of new adventures, growth and a tremendous amount of love.

Resources if you are struggling with Postpartum Depression:

Postpartum Support International  http://www.postpartum.net

Center for Postpartum Health  http://www.postpartumhealth.com 

American Psychological Association  http://www.apa.org 

Understanding Depression

8/29/2012

 
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Understanding Depression by Judith Snyder Kastenberg, MD  215-545-2145

Feeling down? Is getting through the day more like slogging through peanut butter? Have no energy?  At any given time, nearly one out of five people experience symptoms of depression. However there is hope and help out there for you. 

What does depression feel like? It is more than feeling bummed after a break up or sad after a relative has died. It's strong and it's not "shakable." When you know someone with depression, you may want to grab him or her and tell them, "Pull yourself up by your boot straps. Get out of bed!" But they just don't seem to be able to control their sad state. 

For two weeks or more, the person may have a depressed mood or loss of interest and pleasure in nearly all of his or her activities. A depressed person may also have one or more of these symptoms: unintentional weight loss or gain, change in appetite, too little or too much sleep, fatigue, inappropriate guilt, trouble concentrating or making decisions, and recurrent thoughts of death, even suicide. 

Who gets depressed? We are all vulnerable at different times of our lives, but some more than others. Women report being depressed twice as often as men. Other at risk groups include those who are divorced or separated and individuals aged 18 to 44 who suffer depression at higher rates than any other age group.

What causes depression? A variety of factors may be involved, including genetics (i.e. family history of depression), early childhood experiences (such as loss or trauma), environmental factors (like recent stressors or lack of social support) or medical conditions (such as hormone imbalances, infections, cancer, or just having had a baby). 

Sometimes people are told to "Just get over it." A depressed person, however, really can't. Left untreated, depression can last for several months, leaving the sufferer unproductive or even out of work and with disrupted relationships. But with treatment, symptoms of depression can start to clear in weeks and enable people to continue being productive and happy.

What treatments are out there? Medications. Psychotherapy. Bright light lamps. Herbals. What is the first step? Get a complete physical and set of blood tests from your internist, family doctor, ob-gyn, or psychiatrist. There is no blood test for depression, but there are reversible causes of depressive symptoms like low thyroid levels or anemia and there are physical consequences to having been depressed like poor nutrition and lack of sleep that can make you more vulnerable to other illnesses. 

After your complete physical, your doctor may recommend treatments you can do for yourself like getting regular and adequate sleep and exercise, or treatment with psychotherapy and/or medications to jump start your recovery. 

Therapy helps people pinpoint triggers for their depression and deal with the consequences of living with depressive symptoms like trouble at work and in relationships. 

If medication is needed, most medications that treat depression have few or no side effects. You and your doctor can pick one that is right for you by exploring the medication's side effect profile. For example, if one medication makes people sleepy and you experience restlessness at night because of depression and anxiety, that particular medication may work well for you. 

Don't want to take prescription medication? Some herbals may have good anti-depressant properties like St John's Wort or SAM-e. One should know, however, that not enough studies have been done to know for sure how effective herbals might be. Be sure to tell your doctor what herbals you take, or would like to take, since herbals can affect the metabolism of other drugs making them more or less effective or even building toxic levels. Also, the amount of active ingredient in an herbal preparation can vary from pill to pill so one day's dose may have enough ingredient, while another day's dose may not. 

Bottom line to getting better? TALK. Talk to your spouse. Talk to your friends. Talk to your doctor. You are not alone and you can get better with help. 

Also, educate yourself and your loved ones. Here are some good websites to help you start: 

  • American Psychiatric Association
  • Depression & Bipolar Support Alliance 

You can feel better.

    Authors

    Perri Shaw Borish, MSS, LCSW
    Judith Snyder Kastenberg, MD
    Lisa Seufert, MD

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