Friday, May 26, 2006

What is PPD?

Postpartum Depression (PPD) has become an umbrella term for a spectrum of postpartum mood disorders affecting mothers within the first year of the birth of a baby (or later if a breastfeeding mom weans after one year). The spectrum of what is often referred to as PPD includes Baby Blues, Postpartum Depression, Postpartum Anxiety, Postpartum Obsessive Compulsive Disorder, and Postpartum Psychosis. A woman’s symptoms could fall neatly into one of these categories or she could exhibit signs associated with more than one disorder.

Many women who do not develop postpartum mood disorders feel weepy, sad, overwhelmed, isolated, resentful, guilty, and anxious within the first few days of giving birth. These feelings can be surprising and scary to a new mom, who is often led to believe she will be nothing but happy, if a bit sleepy, in the postpartum period. Many of these negative feelings are hormonally driven, but can also stem from lack of practical support, evidenced by the emotional adjustment adoptive parents can experience. These Baby Blues usually resolve themselves within a couple of weeks as a mom adjusts to new demands on her time, builds confidence in her mothering skills, begins bonding with her baby and reaches out for practical help. Up to 80% of mothers experience some form of Baby Blues.

10% - 20% of mothers will develop a more serious postpartum mood disorder.

Postpartum Depression symptoms include:

  • Frequent crying
  • Feeling sad most of the time
  • Inability to concentrate
  • Inability to enjoy pre-baby hobbies and activities
  • Lack of energy
  • Insomnia
  • Feeling like a failure
  • Lack of appetite – everything tastes like sand or an aversion to texture of food
  • Sugar and carbohydrate cravings, compulsive eating
  • Inability to laugh
  • Hopelessness about the future – thinking that she will always feel this bad
  • Feeling that partner and new baby would be better off without her
  • Aversion to caring for the baby
  • Lack of sex drive
Postpartum Anxiety Disorder symptoms include:
  • Racing obsessive negative thoughts
  • Inability to sit still
  • Fear of leaving the house
  • Inability to concentrate
  • Fear of being alone with the baby
  • Shaking, trembling hands
  • Bursts of anger
  • Impulse to run away from home or to hide
  • Inability to comprehend what she reads
  • Gastrointestinal pain, diarrhea, nausea
  • Panic attacks
    • Pounding, racing heart
    • Thinking she is dying or having a heart attack
    • Feeling like she is choking

Postpartum Obsessive Compulsive Disorder symptoms include:

  • Recurring thoughts and images of doing harm to herself or her baby
  • Recurring thoughts and images of outside harm inflicted on her baby
  • Preoccupation with cleanliness and germs
  • Doubts about her ability to care for the baby
  • Excessively elaborate routines to complete common, simple activities

Postpartum Psychosis affects 1% of postpartum women and is considered a postpartum emergency requiring immediate medical attention from her doctor or a visit to the hospital emergency room. Onset of symptoms typically occurs within the first six weeks postpartum and includes:

  • Delusional thoughts and hallucinations
    • Thinking the baby is evil or Satan
    • Feeling that some external force is compelling her to harm herself or her baby
  • Rapid mood swings (irritability to euphoria to depression)
  • Having a concrete plan for harming herself or the baby and a timetable for acting on it
  • Loss of touch with reality for extended periods of time

Risk Factors for Postpartum Depression and/or Anxiety include:
  • Postpartum depression or anxiety with previous pregnancy (50 to 80 percent risk of recurrent episode)
  • Previous depression or anxiety (personal or family history)
  • Depression or anxiety during pregnancy
  • Abrupt weaning
  • Social isolation; few social supports
  • History of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD)
  • Mood changes while taking birth control pill or fertility medication
  • Thyroid dysfunction

Risk Factors for Postpartum Obsessive-Compulsive Disorder (OCD) include:
  • Personal or family history of OCD

Risk Factors for Postpartum Psychosis include:
  • Personal or family history of psychosis, bipolar disorder, or schizophrenia
  • Previous postpartum psychotic or bipolar episode*

Remember, “Risk factors do not cause depression.
They merely set the stage or create an opportunity for it.”**

A woman who is experiencing symptoms for any of the postpartum mood disorders described should get a complete medical exam to rule out other possible sources that have similar symptoms (such as a thyroid condition). A mental health professional is also essential in diagnosing and treating postpartum mood disorders. Please see our link to mental health professionals in Brooklyn.

*Bennett, Shoshana S., Ph.D. and Pec Indman, Ed.D., MFT. Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression. San Jose: Moodswings Press, 2003.

**Kleinman, Karen, M.S.W. The Postpartum Husband: Practical Solutions for Living with Postpartum DepressionThe Postpartum Husband: Practical Solutions for Living with Postpartum Depression. Philadelphia: Xlibris, 2000. 

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What Are PMADs?

PMADs have the following symptoms: insomnia, loss of appetite, nervousness/hypervigilance, frightening and/or suicidal thoughts, escape fantasies, feelings of worthlessness, anger, guilt, sadness/crying, grief, hopelessness, agitation, inability to concentrate, joylessness, sleeplessness/restlessness, appetite changes. You may experience one or some of these symptoms over a period of time.

Founded in 2006, Molly Coffin and Chris Lindsay-Abaire co-created the peer support they needed in their community. In Spring of 2014, Brooklyn PPD Support was joined by Melissa Paschke, LCSW. Melissa has been practicing medical social work since 1994. She is also a mother of two boys and a 500 hour+ certified yoga teacher. Melissa offers individual, partner and group therapies, crisis intervention, family support, health/wellness counseling, and yoga for the pre-natal and postpartum woman. She is a graduate of Yeshiva University, Wurzweiler School of Social Work and holds advanced clinical training certificates from the NYU Silver School of Social Work and Seleni Institute.

Please contact Melissa for information about group participation or individual and partner therapy.

See Melissa on Psychology Today:

What is Brooklyn PPD Support?

If you are a pregnant or post-partum woman experiencing Stress, Depression, Anxiety, and/or other mood challenges, you are welcome to join this group. It is advised that you also reach out to your medical provider to be assessed for any psychopharmacological needs. Group can also be used as a complement to any private psychotherapy you may be receiving, or you may inquire about private therapy with Melissa Paschke, LCSW, in addition to Brooklyn PPD Support Groups.

Brooklyn PPD Support is currently offering groups by Zoom, as per COVID-19 restrictions. There is a suggested fee of $40 to attend. It is the primary intention of Brooklyn PPD Support to remove as many barriers to participation as possible, so if fees are preventing you from attending, please reach out to Melissa. You are encouraged to attend as many meetings as you wish. This is a closed group; Only women experiencing symptoms of PMADs will be allowed to participate. Graduate students, researchers and well-meaning partners may not sit in on meetings.

Emotional support from empathic listeners is one key part of expediting a woman's recovery from PMADs. This offering is a safe, confidential, nonjudgmental environment where women can share their experiences. Women in all stages of stress, illness and recovery are welcome. If you aren't sure or formally diagnosed with a PMAD, you are welcome. You are also welcome if your child is older, but you relate to the stressors described. We are women helping women to share, witness and support each others' experiences. This is a professionally facilitated group led by a licensed clinical social worker who will also offer appropriate referrals for any additional treatment or supportive services that may be needed.

Postpartum Support International's Universal Message:

You are not alone
This is not your fault
You will feel better