NOT WHAT THEY EXPECTED; MOMS WITH POSTPARTUM DEPRESSION OVERWHELMED WITH FEELINGS OF GUILT, WORTHLESSNESS
The Ottawa Sun
Thu 28 Jul 2005
Page: 28
Section: Lifestyle
Byline: BY DARLA CARTER, GANNETT NEWS SERVICE
A VERBAL tug-of-war between actors Brooke Shields and Tom Cruise is drawing more attention to a mood disorder that engulfs some new mothers in guilt, fear, shame and secrecy.
The disorder, postpartum depression, plunged Shields into a dark abyss after the birth of her daughter, Rowan Francis, in 2003, until antidepressants and psychotherapy lifted her out.
"I wasn't thrilled to be taking drugs," Shields wrote in an op-ed piece in The New York Times. "In fact, I prematurely stopped taking them and had a relapse that almost led me to drive my car into a wall with Rowan in the backseat. But the drugs, along with weekly therapy sessions, are what saved me -- and my family."
Shields was responding to comments Cruise made after the publication of her new book, Down Came the Rain: My Journey Through Postpartum Depression (Hyperion, $32.95).
Cruise criticized Shields' drug use and said there's no such thing as a chemical imbalance and referred to psychiatry as a pseudo-science, drawing the wrath of mental health groups from the U.S. to Australia.
The flap caught the attention of researcher M. Cynthia Logsdon, who recently received a national award for postpartum-depression research.
"Tom Cruise is coming off as a jerk," says Logsdon of the University of Louisville and a women's health nurse practitioner.
But "Cruise is actually doing us a favour -- just in terms of ... bringing up the issue on national TV," she says. "It's very difficult now for people to say they've never heard of postpartum depression, and Brooke Shields' book is actually very good."
Postpartum depression affects about 13% of women in the first year after birth and can happen to anyone, says Logsdon.
Contributing factors can include hormonal fluctuations, such as decreased serotonin levels after delivery, stress and, in some cases, major events coinciding with birth, according to the National Mental Health Association.
In Shields' case, her father, who had prostate cancer, died soon before her daughter was born.
Back home after delivery, "I started to experience a sick sensation in my stomach," Shields writes in her book. "It was as if a vise were tightening around my chest. Instead of the nervous anxiety that often accompanies panic, a feeling of devastation overcame me. I hardly moved. Sitting on my bed, I let out a deep, slow, guttural wail. I wasn't simply emotional or weepy, like I had been told I might be. This was something quite different."
Logsdon says it's not uncommon for women to feel down after giving birth. In fact, as many as 80% of women do, she says. But those women have the fleeting "baby blues," whose symptoms generally subside as the mother's hormones start to stabilize, according to the National Mental Health Association.
Women with postpartum depression experience at least two weeks of symptoms that interfere with their ability to function normally, foiling their relationships and their ability to mother, Logsdon says.
MORE THAN 'BABY BLUES'
The difference between baby blues and postpartum depression is "sort of like the difference between a sprinkler system and a rainstorm," says therapist and social worker Dianne Doyle. "Baby blues is not very intense, and it's (of) very short duration."
Postpartum depression "is very intense, and it interferes with a person's ability to make good decisions, to take care of herself, to take care of her other children, to take care of her infant."
"Mom can't read the baby's cues when she has depression," Logsdon says. "Either they don't give the baby enough stimulation or they give them too much stimulation."
Sufferers may have no clue what's really wrong with them or be too ashamed to admit they're not the perfect mom, Doyle says.
"More women need to know about it, learn about it and look for it in close friends or family members."
Logsdon agrees it's important for friends and relatives to be alert and involved, but she warns symptoms might not be readily apparent to them.
Logsdon stresses the importance of formal screening and referrals of women for appropriate treatment.
The American College of Obstetricians and Gynecologists says obstetrical providers should be aware that postpartum depression can be a significant problem and should screen all patients for the condition, says Dr. Paul Gluck of the obstetrics group and an associate clinical professor of obstetrics and gynecology at the University of Miami.
Pediatricians also should be alert, Gluck says, because they are seeing the mother more than any other doctor during that first year.
REPEATED SCREENING
Logsdon says she would like to see all women screened "at every interaction that they have with a health-care provider" during the first year after delivery.
Sufferers can be treated with medication, psychotherapy or a combination of them.
"Rigorous, published, peer-reviewed research clearly demonstrates that treatment works," according to a statement issued by the American Psychiatric Association to counter Cruise. "Medications can be an important and even life-saving part of a comprehensive and individualized treatment plan."
Postpartum depression "can take a very quick turn," Doyle says, developing into a psychosis, and "that's when mothers begin to start considering taking the life of their child or other children in the home."
There's also a risk of suicide, Doyle says.
"Suicide and certainly homicide become a real risk factor, especially if a woman is in isolation and if she doesn't feel or think that she can confide in someone else."
WATCH FOR THE SIGNS:
Suspect postpartum depression if a new mother has symptoms for at least two weeks that keep her from functioning normally. Signs include:
- Strong feelings of depression, anger, anxiety, panic.
- Feelings of worthlessness or excessive inappropriate guilt.
- Inability to care for herself or the baby.
- Trouble doing tasks.
- Changes in appetite.
- Trouble sleeping, even when the baby is napping.
- Much less pleasure -- or none at all -- from things she once enjoyed.
- Little interest in the baby or excessive worry about the baby.
- Fear of harming the baby. (Moms rarely act on this.)
- Thoughts of death or harming herself, including suicide.
- Agitation or lethargy.
- Trouble concentrating or making decisions.
ON THE WEB
- www.nlm.nih.gov/medlineplus/postpartumdepression.html , National Institutes of Health.
- www.postpartum.net , international support group.
- www.depressionafterdelivery.com , nonprofit resource group.
- www.ppdsupportpage.com , online support group.