Sandra Donaldson's clinical background is in kinesiology where she worked in
orthopaedics for 5 years. She then crossed over to work in clinical research
where she has been working for over 10 years. Sandra has worked at University
Hospital (London), Princess Margaret and Women's College Hospitals. She is now
working as a clinical research project manager in paediatric orthopaedic
clinical trials in Toronto.“I started feeling dark and heavy when my son was just seven months old. After I stopped nursing him [at 12 months], things got a lot worse. Two months later, I was hallucinating and hearing voices in the shower.” Her baby was not in danger; she directed all feelings of violence and fear inwardly.
Brochu thought she could solve the problem if she eliminated herself but a rational thought stopped her, “I can’t kill myself – who will care for my child?” Thankfully, her mother caught the signs in time and took her straight to the doctor. Brochu started a treatment of antidepressants and within seven days, she started to see the light.
One in a thousand women who have given birth will experience postpartum psychosis. The potential effects are devastating and can lead to the death of the infant, mother, and sometimes the entire family. Hallucinations, bizarre behaviour and uncontrollable agitation are signs that the mother needs immediate medical attention.
On the other end of the scale is the baby blues, mild symptoms of depression, mood swings and fatigue that generally occur within the first few weeks following delivery. This is the experience for 80 per cent of women and is a normal response to the physical and emotional changes involved in having a baby.
Somewhere in the middle of the scale is postpartum depression. It affects one in 10 women and can last from several months up to a year. The symptoms are more severe than those experienced during the baby blues.
Coping with the everyday demands of a newborn can be overwhelming when the mother is deprived of sleep. Simple chores done before the baby arrived may now seem impossible, which can lead to frustration and depression. New mothers may feel incompetent or experience a loss of identity.
Other situations can contribute to the problem. A colicky baby, caring for many young children simultaneously, money or marital problems, poor support network, and difficulty with breast-feeding can all increase the pressure on an overwhelmed mom.
Who is at risk?
Treatment is tailored to the severity of depression and the needs of the patient. If depression is mild, psychotherapy may work on its own. Research studies show that individual psychotherapy can be a successful form of treatment. If depression is severe, a combination of antidepressant medication and psychotherapy is indicated.
Mothers who are pregnant or breastfeeding may be concerned about taking medications. Until now, there haven’t been any long-term safety studies on antidepressants. Misri has just finished a trial indicating the safety of Prozac, Zoloft and Paxil taken during pregnancy and breastfeeding. She followed infants until they were 5 and found no side effects.
During her research, Misri observed a side effect in women taking high doses (300 mg) of antidepressants while pregnant. When the infant is born, they experience tremors due to withdrawal. This lasts for 24 hours, does not harm the infant and requires no medical intervention. Misri says that women on such high doses are suffering from severe depression, and physicians have no choice but to treat them.
With research this data on these antidepressants, Misri says it would be unethical not to treat a mother who has moderate to severe depression. If depression occurs during pregnancy and remains untreated, there is no way to know how anxiety and depression affects the developing fetus. In more severe situations, the mother is at risk of hurting herself or others.
Many women are concerned about how long they would have to stay on antidepressants. Misri says this is different for each woman depending on how many depressive episodes they have had in the past and how they respond to treatment.
Looking back, she can’t believe she was about to commit suicide. What
advice does she have for other women? “Don’t criticize or judge yourself. If
something isn’t right, no matter how small, talk to your doctor.”
Additional resources:
The
Canadian Women’s Health Network: Postpartum Depression
Edinburgh
Postnatal Depression Scale
Books and
information on postpartum depression by Dr Shaila Misri
Postpartum
Education for Parents: How fathers, families and friends can help
Why Shouldn’t I Be Happy? (1985)
Pregnancy Blues. (August 31, 2005)
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