Baby Blues // Alexis Hershfield, Ed.M.


Thanks to celebrities such as Brooke Shields and Gwyneth Paltrow, postpartum depression is now included in our pop cultural lexicon. While Sheilds’ and Paltrow’s openness about their own struggles with postpartum brought the topic into the public domain, many people still hold misconceptions about the illness.

Research shows that postpartum depression is chronic and episodic in nature, meaning that it reoccurs in thirty to fifty percent of people. While symptoms tend to glean after delivery, vulnerability to depression begins for many women before delivery.  The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) currently uses the term perinatal depression to describe this mood disorder. Perinatal depression encompasses both the period during pregnancy and the period after the birth of a child.  The misunderstanding among many is that postpartum depression is an isolated event and that fallacy puts many women and their children at-risk. The longer one waits to detect or treat depression, the more difficult it is for the episode to remit.  Severity of a reoccurrence also rises with increased episodes. Untreated perinatal depression can be extremely detrimental the child.  Risk factors for the child include lower I.Q. s, language delays, lower birth weights, emotional and behavioral problems and issues with mother-infant bonding.  

On January 26, 2016, the United States Preventative Services Task force - a government appointed health panel - called for the need for screening of maternal mental illness. This initiative underscored the political community’s growing concern about the prevalence of perinatal depression.  The hope is that with the increased use of screening measures by physicians, rates of perinatal depression will decline.

Unfortunately, the road does not end at improved screening measures.  Women with perinatal depression face significant challenges about how to best treat the disorder given the lack of evidence-based treatment options currently available.  A number of studies suggest adverse effects from antidepressants and other psychotropic medications on children, with mounting questions surrounding the lack of data available on the long-term impact medications given during pregnancy and breastfeeding have on children.  This dilemma prevents many women from seeking help. Luckily, there is evidence that suggests that cognitive behavioral therapy (C.B.T) and interpersonal therapy (I.T.P) are effective in reducing depressive symptoms. Promotion of these services by medical practitioners is necessary.

Women need to create conversations around these topics in order to promote early detection and treatment.  Awareness is key.


Citations
Belluck, P. (2016, January 26). Panel Calls for Depression Screening During and After Pregnancy. New York Times. Retrieved from http://www.nytimes.com/2016/01/27/health/post-partum-depression-test-epds-screening-guidelines.html
Bornstein, D. (2014, October 16). Treating Depression Before it Becomes Postpartum. New York Times. Retrieved from http://opinionator.blogs.nytimes.com/2014/10/16/treating-depression-before-it-becomes-postpartum/
de Mello, M. F., de Jesus Mari, J., Bacaltchuk, J., Verdeli, H., & Neugebauer, R. (2005). A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorders. European archives of psychiatry and clinical neuroscience, 255(2), 75-82.
Department of Health (August, 2006). Perinatal Depression. New York State Department of Health. Retrieved from, https://www.health.ny.gov/community/pregnancy/health_care/perinatal/perinatal_depression.htm
Fitelson, Elizabeth et al. Treatment of Postpartum Depression: Clinical, Psychological and Pharmacological Options. International Journal of Women’s Health 3 (2011): 1–14. PMC.

Grigoriadis, S., & Ravitz, P. (2007). An approach to interpersonal psychotherapy for postpartum depression Focusing on interpersonal changes.Canadian Family Physician, 53(9), 1469-1475.
O'Hara, M. W., Stuart, S., Gorman, L. L., & Wenzel, A. (2000). Efficacy of interpersonal psychotherapy for postpartum depression. Archives of general psychiatry, 57(11)
O'Hara, M. W., Rehm, L. P., & Campbell, S. B. (1982). Predicting depressive symptomatology: cognitive-behavioral models and postpartum depression.Journal of Abnormal Psychology, 91(6), 457.
Pearlstein T. Perinatal depression: treatment options and dilemmas. Journal of Psychiatry & Neuroscience : JPN. 2008; 33(4):302-318.

Solomon, A. (2015, May 28). The Secret Sadness of Pregnancy with Depression. New York Times. Retrieved from http://www.nytimes.com/2015/05/31/magazine/the-secret-sadness-of-pregnancy-with-depression.html
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1 comment:

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