Berman spent 10 days in the hospital and another 10 at a psychiatric facility. Misdiagnosed with bipolar disorder, she suffered for more than two months before a therapist finally suggested she contact Depression After Delivery (DAD), an organization for women with postpartum depression. Within days she was under the care of Joyce Venis, a therapist in Princeton, N.J., and the current president of DAD. “Joyce said, ‘This is a classic case of postpartum depression’,” says Berman. “I finally had a name for what I was going through.” Berman was treated with a combination of talk therapy, Prozac and the anti-anxiety drug Klonopin. She also attended support groups. Within a week she was reading a poem that she had written at her sister’s wedding; within two months she was beginning to feel like her old self.
About 10 and 15 percent of all new mothers suffer postpartum depression (PPD) within a year after giving birth. Symptoms include anxiety or panic attacks, feelings of hopelessness and guilt, insomnia, lack of interest in the baby and thoughts about harming the baby or oneself. It’s a serious psychological condition–very different from the “baby blues,” the short-lived period of tearfulness and mood swings that affects up to 80 percent of new mothers within the first two weeks of delivery. The baby blues subside quickly without intervention, while postpartum depression can linger for months. Fortunately, with prompt diagnosis, PPD “is exquisitely treatable,” says psychiatrist Lee Cohen, director of the Center for Women’s Mental Health at Massachusetts General Hospital in Boston.
What distinguishes PPD from other kinds of depression is the mother’s obsessive thoughts about hurting her baby, says Katherine Wisner, professor of psychiatry and reproductive medicine at Case Western Reserve University in Cleveland. “She might think, ‘What if I put the baby in the microwave, or throw it down the stairs?’ " Though most mothers with PPD would never act on those fantasies, they can’t stop thinking them. A tiny fraction–about one tenth of 1 percent–develop postpartum psychosis, which strikes suddenly and is marked by hallucinations and delusions about the baby. Since it can lead to infanticide, it is considered a “psychiatric emergency,” says psychiatrist Margaret Spinelli, director of maternal mental health at Columbia University College of Physicians and Surgeons.
No one knows exactly what causes PPD. It may be partly hormonal; after delivery, all women experience fluctuations in their levels of progesterone, estrogen, cortisol and prolactin. Women with a history of depression face a greater risk of developing PPD, as do women who were depressed during their pregnancies. Those who suffered PPD after one birth are more likely to have it with subsequent ones.
The up side is that more and more obstetricians are monitoring their patients for early signs of PPD. Some even begin before the delivery; patients of doctors at Mass General fill out questionnaires evaluating their emotional state in their second trimester as well as six weeks postpartum. Once detected, PPD responds to treatment. Many doctors favor anti-depressants like Prozac, Zoloft, Effexor and Paxil. Some studies have shown that for women at high risk for PPD, taking antidepressants during pregnancy or right after delivery can significantly reduce the chances of its developing. Research has been inconclusive on whether the drugs affect the fetus or the newborn through the mother’s breast milk. But many doctors believe that in some cases, the benefits of drug therapy outweigh any risks. Still, those opposed to taking meds can find relief with “interpersonal psychotherapy,” a kind of brief but intensive talk therapy that focuses on the here and now instead of on the past.
That gives Randy Berman a lot to think about. She is expecting another baby in June, and is leaning toward starting preventive antidepressants after the birth. “Part of me says I should see what happens,” she says. “But the right thing is not to take a chance. I know that I’m not invincible. I also know what to do and where to get help.”
