Where Health Care Meets Policy with Dr. Mike Magee
Speaking Up About Postpartum Depression
• Affects one in eight women who give birth • Just now receiving attention it deserves Accolades go to two brave moms who survived postpartum depression and are speaking out about it • Brooke Shields • Mary Jo Codey Postpartum Depression Can Have Devastating Consequences
Tom Cruise on the Today show, late June 2005 Suggested Shields shouldn’t have sought psychiatric help for postpartum depression, but should have relied on vitamins & exercise instead Brooke Shields: Cast into the Limelight “ I thought I would be overjoyed when my daughter was born. But instead, I felt completely overwhelmed. This baby was a stranger to me. I didn’t know what to do with her. I didn’t feel at all joyful. I attributed feelings of doom to simple fatigue and figured that they would eventually go away. But they didn’t; in fact, they got worse.” – Brooke Shields Shields fired back in The New York Times, July 1 Gave voice to a silent force of women affected by postpartum depression Sources: Today show. June 25, 2005. Transcript available at: http://www.msnbc.msn.com/id/8343367/. Shields B. War of Words. The New York Times . July 1, 2005.
• 15% - 25% of Americans suffer from the disease • It is twice as common in women as in men • Peak prevalence in those age 18 to 44 • Hormone fluctuations increase vulnerability Depression is Common in the United States It’s not surprising that childbearing women are at risk – it’s just surprising how it’s been kept a secret. Source: Epperson CN. Postpartum major depression: detection and treatment. American Family Physician . 1999;59:2247.
Least serious: “baby blues” • Affects approximately 70% of new mothers • Crying, sadness, irritability, anxiety, irregular sleeping / eating • Peaks 3 - 5 days after delivery • Disappears within two weeks • Emotional letdown that does not impair functioning True postpartum depression • Takes hold within days of delivery and can last up to a year • Can impair mother & delay child’s cognitive / social development • When poorly managed, often leads to divorce Depression Following Birth Ranges from Mild to Life Threatening Sources: American Psychiatric Association. Fact Sheet. Available at: http://www.healthyminds.org/postpartumdepression.cfm. Wisner KL, Parry BL, Piontek CM. Postpartum depression. NEJM . 2002;347:194-199.
Immediate evaluation is required if a woman experiences 5 symptoms: • depressed mood • marked disinterest in activities • appetite or sleep disturbance • physical agitation • extreme fatigue • sense of worthlessness • decreased concentration • suicidal thoughts Baby Blues Clear Rapidly; Postpartum Depression Lingers or Worsens Effective treatment: psychotherapy/anti-depressive medication Source: Nonacs R, Cohen LS. Postpartum mood disorders: diagnosis and treatment guidelines . J Clin Psychiatry . 1998;59:34-40.
• In 1 - 2 of every 1,000 births • First weeks after delivery • Delusions and hallucinations – Voices instructing them to harm or kill their babies • A medical emergency requiring hospitalization Small Sub-group of Women Who Give Birth Experience Postpartum Psychosis Source: Nonacs R, Cohen LS. Postpartum mood disorders: diagnosis and treatment guidelines . J Clin Psychiatry . 1998;59:34-40.
• Women are not screened for it • Women are not properly made aware of it • They don’t know: - If they’ve had depression before, there’s a 30% chance they’ll suffer postpartum depression - If they’ve had postpartum depression with one child, there’s a 50% chance they’ll have it with the next; 70% chance if they’ve had postpartum psychosis How Has Postpartum Depression Remained So Well Hidden? The pain, discomfort, and symptoms of postpartum depression affect more than 500,000 U.S. women a year Sources: Nonacs R, Cohen LS. Postpartum mood disorders: diagnosis and treatment guidelines . J Clin Psychiatry . 1998;59:34-40. Reighard FT, Evans ML. Use of the Edinburgh Postnatal Depression Scale in a southern, rural population in the United States. Neuro-Psychopharmacol. & Biol. Psychiat. 1995;17:1219-1224.
• Follow-up visit with obstetrician is not until 6 weeks • Edinburgh Postnatal Depression Scale is infrequently used • Well baby visits with pediatrician focus on baby, not mom • Confusion / change among new moms and dads – Estrogen and progesterone levels plummet with birth – Endorphins and thyroid hormones drop – Exhaustion is profound – Insecurity and fear regarding mothering, breast feeding, delegating are common – Family relations must be adjusted split-second Additional Reasons Postpartum Depression Often Goes Undiagnosed and Untreated Sources: Reighard FT, Evans ML. Use of the Edinburgh Postnatal Depression Scale in a southern, rural population in the United States. Neuro-Psychopharmacol. & Biol. Psychiat. 1995;17:1219-1224. Hibbert CG. Postpartum Mood Disorders: An Informational Guide for Couples. Available at: www.psychotherapy.com/mom.html.
Sometimes women: • assume feelings are temporary, part of normal adjustment • try to live up to the “good mother” label • keep thoughts and fears to themselves to avoid someone thinking they’re crazy and possibly taking their baby away Many Women Try to Brush the Feelings Aside Sources: Epperson CN. Postpartum major depression: detection and treatment. American Family Physician . 1999;59:2247. Hibbert CG. Postpartum Mood Disorders: An Informational Guide for Couples. Available at: www.psychotherapy.com/mom.html. Most women come into motherhood with myths : All moms and all babies are perfect All dads will chip in I can do this, and my life will be basically the same
2 decades ago, New Jersey’s First Lady, Mary Jo Codey, suffered from postpartum depression. With irrational thoughts of harming her baby, she sought psychiatric help. But information wasn’t available Postpartum Depression Should Be Managed from Conception Through the Child’s First Birthday Source: N.J governor’s wife getting support. USA Today . February 11, 2005. “ There was nothing out there for me. There was not one book. I made up my mind in the psychiatrist’s office, if I ever got out of it, I would educate the public about it.” – Mary Jo Codey
Televised public service announcements advise moms and families not to go silent, but to seek help. • Call 1-800-328-3838 or 1-877-773-4673 • Access New Jersey Department of Health postpartum depression Web page Mary Jo Cody is Working to Educate the Public Mary Jo’s Advice For moms: you’re not alone, not to blame, it’s not just “the blues” Talk about it, get help, and you will get better For caregivers: screen early and often, involve family members For family: take action, get help, listen and support Sources: N.J. Governor Confronts DJ Over Comments. ABC 7 News . January 26, 2005. New Jersey Department of Health and Senior Services webpage. Postpartum Depression. Available at: http://www.state.nj.us/health/fhs/ppd/home.shtml.
www.healthpolitics.com with Dr. Mike Magee Speaking Up About Postpartum Depression