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.Because of the physical stress and sudden hormonal changesoccurring immediately after birth it is common for mothers to acknowledge having thebaby blues.Even women who have delivered other children may report that, either unlikeor like in other births, they are experiencing emotional problems that range from mild tomoderate in severity.Symptoms associated with the baby blues generally last for aboutthe first 10 days after delivery, but may continue for several weeks.Many women report that the severity of the symptoms peaked after the first week ofdelivery, and spontaneously disappeared during the second week7.Patients and familiesare advised to seek a professional psychiatric evaluation immediately if these or othersigns of depression persist beyond 2 or 3 weeks. Atlas of bipolar disorders 72Symptoms of Baby Blues" Occur almost immediately after giving birth." Do not occur with every birth." Having not had the baby blues with a previous delivery does not signal that thesymptoms will not appear when giving birth in the future." Having symptoms with one delivery does not predict that baby blues symptoms willappear in future births." Baby blues last between a few days and a few weeks, and spontaneously disappear." Major psychiatric symptoms include: Fatigue; Anxiety; Irritability; Crying (often for reasons the mother cannot explain); Worry over mothering skills, ability to balance home, child care, work, andrelationship responsibilities; Inability to fall asleep; Appetite fluctuations and sudden weight gain and loss.POSTPARTUM DEPRESSIONUnlike the baby blues, postpartum depression will last longer than a few days or weeks,may appear at any time during the child s first year of life, often causes more severesymptoms, and is less likely simply to disappear with time.Researchers currently debatewhether postpartum depression can occur beyond the child s first birthday.People aresurprised to discover that this is not a rare psychiatric disorder.Approximately one in tenand up to 15% of women having a baby experience mild to severe postpartumdepression7,9.The large number of postpartum episodes occurs at least in part because anumber of women deliver children having an undiagnosed and untreated depression orbipolar disorder.One study using self-report rating scales with 3472 pregnant womenfound that 20% scored above the clinical cut-off score for depression.That is, thescreening instrument found that approximately 694 women warranted a full assessmentfor depression.Furthermore, only 14% of those identified as possibly having depressionwere receiving treatment10.Hidden disorders place mothers at greater risk for postpartumdepression, and prevent medical providers from assertively providing preventivetreatments and support.Additionally, women who unknowingly suffer from mild bipolarII disorder or cyclothymia are at added risk for having their depression symptomsmisdiagnosed and treated with only an antidepressant.It is important for families to understand that postpartum depression is more thansimply feeling sad, worried, or anxious.Without coaching and education, familymembers and friends may disregard and even refuse to listen to a mother s ruminationsabout not being able to care for the baby or to provide adequate attention and love.Culture teaches that women biologically and emotionally are made to have and care for a Suicide and bipolar disorders 73baby.Families and community leaders literally do not know how to respond to amother s expressions of doubt or fear.They often view the mother s concerns asoverstatements, drama, or fatigue that will quickly pass.It is extremely difficult for amother who is developing postpartum depression to be heard and validated by hersupport systems.Without guidance, families find it impossible to comprehend how amother who, before giving birth, looked joyfully forward to parenting, is now painfullyand completely convinced that she cannot today, tomorrow, or ever rise to the occasion ofnurturing, protecting, and physically caring for a child.Even more baffling for people iswhy the mother is not consoled by concrete help and reassurance, and why she simplydoes not function regardless of her self-perceptions and feelings.It is extremelydifficult for untrained individuals to independently grasp that depression removes one sability to cognitively and emotionally discover or accept alternative solutions.For anuntrained person who has never been depressed it is difficult to understand that thepatient is not simply rejecting advice, but is unable to perceive that unexplored solutionsand hope realistically exist.Additionally, mothers and family members are reluctant toinitiate a discussion about depression with their internal medicine doctor, let alone mentalhealth professionals.As a result, health and mental health providers have to be assertive,yet sensitive to the fact that a mother s ambivalence may stem from:(1) Lack of awareness and understanding about what is happening to her;(2) Cultural beliefs, or significant family members and supporting community who do notbelieve in psychotropic medications, and define depression as a choice or characterflaw;(3) Self-shame, embarrassment, and guilt;(4) Fear that she will be reported to child-protection services and her baby will be placedin a foster home;(5) Belief that her family and friends will not understand;(6) Lack of awareness that treatments are effective, and one does not have to tough itout ;(7) Loss of energy and ability to plan cognitively how to obtain help.Perhaps one of the most common symptoms seen in postpartum depression is obsessivethoughts randomly occurring throughout each day7,11.The thoughts usually focus on acentral theme such as lacking ability to care for the child, unworthiness to be a mother,inability to protect the child from lurking worldly dangers, fear and belief that the baby isin pain, or physical problems causing personal fatigue.Research indicates that self-criticism makes a new mother more vulnerable to postpartum depression11 [ Pobierz całość w formacie PDF ]