(PSYCHIATRIC TIMES) - Rates of postpartum depression (PPD) in the United States have been estimated to be between 6% and 9% across African American, Hispanic and white female populations (Yonkers et al., 2001). Suicide risk for the mother in the first postnatal year is increased 70-fold (Appleby et al., 1998). In a review of maternal mortality in Sweden, suicide was found to be the leading cause of postpartum maternal death after malignancy (Hogberg et al., 1994). Despite increased awareness of PPD, too many women are still suffering and dying from it. The seriousness of this disease is highlighted by the recent case of Andrea Yates.
Ms. A, a 28-year-old woman, was admitted to our inpatient unit for PPD following the birth of her first child. She had no prior psychiatric treatment, but history revealed a probable long-standing anxiety disorder with some avoidant traits. Her symptoms began toward the end of her pregnancy and got markedly worse after the birth of her son, when she had fantasies of running away and leaving the baby and her husband behind forever. She was new to the area, with no friends or relatives in the vicinity. She did not have the kind of relationship with her own mother, an alcoholic, that would have enabled her to call for support or advice.
This being her first child, she had little idea how to care for him and read numerous books on child care, only to find that each book had a different prescription for the best care, often proffering conflicting advice. She interpreted one such book as saying she should never put her child down, so she spent nearly every waking moment with him in her arms and kept him in her bed all night. Although nursing was not going well, she felt that to stop would deprive her son. She persisted despite distress to herself and her baby.
Given this picture of isolation and sleep deprivation, in addition to her premorbid personality and anxiety, it is not surprising that she developed symptoms of depression. She was started on a selective serotonin reuptake inhibitor in the hospital, and her symptoms began to improve over the next several days. More importantly, numerous recommendations were made by the treatment team about restructuring her home environment. She was told to stop breast-feeding, a decision made easier for her by the presence of medications. The family had the financial resources to hire a nanny to help her. She was connected with a mothers' group that met weekly, and her husband began spending more time at home. Finally, she was seen in weekly psychotherapy sessions, where the focus was issues of identity and motherhood, particularly in reference to her own mother who could not serve as a model for her. She did very well in subsequent weeks and is now virtually symptom-free.
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