Postpartum Depression Counseling

Postpartum depression can only be diagnosed by a healthcare provider. Since the symptoms of postpartum depression can vary widely between women and can be broad, a healthcare provider can help ascertain whether the symptoms are tied to postpartum depression or something else. Any mother who is experiencing these symptoms should speak to a healthcare provider as soon as possible.

Perinatal depression is a depressive disorder that occurs during pregnancy and is often an early indicator of postpartum depression, which occurs after the child is born. The symptoms of perinatal depression are similar to those of postpartum depression and include mood shifts, changes in behavior, bodily changes such as fatigue or loss of appetite, cognitive difficulties, depression, fluctuations in weight, and difficulty sleeping or resting.

Perinatal depression affects about 1 in 7 women. Perinatal depression is one of the most common complications that occur during pregnancy and can result in many negative short- and long-term outcomes on both the mother and child.

The United States Preventive Services Task Force (USPSTF) has found compelling evidence which suggests that receiving a counseling intervention, such as cognitive-behavioral therapy and interpersonal therapy, can be an effective measure in preventing perinatal depression in women who are at increased risk. Risk factors for perinatal depression include a history of depression, experiencing depressive symptoms, complications during pregnancy, unwanted pregnancies, physical or sexual abuse, stressful life events, dearth of financial or social support, and diabetes. The USPSTF also found that receiving counseling intervention presents a low risk and low likelihood of serious harm for the client.

Although no data exactly identifies the ideal time for starting a counseling intervention, most are implemented during the second trimester of pregnancy. Counseling sessions typically range from 4 to 20 sessions over a period of 4 to 70 weeks. The counseling format generally consists of group and individual sessions, with in-person visits being the primary method of implementation.

• Perinatal Anxiety: It is estimated that 15-21% of pregnant women experience moderate to severe symptoms of depression or anxiety (Wisner KL, Sit DKY, McShea MC, et al. JAMA Psychiatry 2013).
• Perinatal Panic Disorder: This is a form of anxiety that occurs in up to 11% of new mothers. Symptoms include: feeling very nervous, recurring panic attacks (shortness of breath, chest pain, heart palpitations), many worries or fears (Wenzel A. 2011).
• Perinatal Obsessive-Compulsive Disorder: This is the most misunderstood and misdiagnosed of the perinatal disorders. It is estimated that as many as 11% of new mothers will experience the following symptoms: obsessions (persistent thoughts or intrusive mental images often related to the baby), compulsions (doing things over and over to reduce the fears and obsessions) or avoidance, and a sense of horror about the obsessions. These mothers know their thoughts are bizarre and are very unlikely to ever act on them (Miller ES. J Reprod Med 2013).
• Postpartum Posttraumatic Stress Disorder: An estimated 9% of women experience PTSD following childbirth (Beck C, et al Birth 2011). Symptoms typically include: Traumatic childbirth experience with a reexperiencing of the trauma (dreams, thoughts, etc.), avoidance of stimuli associated with the event (thoughts, feelings, people, places, details of event, etc.), and persistent increased arousal (irritability, difficulty sleeping, hypervigilance, exaggerated startle response).
• Perinatal Bipolar Disorder: Over 70% of women with bipolar disorder who stop medication when pregnant become ill during the pregnancy. Twenty-two percent of depressed postpartum women are suffering from a bipolar depression (Wisner KL, Sit DKY, McShea MC, et al. JAMA Psychiatry 2013).
• Postpartum Psychosis: Occurs in approximately 1 to 2 of every 1,000 deliveries (Sit, et al, 2006). The onset is usually sudden, most within the first 4 weeks, with symptoms including: delusions (strange beliefs) and/or hallucinations, feeling very irritated, hyperactive, decreased need for sleep, and significant mood changes with poor decision-making. There is a 5% suicide rate and 4% infanticide rate associated with Psychosis and thus immediate treatment is imperative (Sit D, et al, JWH 2006).

Postpartum depression is a mood disorder that can affect some women after childbirth. It affects about 10% of mothers with newborns. Mothers with postpartum depression may experience intense feelings of anxiety, fatigue, and sadness that make it difficult to engage in daily tasks. Postpartum depression is not attributed to a single cause. Rather, it likely stems from a combination of physical and emotional factors, alongside life experience; it is not a result of something a mother does or does not do during pregnancy.

After childbirth, the levels of the hormones estrogen and progesterone, which are high during pregnancy, drop drastically. This leads to chemical changes in the body and the brain that can lead to mood swings and other symptoms of postpartum depression. Mothers may be unable to get the rest that they need to recover from childbirth. This can result in sleep deprivation, which can further exacerbate symptoms.

The risk for postpartum depression has been observed to be higher in some women, such as with low-income women or single mothers and in areas where mental health or illness is not recognized. Moreover, women who have had a prior history of mood disorders are at higher risk than those who have not. For those who are on medication, changes in their medicine regimen due to pregnancy or after childbirth can result in turbulent emotions.

Pregnant mothers may also develop depression during pregnancy, called perinatal depression, which can be an early indicator of postpartum depression. If a mother is showing early signs of postpartum depression, the sooner she talks to a doctor or counselor, the earlier she will start to feel better again.

• Effective treatments for postpartum depression exist. A healthcare provider can help the woman determine the best course of treatment for her. Some treatment options include:
  • Counseling: Also known as talk therapy, this process involves talking with a mental health professional, which may include counselors, social workers, therapists, psychiatrists, or psychologists. There are two types of counseling that have shown to be helpful in treating postpartum depression.
    • Cognitive Behavioral Therapy (CBT): A type of psychotherapy in which negative patterns of thought about the self and the world are challenged in order to alter unwanted behavior patterns or treat mood disorders.
    • Interpersonal Therapy (IPT): A type of psychotherapy that is time-limited, focused, and an evidence-based approach to treat mood disorders. The main goal of IPT is to improve the quality of a client’s interpersonal relationships and social functioning to help reduce their distress.
  • Medication: Antidepressants are typically prescribed for postpartum depression. Antidepressants are designed to balance chemicals (neurotransmitters) in the brain that affect mood and emotions. They include selective serotonin reuptake inhibitors (SSRIs), atypical antidepressants, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). Women should talk with their doctors to see how antidepressant medication can affect breastfeeding or their pregnancy. These treatments can either be used alone or in combination (called combination therapy).

These treatments can either be used alone or in combination (called combination therapy).

Left untreated, postpartum depression can last for months or even years. It will affect the mother’s physical and mental health and will hinder the mother’s ability to connect with and care for her child. This may result in the baby developing problems with behavior, sleeping, and eating as they develop.