How Can Postpartum Depression Be Prevented?
Postpartum depression (PPD) is the most common illness of the postpartum period. It is affects up to 20 percent of new mothers within the first year of childbirth. The effects of the condition can be devastating; suicide for example is a major cause of perinatal maternal death. Although the causes of postpartum depression are not fully understood, certain risk factors have been identified. These include a history of hormone swings, partner stresses, lack of social support, nutritional deficits, lack of physical activity and family history of mood disorders. Reducing your risk factors means you may be less vulnerable to developing PPD, or if you do develop it, it will reduce the severity and duration of your symptoms. Much of of the advice in this article is also useful for helping to prevent the milder form of depression called the baby blues. If you are considering pregnancy or are already pregnant and are worried about PDD, talk to your doctor about performing a risk assessment.
Identifying women who are at risk of PPD early is crucial to prevention. There is no accepted screening tool for PPD, but the postpartum depression quiz goes some way towards achieving this. A clinical assessment is also necessary as it will identify women particularly high risk of PPD. That is, those with a history of depressive episodes (even if not previously diagnosed), premenstrual dysphoric disorder (severe periods), stressful relationships and lacking in social support. Once identified as high risk, a prevention strategy can be put in place.
To help establish who is high-risk, researchers started by identifying what type of woman is least likely to develop PPD. She:
• Has minor hormone fluctuations at all stages of life, her PMS symptoms are mild.
• She has good stress management skills.
• She knows how to access social support.
• She eats a healthy diet including the key anti-depression nutrients.
• She has at least 30 minutes of aerobic activity a day.
• She is exposed to enough light during the day.
• She ensures she gets enough sleep.
• She only breastfeeds if she wants to.
• She has babies when she wants to.
If a woman does not possess one of the above attributes or the attribute needs strengthening - this should be addressed in a personal prevention strategy plan. Prevention methods include therapy (either cognitive-behavioral psychotherapy or interpersonal psychotherapy), antidepressant medications, learning stress reduction techniques, strengthened social support, diet and exercise improvements and family planning advice.
Antidepressant Medications Prophylactic Treatment
Doctors sometimes prescribe antidepressants as a preventative measure to women with a history of major depressive episodes (particularly if these episodes occurred in a previous pregnancy). The key question doctors need to decide is when to start the medication. Starting immediately after delivery is usually very effective. But in some instances it needs to be asked should they be started sooner, while the woman is still pregnant. The risk a major recurrence in pregnancy in women with a history of mood disorders is as high as 68 percent. Ultimately the decision will be the woman’s to make. She will need to weigh the risk of a relapse versus the potential effects of antidepressants on a growing fetus. Another key question is how long to take the medications. Studies show they should be taken for at least 6 months, although some women with severe risks may need to take them indefinitely. See also antidepressants for postpartum depression.
Counseling can help women emotionally make the transition to motherhood, reducing her risk of PPD. Ideally therapy should start before or during pregnancy to have a preventative effect. For more details on cognitive behavioral therapy which helps the woman focus on realistic expectations and interpersonal psychotherapy which focuses on teaching them to seek help for needed support, see postpartum depression treatment.
Lack of social support - feeling that you are on your own, emotionally and practically - is a main risk factor for PPD. Ideally this support should come from a partner or immediate family. If this is not likely then joining a local support network such as an outreach group run by public health nurses, or the church are also good options. In most towns and cities you will also find new mom or single parent support groups by googling 'new mothers support groups' on the internet. Do check out books on depression for personal stories and more prevention advice.
Most pregnant women in the U.S. do not eat enough omega-3 essential fatty acids (n-3 EFA), folic acid, vitamin B-12, iron and vitamin D. These are essential nutrients which have been associated with increased risk of depressive symptoms. Omega-3 is by the most important nutrient. See our article on natural treatment for postpartum depression for nutritional sources.
Studies show that regular physical activity protects neurons in the brain from the toxic effects of stress - this results in fewer symptoms of depression. Most pregnant women do not get enough exercise, if they did, it could significantly reduce the current rates of PPD. The American College of Obstetrics and Gynecology recommend at least 30 minutes of moderate exercise (like walking) at least 5 days a week for pregnant women. One of the biggest obstacles is that many pregnant women believe the myth that exercise is dangerous and could cause pregnancy complications. This simply is not true. However if you are worried, ask your doctor or Ob/gyn to prescribe a suitable exercise plan for you. Also, read about the dangers of stress and check how stressed you are by taking our online stress test.
Sleepless nights with a newborn are of course to be expected, and are not generally associated with causing PPD. However, studies show that PPD is more likely if you are regularly awake for 2 hours or more between the hours of midnight and 6am and nap for less than an hour during the day. In other words, difficulties falling back to sleep after caring for your baby and lack of opportunities for a day time nap can increase the risk of PPD. To counteract this doctors recommend:
• Breastfeeding and co-sleeping with your baby. Apply safety measures such as a firm bed or attach an infant bed.
• Lie on one side while breastfeeding.
• Take naps during the day.
• Learn and practice wind-down relaxation techniques.
• Arrange the bedroom so that it is conducive to sleep (less noise and light and cooler surroundings).
• Avoid stimulants like caffeine and cigarettes before bedtime.
While breastfeeding may protect the body from stress, there is no evidence that it protects from PPD. However studies show that in certain situations, breastfeeding and the pressure to breastfeed can become a stressor, enough even perhaps to trigger PPD. Factors that increase the stress include insufficient milk supply, lack of support from a partner or work colleagues, physical challenges and sleep deprivation. In some cases the decision not to breastfeed is the right one if the stresses outweigh the benefits. If you are finding it difficult but would still like to breastfeed, consider talking to a lactation consultant. Your ob/gyn will be able to recommend a suitable professional.
Nearly 50 percent of all pregnancies are unplanned. Numerous studies show that unwanted or poorly timed pregnancies significantly increase the risk of postpartum depression symptoms. For this reason it is worth familiarizing yourself with all family planning options including condoms, the female condom, the Pill and morning after pill.
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