- The Washington Times - Sunday, November 5, 2000

Four months after her second child was born, Karen Peterson found it hard to get up in the morning. Mrs. Peterson, of Potomac, didn't want to leave the house, and she didn't have the same energy level she had had after the birth of her first child six years earlier.

Friends told Mrs. Peterson to take a long walk, soak in a hot bath, get away from the children for an hour.

About a month later, however, Mrs. Peterson began to have thoughts of suicide. She says she would stand on the bedroom balcony and think about how easy it would be to let go.

"I realized then I needed help," Mrs. Peterson, now 39, says of those dark days in 1997. "I went to a psychiatrist the next day."

Mrs. Peterson was diagnosed with postpartum depression. Postpartum depression is a serious condition that affects 15 percent to 20 percent of new mothers, says Dr. Valerie Davis Raskin, a Chicago psychiatrist who has written two books on women and depression.

Postpartum depression can show up any time in the first year after a baby's birth, Dr. Raskin says. Typically, it begins one or two months after delivery, she adds. About a third of the time, the condition, which is marked by insomnia, feelings of guilt or helplessness, appetite changes and lack of concentration, goes away on its own within a year.

Left unresolved, however, postpartum depression can turn into serious depression. The majority of cases need a combination of medication and therapy, Dr. Raskin says.

After Mrs. Peterson's symptoms intensified, she began taking the anti-depressant Paxil. She says she felt better almost immediately.

"This proves to me the condition is chemical," Mrs. Peterson says. "There is such a stigma attached to depression, and moms put so much of a burden on themselves. Mothers usually are the glue in the family. They feel if they show cracks, the family will fall apart."

A mysterious mixture

Most researchers agree that postpartum depression is, like other forms of depression, caused by a chemical imbalance. What still is being researched is the combination that sets events into motion. Is it only the huge influx of hormones childbirth brings? Or do outside stresses such as marital difficulties or setting lofty standards to be the perfect mother play a part? Is it exacerbated by the drastic life change that comes with a new baby?

These are questions researchers are trying to answer, says Dr. Cathy Roca, a psychiatrist in the National Institutes of Health's behavior endocrinology branch.

Until recently, research into postpartum depression was scarce. That is partly because postpartum depression was not recognized as an official diagnosis by the mental health community until 1994. Conducting research on pregnant women or nursing mothers also is difficult, Dr. Roca says.

Dr. Roca is studying how different levels of the hormones progesterone and estrogen which run rampant during pregnancy and shortly after affect women with a history of depression. The results will not be known for about another year, but the finding "will affect how we treat postpartum depression," Dr. Roca says.

She theorizes that many of the women who get postpartum depression are sensitive to hormonal changes. These same women usually suffer extreme premenstrual syndrome symptoms.

Women who have been prone to depression in the past even if it was undiagnosed also seem particularly vulnerable to postpartum depression.

That was the scenario when Susan Kushner Resnick struggled with postpartum depression after the birth of her son in 1996. Ms. Resnick, of Sharon, Mass., had had mild depression in the past, but she did not think she had postpartum depression even though she was wracked by insomnia, weight loss and feelings of guilt and inadequacy. She also had fleeting thoughts that she would lose control and place her baby in the oven, she says. Those feelings were terrifying, but Ms. Resnick was still unsure of what her actual condition was.

"I always thought that clinical depression meant you couldn't get out of bed and were so sad," says Ms. Resnick, who later chronicled her struggle in the book "Sleepless Days: One Woman's Journey Through Postpartum Depression." "I had to work hard to realize that postpartum depression was not a character flaw. It didn't mean I was a bad mom, but that is hard to realize when you are nuts."

Ms. Resnick overcame the illness by taking the anti-depressant Zoloft, undergoing counseling and attending a local support group.

Dr. Raskin says selective serotonin reuptake inhibitors (SSRIs) such as Paxil, Zoloft and Prozac are all effective at overcoming postpartum depression. When Ms. Resnick's problems occurred more than four years ago, her psychiatrist advised her not to take medications until she stopped nursing her son. More recently, however, doctors have discovered that the small amounts of SSRIs a nursing baby would get are less harmful than having a depressed mother.

"The data that we have so far is that it seems OK [to breast feed while taking SSRIs]," Dr. Roca says. "It is hard to know what the long-term effects are because the research is new, but tests have looked at the SSRI concentrations in breast milk, and it has shown no acute effects on babies."

Dr. Joel Match, an obstetrician at Columbia Hospital for Women in Northwest, says he occasionally prescribes SSRIs as a preventive measure for a woman with a past history of postpartum depression.

"If a woman has postpartum depression once, it is more than likely to reoccur with the next baby," Dr. Match says. "So sometimes I will recommend she begin taking medication right after delivery."

The effort to screen

Dr. Match says he always asks about the mother's well-being at her six-week postpartum checkup.

Because postpartum depression may not begin until sometime after that checkup, it is important for new mothers and fathers to be able to recognize signs and understand avoidance and treatment.

Earlier this month, Congress passed a resolution aimed at increasing awareness of postpartum depression. Introduced by Rep. Lois Capps, California Democrat, the resolution recommends that all hospitals that deliver babies provide departing families with information on recognizing and treating postpartum depression.

The resolution also encourages all obstetricians to inquire prenatally about the mother's history of depression and to include screening questions upon discharge from the hospital and at the six-week checkup. It also recommends that a registry system be developed to collect data on the disorder.

Though people expect a certain amount of stress with a new baby, it is crucial not to ignore feelings of being overwhelmed, Dr. Raskin says. Be honest with yourself and with other family members about your feelings, she says.

"People think you are not supposed to hate motherhood," Dr. Raskin says. "We all feel overwhelmed at times. But if it is a persistent feeling, then something is wrong."

Says Ms. Resnick: "My husband figured I knew what was going on more than he did. But he was following my denial clues, agreeing with me that I just needed sleep and [I would] be fine. He didn't want to face that it was serious."

Social support can play a big part in coping with postpartum depression. For some women, the fact that no one they know has been depressed can make them feel worse.

"I had friends, but it's not like they had ever been through this," Ms. Resnick says.

She says there is a lot of truth in calling the months following childbirth "the fourth trimester." She believes her situation might not have been so bad if she had received more help with her older child and had put less pressure on herself to be so active immediately following her younger child's birth.

"Women need a lot more help than they think during this time," Ms. Resnick says.

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