This presentation identifies the symptoms of postpartum depression and anxiety that can occur in both mothers and fathers, how to seek support, as well as know when to seek treatment.

1. Postpartum Depression
Presented by:
Nicole D. Swain, LPC,
NCC, ACS, ACT
Behavioral Health &
Cognitive Therapy Center

2. Why Treat?
• Behavioral problems: sleep problems, aggression and
hyperactivity
• Cognitive delays: walk and talk later, problems in school
• Social problems: difficulty developing relationships,
socially withdrawn, aggressively act out
• Emotional problems: lower self-esteem, higher levels of
anxiety
• Psychological problems: high risk of developing
depression

3. Who?
• Across all cultures
• 12 - 20%* of all women having a
– live birth
– still birth
– miscarriage
– abortion

4. Etiology
• Biology
– Sudden change in hormone levels
– Poor diet
– Lack of efficient sleep
– Pain

5. Continued
• Stress
– Sudden change in lifestyle
– Change in level of marital support
– Societal expectation of the “Happy Mother”

6. Risk Factors
• Women with a previous history of depression or anxiety
• Stressful event during pregnancy (trauma)
• Premature or Complicated birth
• Women with previous history of PPD (55%)
• Illness
– Diabetes (50% more likely)
– Thyroiditis (33% more likely)

7. Symptoms of “Baby Blues”
• 65 to 80% of all women
• Duration - first two weeks, symptoms usually begin 3-4
days after event
• Mood swings
• Sleep disturbance
• Irritable
• Weepy
• Worry
• Resolves in 4 weeks

8. Symptoms of PPD
• Duration post “baby blues”
• Significant decline in self care
• Lack of interest in baby
• Negative feelings towards baby
• Lack of concern for yourself

9. continued
• Uncontrollable crying
• Insomnia
• Panic Attacks
• Thoughts of death

10. Assessment
• Clinical Interview
– Patient
– Family / Significant others
• Formal Assessment Tools

11. Clinical Interview
• DSM IV-R Criteria for Major Depressive Disorder:
– duration lasting more than two weeks
• Ask questions about:
– Appetite
– Sleep
– Daily Self Care
– Mood
– SI/HI

12. Clinical Interview Question Screen
• 2 Question Screen *Sensitivity 98%, Specificity 67% -79%
– During the past month have you often been
bothered by feeling down, depressed or
hopeless?
– During the past month have you often been
bothered by little interest or pleasure in things?

13. Formal Assessment Tools
• PHQ-9
• Edinburgh Postnatal Depression Scale
– English & Spanish versions
– Score over 10 indicative of depression
• Max score 30
• Pay particular attention to question #10 (SI/HI)

14. Treatment
• Cognitive Behavioral Therapy
• Interpersonal Therapy
• Medication
• Self-help support

15. CBT & Interpersonal Therapy
• The only two non-pharmacological interventions that have
demonstrated empirical effectiveness in helping reduced
mild to moderate depressive symptoms and improved
social adjustment in women experiencing PPD.
• Both short term
• Represents the only alternative for women who are prefer
no medication (e.g. won’t take because of breastfeeding)

16. CBT
• CBT: effective in targeting negative thoughts
– Teaches about:
• Automatic thoughts
• Common cognitive distortions
• Assumptions & Beliefs
– Skills:
• Examining and Challenging Cognitive Distortions
• Thought Records
• Cost-Benefit Analysis
• Asking for Things That are Important to Me

17. Medication
• Tricyclics
– Elavil - YES
– Doxetin - NO
• SSRI’s
– Prozac (only FDA approved during pregnancy)
– Zoloft* (considered best choice breastfeeding)
– Paxil*, Celexa*, Effexor* (in order)
*Levels of medication that reach the baby through breastfeeding are either
low or undetectable

18. Self Help Support
• Depression after Delivery: National foundation that
provides support and information for PPD.
http://www.depressionafterdelivery.com
• Postpartum Progress: the most widely read US based
blog focused specifically on postpartum depression,
anxiety and psychosis. http://postpartumprogress.typepad.com/weblog/
• Marce Society: an international society for the
understanding, prevention and treatment of mental
illness related to childbearing.
http://www.marcesociety.com/

19. Resources
• US Department of Health & Human Services:
http://www.womenshealth.gov/faq/depression-pregnancy.cfm
• American Academy of Family Medicine:
http://familydoctor.org/online/famdocen/home/women/pregnancy/ppd/general/
379.html
• National Institute of Mental Health:
http://newsinhealth.nih.gov/2005/December2005/docs/01features_02.htm
• International Lactation Consultant Association:
http://www.ilca.org
• Postpartum Support International:
http://postpartum.net/resources/