Postpartum depression: complex illness involving mother and infant

New research points to the importance of a comprehensive approach to treating postpartum depression.

Postpartum depression affects between 15 and 20 percent of new mothers. During a time many expect to be the happiest of their lives, depression, anxiety and sometimes psychosis can make things very difficult.

Until recently, antidepressant medication and cognitive therapy have comprised the most common treatment for postpartum illness. Now new research shows treatment models need to take a more comprehensive look at not only the mother, but the infant, family and other issues that may be complicating matters.

Although the major hormonal changes occurring within a new mother may make her susceptible to depression at this time, other factors should also be considered when assessing her situation and determining the best treatment course. These can include the mother's support network, relationships, family history and other life stressors.

Postpartum depression has a direct effect on the wellbeing of the mother as well as the social and emotional development of the infant.

Not only is the mother-child relationship often disrupted because of the depressed mother's impaired ability to respond appropriately to her child, but insensitivity and emotional unavailability on the part of the mother can cause increased infant irritability, distress and crying.

In studies, infants of women with postpartum depression show less activity in the feel good centers of the brain during playful interaction. Also, infants and toddlers of postpartum depressed mothers show more negative responses to social initiations as well as a tendency toward increased behaviour problems.

The child's health can also be negatively impacted by postpartum depression when the mother is unable to focus attention on preventive health practices or getting appropriate medical advice.

Since depressed women may not recognize their symptoms because of the fatigue, early morning waking and weight fluctuations common during this time, infant behaviour can also be used to determine distress in the mother-child relationship. This may help doctors diagnose postpartum depression in some cases.

Infants of depressed mothers may be more difficult to soothe, more drowsy, distressed or fussy than other babies. They may also look less at their mothers, be withdrawn, less sociable and engage in more self-directed activity. All of these as well as difficulties with infant sleep and feeding patterns could point to stressors within the mother-child relationship.

Although infant cues can be used as diagnostic aids, attention should be paid to the reasons for these behaviours. Evidence suggests it is not postpartum depression itself that contributes to problems with infant development and behaviour, but rather the parenting and responses associated with depression.

Depressed mothers gaze less at their babies, rock them less, are less active and show poorer responsiveness overall than non-depressed mothers. These maternal behaviours can also assist in diagnosing a stressed relationship.

Healthcare providers need to consider a wide range of factors that may indicate poor maternal mental health. Broader social and family factors should also be considered when assessing each situation.

Not every infant of a depressed mother will show developmental difficulties. The presence of another significant caregiver such as a father or grandparent can have a protective effect. Similarly, infants do better when mothers have a strong social support system.

All of the complexities involved in postpartum depression require not a single treatment for every situation, but a comprehensive, community-based approach tailored to each patient and treating the mother, infant and family. When a family's whole situation is taken into account during treatment, outcomes are improved for both mother and child.

If you think you may be experiencing postpartum depression, speak with your doctor right away. Treatment and community resources are available.


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