Women And Postpartum Depression, Talk therapy for postpartum depression
Prolonged postpartum depression creates
a strain on the mother's relationship with her new baby, spouse,
the baby's older siblings, friends and co-workers. Researchers at
the University of Iowa studied the effects of psychotherapy on 99
postpartum women with major depression. These women were
predominantly white, well-educated and in stable marital
relationships. The researchers randomly assigned the women either
to 12 weeks of psychotherapy or to a waiting list for
psychotherapy. About 40 percent of the women who received
psychotherapy recovered from their depression by the end of the
12 weeks, compared to only about 14 percent of those on the
waiting list.
* WHAT'S NEW: Women with postpartum depression may not wish to be
treated with antidepressant drugs, especially if they are
breast-feeding. This is one of the few studies to assess the
effectiveness of psychotherapy as an alternative.
* CAVEATS: The results may not apply to other ethnic groups,
less-educated women or those with unstable marital relationships.
Also, the recovery statistics are based on answers to several
psychological tests that assess depression; these answers could
have been influenced by whether the women had received treatment
or not. In addition, the authors point out that the women on the
waiting list cannot be considered a real control group.
* BOTTOM LINE: Women with postpartum depression should receive
treatment as quickly as possible. Psychotherapy is an effective
option for those who wish to avoid antidepressants.
The relationship between breastfeeding and depression was studied by
Kumar and Robson in mothers who totally breastfed and those who totally
bottled fed. No relationship was found between depression and feeding
method. A prospective study following 103 women postpartum recorded a
13% incidence of marked postnatal depressive illness and an additional
16% of minor depressive illness of at least 4 weeks' duration. No
correlation was made with method of feeding until the mothers were asked
about their feeding methods and oral contraceptive use in an attempt to
determine the influence of hormones on depression. The authors
speculated that the prolactin, estrogen, and progesterone levels would
vary with the amount of breastfeeding, amount of other foods consumed by
the baby, and amount of hormones taken in the form of contraceptives.
In this study, the bottle feeders received estrogen and progesterone as
contraceptives, but breastfeeders received only progesterone. Total
breastfeeders who were not taking contraceptives were somewhat more
likely to report depressive symptoms. Feelings of fatigue may have
influenced this. The mothers least likely to be depressed were those
who were likely to have normal hormone levels, that is, non-pill taking
partial breastfeeders. Clearly, breastfeeding women are not immune to
postpartum depression.
The impact of the mother's depression on her breastfeeding and nursing
attitudes was reported by Tamminen and Salmelin in a study of 199
healthy primiparous women using the Beck Depression Inventory (BDI)
attitude scales and other questionnaires. 8% of the participants were
clinically depressed, but 25% of the sample did not return the
questionnaire, which is possibly more common in depressed subjects.
Depressed mothers had more difficulty with breastfeeding. In a
continued study as part of a larger study, qualitative analysis of
mother-infant interactions during breastfeeding showed depressed mothers
to be less able to sense the infant's needs, cues, and problems.
Furthermore, they saw the problems in psychologic terms, i.e., the
infant did not want their milk or did not like it. They did not
understand that difficulties in breastfeeding could be somatic in
nature. Depressed mothers achieved less satisfaction and mutual
pleasure in breastfeeding.
These studies all support the recommendation that the primary care
physician would do well to identify the mother with depression using a
simply inventory such as the 10 item Edinburgh Postnatal Depression
scale, which has been validated and specifically designed for use by the
primary health care team during routine health care visits. It relies
on self-reporting.