Depending on the severity of your depression, the psychologist may suggest a referral for medication as an adjunct (not a substitute) to the cognitive behavioral therapy that she will provide. Medication usually takes at least three to four weeks to begin to work and some time may be needed to find the most suitable antidepressant. While it can be less, it may take three to six months before you’ll feel better.
You can see that more than you are at risk here as PPD can have quite adverse effects on your baby’s development, as well as on the well being of other family members.
Postpartum psychosis, a very severe and rare form of depression is what one often sees depicted in movies or in court. It may begin days or weeks after delivery, comes on dramatically and often is serious enough to require hospitalization. Symptoms include severe depression, extreme agitation and anxiety, rapid and pressured thoughts, extreme uncontrollable fear, severe mood swings, a severe sense of loss of control and thoughts of harming yourself or your baby. It can be very scary for an outsider to watch and at times you may seem paranoid and “possessed.”
Treatment is urgent because both you and your baby are at high risk. Your safety is of utmost importance and often you and your family don’t realize that there is a problem or may minimize the severity. Psychiatric treatment is essential and only afterwards will psychological care be helpful.
If you, a friend or family member experience postpartum difficulties, seek professional help. If you have signs of depression or anxiety during your pregnancy – crying and generalized unhappiness or difficulty feeling good about your pregnancy – you should discuss this with your midwife or physician. If your adjustment seems “at all beyond normal” it is better for you to be seen professionally and to be reassured and followed, than to wait endlessly in hopes that it will just “go away.”
New moms may require lots of assistance. You may feel poorly equipped for “entering the trenches” and facing this new and very demanding job that requires twenty-four plus hours a day and tremendous flexibility. The rewards are limitless but sometimes, you may have difficulty focusing on the positive. Most babies are far more difficult than you might expect and getting to know and love your baby takes time. Motherhood and breastfeeding are not completely instinctive but have to be learned. Friends can encourage you to look after yourself, eat, exercise, get out alone for a bit, and rest. People can baby-sit so that you can hop into the shower, they can help with chores, delegate some non-baby related tasks, drop over with a snack and just be there to see that initially you simplify and do only what needs to be done in order to take it easy. Sometimes the hardest job you may face is learning to let things go a bit, relinquish control and attempt to settle into your new life.
If a psychologist is involved with a family early on, she has a chance to see how parents do with the older children, how older children do with the baby and help the older child to feel included while ensuring that his needs are met. Parents can be encouraged to share feelings and talk to each other and to have “dates” or time alone. A professional can help put things in perspective and encourage the development of realistic expectations. If moms are depressed or simply feel inadequate and doubt their ability to parent, they may inadvertently withdraw from their baby and neither notice or respond to their babies’ needs. A demanding and difficult baby can be hard to engage and a depressed parent may not try or be poorly attuned to the baby’s needs. This can make for profound difficulties later on. As a friend or family member, you can help a depressed mom understand the tremendous impact depression can have on her parenting and help her seek the appropriate professional help that is essential to her true enjoyment of parenting. Good luck!
Dr. Batya L. Ludman is a licensed clinical psychologist in private practice in Ra’anana, Israel. Look for her columns in The Jerusalem Post. This has been exerpted from her new book , Life’s Journey. Exploring Relationships Resolving Conflicts, available thorough bookstores and Judaica shops. Send correspondence to [email protected] or visit her website at www.drbatyaludman.com.