Most women who experience postpartum depression
, at some point or another, wonder, why did this happen
? Our best answer to this is that a number of factors combine to put a woman at risk for depression after childbirth, some of which are hormonal, biologic, genetic, environmental and psychological.
Taking a closer look at what may have put you at risk may help you better understand your experience as well as prepare you for a subsequent pregnancy, if that is something you are worried about. Consider the following circumstances and how they may have impacted your experience:
1) You may be especially sensitive to hormonal changes. Hormones, such as estrogen, progesterone, thyroid hormones and cortisol may become unbalanced in women who are especially vulnerable.
2) Sleep deprivation or irregular, unpredictable sleep patterns can lower your resistance.
3) If depression runs in your family, you are more at risk to experience it yourself. Understanding the course of any illness experienced by a family member may offer insight into the treatment of your own. In other words, if several family members have been successfully treated with a certain antidepressant, it provides useful information for your treating physician, because odds are that you will do well on the same antidepressant.
4) There does seem to be an unsubstantiated, but clinically relevant association between the tendency to be a perfectionist or a "control freak" and difficulty in the postpartum period (when things are so drastically out of control for a while!)
5) Pre-existing anxieties, predispositions to worry or ruminate, or obsessive qualities will put a woman at risk.
6) Any premorbid psychiatric history (that which occurred prior to PPD), such as obsessive-compulsive disorder (OCD), a previous episode of PPD, depression unrelated to childbirth, or other diagnosed disorder for which you did or did not receive treatment will put you at risk.
7) Any history of early loss, trauma, abuse or significant dysfunction in your family will likely affect your ability to cope after the birth of your baby.
8) Other current outside stressors, such as major losses or changes related to: job, move, illness, death, divorce, for example.
Just to illustrate out extensive a woman's risk for PPD is, here is a list of some additional factors that may contribute to the emergence of depression after childbirth. Remember these factors do not cause depression, but they may increase your vulnerability. Also keep in mind, that if you have a number of risk factors, this does not mean you will necessarily experience depression again. But it does mean you are armed with important information that may better protect you in the future. See how many of the factors below apply to your situation. You can see by this wide-ranging list how easy it is to be at risk for PPD!
- Previous personal or family history of postpartum depression, other clinical depression, anxiety or panic disorder, bipolar illness, eating disorders, or obsessive-compulsive disorder.
- A mother who had PPD
- History of severe PMS
- Thyroid problems or family history of thyroid problems.
- Depression during pregnancy
- Unplanned or unwanted pregnancy
- Complicated pregnancy and/or delivery
- Extreme weight gain during pregnancy and/or difficulty losing weight after pregnancy.
- Traumatic birth experience
- Chronic sleep deprivation
- Premature baby
- High-needs or colicky baby
- Difficulty or perceived difficulty with breastfeeding
- Abrupt discontinuation of breastfeeding
- Social isolation
- Marital instability
- Unsupportive partner
- Pre-existing and unresolved issues with partner
- Impaired family relationships, especially mother.
- Lack of or distance from extended family
- Adverse life events, such as difficulty at work, a recent move, a new job or other major change, the death of a loved one, financial problems
- History of childhood violence or abuse, emotional, physical or sexual
- History of early major loss, especially parent
- History of drug or alcohol abuse
- Birth control use
- Impaired self-esteem
- Tendency toward perfectionism
- Desire for control
That's a LONG list of risk factors! It's worth repeating that risk factors do not cause postpartum depression. What risk factors do is set the stage for depression if the circumstances are right, making you more vulnerable to the illness. So it follows, that even though we may not be able to actually prevent depression, it is prudent for you take a close look at areas in which you may be weak, which, in turn, may expose you to greater risk. Understanding these factors and taking steps to strengthen your resources will serve to protect you, as well as reestablish a sense of control over future experiences.
So what can you actually DO to intervene on your own behalf, especially if you are planning another pregnancy? Studies show that your involvement and active preparation will lower your risk of PPD. Be informed. Be proactive. Do the groundwork. Take steps to understand and deal with areas of vulnerability. Go to therapy to gain insight and self-awareness. Prepare your marriage. Fully engage in this process.
Bottom line: Be your own best health advocate. Let your doctor and your partner know what risk factors concern you the most.
Copyright 2012 Karen Kleiman, MSW, LCSW postpartumstress.com