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Post Partum Mood Disorders

Abstract: Post partum mood disorders are not uncommon [1]. While the medical treatment of these conditions is similar regardless of religious background, certain social conditions within the halacha observant community should be taken into consideration. In some segments of the community, there remains a reluctance to seek psychological help [2]. Familial patterns such as closely spaced children or the mother as a major breadwinner may increase the stress under which an affected woman is trying to recover. Contraception during recovery [3] will raise religious issues as well.

Discussion: It is not uncommon for women to experience extremes in mood in the days after childbirth [1]. Some feel very sad and weepy ("baby blues"), others feel euphoric and as if they could conquer the world, others swing from one extreme to the other [4]. Any of these within the first two weeks, as long as there are no serious thoughts of harming oneself or the baby, are an expected phenomenon and are not a cause for concern [5]. Simple interventions to assist the mother generally help her feel better. These include napping when the baby naps [6] and reducing to the absolute minimum any other household responsibilities of the new mother. Even better than waiting to see if the mother will have trouble is arranging support in advance [7] - a gift of household help is of greater use to most families than yet another outfit the infant will soon outgrow.

If the feelings to do not subside after two weeks, or occur later in the first year de novo, the diagnosis of clinical depression should be considered [8]. True clinical depression can be distinguished from simply feeling sad because of the much greater impact on a woman's well being and functioning [8]. Physicians working with women in this life stage should consider office routines to identify affected women, as embarrassment or depression induced apathy will prevent many women from actively seeking help [9]. Standardized questionnaires can aid the busy clinician [10].

Treatment of the mother is important both for the mother and for the infant; studies have shown impacts such as decreased weight gain among of infants of depressed mothers [11]. Depending on degree, treatment can include counseling, support groups, and/or medication [12]. Should medication be needed, preparations compatible with breastfeeding are available [13]. In general, if intervention begins sooner, the duration of postpartum depression and the associated suffering can be minimized.

Information specific to observant Jewish women can be obtained through NITZA - The Israel Center for Maternal Health. This organization was founded in 1997 as a grassroots organization supporting and financially assisting women across Israel suffering from the devastating effects of Pospartum Depression and its related syndromes. For information about NITZA contact: (02) 533-2810 or nitzappd@013.net or visit our their website at www.nitza.org.

General information about depression during and after pregnancy can be obtained by contacting the National Women's Health Information Center (NWHIC) at 1-800-994-9662 or the following organizations.

National Institute of Mental Health, NIH, HHS
Phone: (301) 496-9576
Internet Address: http://www.nimh.nih.gov

National Mental Health Information Center, SAMHSA, HHS
Phone: (800) 789-2647
Internet Address: http://www.mentalhealth.org

American Psychological Association
Phone: (800) 374-2721
Internet Address: http://www.apa.org

National Mental Health Association
Phone: (800) 969-NMHA
Internet Address: http://www.nmha.org

Postpartum Education for Parents
Phone: (805) 564-3888
Internet Address: http://www.sbpep.org

Postpartum Support International
Phone: (805) 967-7636
Internet Address: http://www.postpartum.net

Implications for Practice: Post partum depression is a common phenomenon. Some segments of the halacha observant population are less likely than the general population to request medical help for emotional issues. Therefore, it is important that the physician be proactive in looking for the symptoms and offering care when needed.

Medical References

[1] Brockington I. Postpartum psychiatric disorders. Lancet 2004 Jan 24;363(9405):303-10.

[2] Greenberg D, Witztum E. Ultra-orthodox Jewish attitudes towards mental health care. Isr J Psychiatry Relat Sci 1994;31(3):143-4.

[3] Gregoire, AJ, Kumar, R, Everitt, B, et al. Transdermal oestrogen for treatment of severe postnatal depression. Lancet 1996; 347:930.

[4] O'Hara, MW, Schlechte, JA, Lewis, DA, Wright, EJ. Prospective study of postpartum blues. Biologic and psychosocial factors. Arch Gen Psychiatry 1991;48:801.

[5] Steiner, M. Postpartum psychiatric disorders. Can J Psychiatry 1990;35:89.

[6] Dennis CL, Ross L. Relationships among infant sleep patterns, maternal fatigue, and development of depressive symptomatology. Birth 2005 Sep;32(3):187-93.

[7] Andresen, P, Telleen, S. The relationship between social support and maternal behaviors and attitudes: A meta-analytic review. American Journal of Community Psychology 1992;20:753-774.

[8] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Primary Care Version (DSM-IV-PC). Washington: American Psychiatric Association Press,  1995.

[9] Whitton A, Warner R, Appleby L. The pathway to care in post-natal depression: women's attitudes to post-natal depression and its treatment. Br J Gen Pract 1996 Jul;46(408):427-8.

[10] Murray L, Carothers AD. The validation of the Edinburgh postnatal depression scale on a community sample. Br J Psychiatry 1990;157:288-290.

[11] Murray, L, Stein, A. The effects of postnatal depression on the infant. Baillieres Clin Obstet Gynaecol 1989;3:921.

[12] Nonacs R, Cohen LS. Postpartum mood disorders: diagnosis and treatment guidelines. J Clin Psychiatry 1998;59 Suppl 2:34-40.

[13] Hale, TW. Pharmacology Review: Drug Therapy and Breastfeeding: Antidepressants, Antipsychotics, Antimanics, and Sedatives. NeoReviews 2004;5:e451.


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