Category Archives: Postpartum Depression and Children

Guest Blog: PPD may have delayed onset…

…and recovery is always possible

My first year with the baby was dreamy, so when I started to decline, I didn’t think it was Postpartum depression (PPD). The docs had said PPD could occur anytime in the first year. They didn’t say what it was when depression occurred after that. Since my self-esteem was plummeting, which is one of the hallmarks of PPD, I concluded that my downward spiral was my own fault, due to poor management of my time and energy. It got ugly as the chemistry in my brain lost more and more balance.

sun-in-fog

What it felt like is that the sun that energizes the earth and had brightened my day was no longer available. I couldn’t feel its warmth. People often use the sun metaphor when talking about depression. When the depression lifts, they say, it is like the sun comes out again. This is very much what it was like for me. When the sun was absent, it was so frustrating because I knew what was missing – a connection to the universe – but I could not get it back. Movement, light, forward momentum – they were gone.

For me, PPD was closely related to the amount of sleep I got. It resolved almost immediately when I got five consecutive good nights of sleep at my mom’s house. She cooked for me and did laundry while my sister looked after the baby. I wrote this poem about it:

Usually, when you walk, you go forward.
In the dark season, your footsteps dissolve in the mighty, silent ink.

Lost, you have no choice but to sink into what you cannot see.

You reach out but your hands slide down the slick walks of despair,

grasping nothing.

This relentless, downward pitch can only be a vein of hell.

And then,

the baby sleeps through the night, you get a day off, you lie down and rest.

Stop

Stop

Stop,

beats your heart. Your mind says nothing.

You feel heat again in your spine. You see orange at the corners of your eyes.

This quiet place at the bottom where the flame always burns,

must be a chamber of heaven

that it took the darkness for you to see.

I wish that I had known sooner that what I was experiencing was a delayed onset of PPD. I would have sleep-trained the baby earlier, and arranged for more visits like the one I just had at my mom’s. A late-onset PPD diagnosis also might have prevented a lot of anger directed at myself for being such a failure at managing my life. So I say, if you have a child under two and you meet the criteria for PPD, it probably is PPD and deserves to be treated as such. At the risk of stating a cliche, you deserve the support you need to feel better.

smileandlean

Sheira Kahn is a recovered bulimic and Marriage and Family Therapist who practices in the East Bay and Marin County. She teaches self-esteem workshops and classes on reducing emotional eating and is co-author of The Erasing ED Treatment Manual, available on Amazon.

At the age of 50, she gave birth to Alexandria in April of 2014. Her blog can be found on www.sheirakahn.com.

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What causes an Eating Disorder or Depression and if I have it, is my child doomed to have it, too?

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The short answer? “It’s complicated.”

The longer answer: Genetics and temperament both play a strong role in the possibility of Depression or an Eating Disorder developing, but do not determine it.

The hopeful answer: Even if your child develops an Eating Disorder or Depression, it is possible to recover.

In this post, I will look at some of the risk factors that can lead to an Eating Disorder or Depression.

Eating Disorders: Are they inherited?

Eating Disorders develop as a combination of genetic vulnerability combined with temperamental traits and a facilitating environment. Some (but not all) risk factors named in Carolyn Costin and Gwen Schubert Grabb’s book 8 Keys to recovery from an Eating Disorder (W.W. Norton, 2012) that can contribute to developing an eating disorder include:

  • being overweight or dieting as a child
  • having a mother who diets or has an eating disorder
  • early menstruation
  • being bullied or teased
  • engaging in sports or activities with a focus on appearance or weight (for example ballet, cheerleading, ice skating, wrestling, gymnastics, modeling)
  • a history of childhood abuse

In a 2000 study in the American Journal of Psychiatry, results showed that anorexia nervosa has a heritability of 58%, but the authors were unable to rule out the contribution of environment. However, they did conclude that genetic factors influence anorexia and contribute to comorbidity of anorexia and depression.

Along with genetic links being discovered with both anorexia and binge eating, certain temperamental traits tend to foster the birth of an Eating Disorder. Ovidio Bermudez, in presenting at Eating Disorder Recovery Services conference* this past year discussed the following temperament traits as those at risk of developing an Eating Disorder:

  1. Anxiety, Depression, or OCD
  2. Low stress tolerance
  3. Low distress tolerance
  4. Sensitivity to real or perceived injury

So in other words, if you have a sensitive child who struggles with tolerating “distressing” feelings such as sadness, anger, or shame and you (or a family member) struggle with Depression, Anxiety or OCD, the ground is fertile for the seed of an Eating Disorder to sprout.

What about Depression?

At least 10% of people in the U.S. will experience Major Depressive Disorder at some point in their lives. According to statistics, two times as many women as men experience major depression. (There is a lot to be said there in terms of mis-diagnosis of symptoms, gender bias, and who reaches out for support to mental health professionals, that can affect these statistics, but that is for another blog.)

According to two Stanford doctors writing about genetics and brain function, genetics play a strong role in causing Major Depression (Levinson, Douglas F. M.D. and Nichols, Walter E. M.D., Professor in the School of Medicine Department of Psychiatry and Behavioral Sciences, Stanford, 2015). They write:

  • The heritability (or percentage of the cause due to genes) is probably 40-50%, and might be higher for severe depression.
  • The situation is a little different if the parent or sibling has had depression more than once (“recurrent depression”), and if the depression started relatively early in life… the siblings and children of people with this form of depression probably develop it at a rate that is 4 or 5 times greater than the average person.

What else contributes to Depression? And what about Postpartum Depression?

Stressful life events (trauma, loss of a loved one, moving/loss of support, having a baby) can lead to depression in and of themselves. When combined with a genetic risk, there is a stronger possibility of developing depression. And having one (or more) episode of depression increases the risk of having future episodes. (Kendler, Thornton, and Gardner, 2001)

While many women experience some mild mood change or “the blues” during or after the birth of a child, 1 in 7 women (and some recent research says 1 in 5) experience more significant symptoms of depression or anxiety. 1 in 10 Dads become depressed during the first year. (Postpartum Support International)

Risk factors for Postpartum Depression

Some women are more likely than others to develop Postpartum depression. The following factors put you at an increased risk:

  • Previous history of depression
  • History of severe PMS or premenstrual dysphoric disorder
  • Medical complications for you or your baby
  • Lack of support from family or friends
  • A family history of depression or another mental illness
  • Anxiety or negative feelings about the pregnancy
  • Problems with a previous pregnancy or birth
  • Marriage, Relationship, or money problems
  • Stressful life events
  • Substance abuse

How does Postpartum Depression impact children?

Postpartum Depression and other Perinatal Disorders (Anxiety, OCD, Psychosis) can affect children in the following ways:

  • Behavioral Problems
  • Delays in Cognitive Development
  • Emotional Problems and/or Depression

 According to Zero To Three, a research-based resource for federal and state policymakers and advocates on the unique developmental needs of infants and toddlers, untreated Depression can have detrimental effects on children’s functioning and future outcomes (2009).

The mental health of parents can affect young children… infants of clinically depressed mothers often withdraw from caregivers, which ultimately affects their language skills, as well as their physical and cognitive development. Older children of depressed mothers show poor self-control, aggression, poor peer relationships, and difficulty in school.

and

Unlike adults, babies and toddlers have a fairly limited repertoire of responses to stress and trauma. Mental health disorders in infants and toddlers might be reflected in physical symptoms (poor weight gain, slow growth, and constipation), overall delayed development, inconsolable crying, sleep problems, or aggressive or impulsive behavior and paralyzing fears. Early attachment disorders predict subsequent aggressive behavior. Some early mental health disorders have lasting effects and may appear to be precursors of mental health problems in later life, including withdrawal, sleeplessness, or lack of appetite due to depression, anxiety, and traumatic stress reactions.

So, if you have had or are currently suffering with and through (because it is possible to recover and get through it) an Eating Disorder or Depression, your child does have risk. But that does not mean they are doomed. It means, even more important than ever, that you get treatment and recovery yourself! When I attended Postpartum Support International’s training on Perinatal Mood Disorders, the message that they gave was: There is Hope and You are not alone. It is possible to recover and in recovering yourself, you help build a more protected base from which your child can thrive and grow. 

References/Resources:

Wade, Tracey D, Ph.D., Cynthia M. Bulik, Ph.D., Michael Neale, Ph.D., and Kenneth S. Kendler, M.D., “Genetic and Environmental Risk Factors Anorexia Nervosa and Major Depression: Shared Risk Factors,” Am J Psychiatry 2000; 157:469–471.

Eating Disorder Recovery Services The mission of EDRS (Eating Disorder Recovery Support), Inc. is to promote recovery and wellness for those impacted by eating disorders by providing support, information, and education to individuals, families, professionals, and the community at large regarding eating disorders and recovery resources. EDRS.net

Ovidio Bermudez, MD Dr. Bermudez has lectured nationally and internationally on eating pathology across the lifespan, obesity and other topics related to pediatric and adult healthcare, and has been repeatedly recognized for his dedication and advocacy in the field of eating disorders.  eatingrecoverycenter.com

“Major Depression and Genetics” Douglas F. Levinson, M.D. and Walter E. Nichols, M.D., Professor in the School of Medicine
Department of Psychiatry and Behavioral Sciences (2015) Depression and Genetics

Zero To Three The Zero To Three policy Center is a nonpartisan, research-based resource for federal and state policymakers and advocates on the unique developmental needs of infants and toddlers. zerotothree.org

Link to Depression during and after Pregnancy Fact Sheet

Perinatal Depression Fact sheet

Link to study on teaching sleep with infants to prevent Postpartum Depression:

postpartum+depression+sleep

Link to study on effects of Lexipro on treatment of Postpartum Depression:

clinical trials postpartum+depression

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