Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Tuesday, April 19, 2011

Why Should We Worry About Maternal Depression?

It seems as if I’ve had a lot of discussions of maternal depression lately-- both the perinatal mood disorders of birth mothers and post-adoption depression. When these topics come up, there are a lot of different responses. Some deny that there could be post-adoption depression, because they’re convinced that the hormones of pregnancy cause perinatal mood disorders (although if this were the case, it’s not too clear why all women don’t have the same problems). Others feel that the women are just suffering from “buyer’s remorse” and could do perfectly well if they just pulled their socks up. Still others feel that such mood disorders are excuses given by people who don’t like the hard work of early motherhood.

In most cases, people focus on the mother as the significant person, the one who’s influenced by depression. They forget the fact that the impact of maternal depression on a baby’s development can be quite negative. They also forget that this is an issue that has significance not just for mothers but for all major caregivers. Depression in nannies, day care providers, or grandmothers who “watch” the child while the mother works all have the potential for interfering with optimum development. (You notice I don’t say “normal development”. Things have to get pretty bad before development gets below the bottom of the normal range-- but long before that there may be a deviation from a baby’s best developmental trajectory, the one that will result in the best developmental outcome.)

So, what do depressed mothers and caregivers do that’s so different from what better-functioning people manage?

Imagine your own experiences with depression-- whether they involved an afternoon of low interest in life, or a long, serious problem with thoughts of suicide. Think how you feel when you’re depressed, what you feel like doing, and how you respond to other people. You’ll probably realize that you feel not only sad, but slow, tired, unresponsive, hard to please, pessimistic, and perhaps guilty or even worthless. You’d like people either to leave you alone completely or to nurture you without thought of themselves. You don’t want to talk or listen to others, you don’t want to make eye contact, you don’t smile or show expression in your posture or gestures.

Then, imagine how you feel when you’re with someone else who is depressed (and you aren’t). You may feel and act sympathetic at first, but that might not last long in the face of their negative mood. You interpret the other person’s mood as anger or hostility or rejection, and soon you respond to that perceived mood by being angry yourself. You don’t want to be with that person, and if you have to be (you live together, for instance), you may end up picking a fight just to get some acknowledgement of your existence.

Now, I don’t want to act as if I think babies have the same interpretations of other people’s behavior as adults do. I’m positive they do not. But when you consider how you feel when you’re depressed, and how you react to other depressed people, I think you can catch something of the flavor of a baby’s reaction to a depressed caregiver. In addition to that “flavor”, though, it might be good to consider some things depressed caregivers do or don’t do, and how those things relate to a baby’s needs.

1.Depressed caregivers don’t talk much.

Babies need to hear speech from the earliest months. Initially, hearing speech helps babies learn which noises adults make as part of speech, and which are not part of speech. To understand a language, you have to learn that particular sounds determine the meaning of speech, and others, like humming, coughing, or saying “ummm” do not. Different languages have different proportions of certain speech sounds and sometimes don’t use a particular sound at all. Babies who hear little speech are delayed in their understanding of the way their native language works and which sounds they need to pay attention to in order to understand.

2.Depressed caregivers make the “still face” often.

By a few months of age, certainly by 4-6 months, babies have normally learned to expect adult facial expressions to change in response to baby communications. When an adult makes the “still face”-- gazing blankly and unresponsively as if he or she can’t see the baby-- it’s very disturbing to the baby, who will begin to cry quite soon, will avert his or her gaze and become disorganized, sometimes hiccupping or spitting up. Adults can make still faces under perfectly normal situations like trying to remember where the car keys are or trying to talk to the plumber on the phone while the baby makes a bid for attention. Ordinarily, though, the non-depressed adult quickly comes back and re-engages with the baby, repairing their temporarily troubled communication. Depressed caregivers, on the contrary, may not only do the still face more often, but may lack the energy or interest to help the baby later understand that everything is okay and resolve the disorganization and anxiety the baby feels.

3.Depressed caregivers do only the basics.

Fatigue and slowing of responses are part of depression and interfere with normal infant care routines. Ordinarily, caregivers do a lot more than just the physical jobs of caring for a baby. The non-depressed caregiver who is changing a diaper talks to the baby in an interesting, voice that catches the baby’s attention. She plays with the baby at the same time, making eye contact, smiling, tickling or blowing on the tummy, perhaps giving the baby a toy to hold (not entirely play, of course, this is a good strategy for keeping the little hands out of the dirty diaper). When feeding the baby, she talks and jokes, perhaps pretending to eat some of the food herself (for some reason, this is a wow with the high-chair set), or helping the baby pick up some finger food. The depressed caregiver goes through these routines without any of the usual grace notes, doing the minimum and missing out the actions that pique the baby’s interest and foster communication, as well as those that encourage learning.

4.Depressed caregivers may not be very careful or attentive.

When babies can roll over, or pull to stand in their cribs, or later on crawl and so on, caregivers need “eyes in the back of their heads” to ensure safety. Even so, most babies experience a few scary tumbles as their caregivers fail to anticipate their doing something for the first time. The depressed caregiver moves slowly and has trouble paying attention to more than the troubles in her own thoughts and feelings. She may be so preoccupied that the baby might as well be at the top of the stairs or in the bathtub alone. Paradoxically, the depressed caregiver’s sense of guilt or worthlessness may concern her so much that she fails to prevent accidents and thus really does become guilty.

These are only a few of the caregiving problems that can be associated with depression. It may well be that the best thing we could do to foster good early development would be to attend to and treat the depression of mothers and other infant caregivers, so they can do the optimum job of bringing up young children.








10 comments:

  1. Interesting food for thought. I've had recurrent depression that has become worse after the births of each of my children. Last year I was finally diagnosed with ADD, and tried stimulant medications in addition to antidepressants (which had always been only marginally effective for me). I became a much better mother, much less irritable and angry, much less overwhelmed, less depressed, and more responsive. Then we had an unexpected pregnancy. Stopping the stimulant and relying only on sertraline has been very difficult. Unfortunately, I can't breastfeed while taking the meds I was previously -- and I'm trying to decide between formula feeding from early on (after only a few weeks of breastfeeding) and going back on my medication, or breastfeeding longer and waiting for several months to a year before being able to get back on. Information on the risks of poor mental health provide helpful information, thank you.

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  2. Thanks so much for telling your story and pointing up how perinatal depression complicates an already complex situation. Best wishes for your decision-making about how to proceed in those early months-- and if you feel like telling how things work out, I for one would be very much interested in hearing the next chapter of the story.

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  3. Oh this is a very good post. I think and have written about the stigma attached to depression in mothers and the myths that tell them how they are supposed to feel. Maybe if women realize the impact it could have on the optimum development of a child in their care it would help them reach out to someone for help instead of trying to cope in silence out of shame.

    I need to follow your blog so I'm reminded to stop by more often!

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  4. Thank you-- always glad to hear that "the Campbells are coming"!

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  5. Another very interesting post! I hope I never get depressed like that. My mother currently has a wide array of mental issues... as of 2007 (when I was 17 and my brother was 15) she was diagnosed by a court-order with:

    Generalized Anxiety Disorder, Dysthymic Disorder, Alcohol Abuse, and A Personality Disorder not Otherwise Specified with Borderline, Dependent, Histrionic, and Obsessive Compulsive traits - and at that time the psychiatrist also said she had a Global Functioning level of Fifty.

    I hope none of those are genetic and get passed on to me. And I hope she realizes she has mental illnesses and gets help eventually. Right now she's still in denial and is somewhat dangerous - she's tried to get my wonderful father in jail multiple times - so we've cut off all contact with her. Luckily though she was much better when my brother and I were young. I don't think she suffered from any type of depression after our births. ;)

    I love the way you write on the blog and I am very curious to check out your book(s)... I'll probably get to reading them soon. XD

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  6. Thanks for the compliments, Emily-- I too hope that you don't suffer from depression in the future-- but at least you must realize that your mother's problems are not depression alone.

    If you do find that you're experiencing depression at some point, please recognize it for what it is and seek treatment. A great deal can be done to alleviate the problem. Maybe the "bright side"(if there is one) of having to deal with your mother has been to make you more aware of mental illness and effective treatments for it.

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  7. Your blog is fantastic, Jean! It's like a great book I can't put down.

    La Mama Loca's story is so familiar. I also have ADHD and take sertraline for depression as well as anxiety, directly related to my menstrual cycle - I have all the classic premenstrual symptoms magnified by ten. After a few long talks with my psychiatrist (a wonderful, caring doctor!), I decided discontinued the Adderall while I was pregnant but stayed on the sertraline, along with lamtrogine (but at a lower dose than before pregnancy). He impressed upon me real the risks of depression both in pregnancy and after so I felt comfortable with my choices. In fact, my OB was really impressed with how much I had researched before my first visit.

    I decided on that I was going to feed my son formula so I could go back on Adderall as soon as possible. I'm glad I did and if we have another one, I'll do the same!

    One last note, on the topic of facial expressions and infants... I did experience the 'baby blues', or whatever you want to call it, about 7-8 days after he was born. I remember it coincided with my milk coming in and my pain medication running out (I had a c-section). It hit me like a ton of bricks. It was awful - I walked around the house sobbing and felt despairing - that's the only word I know to describe it. It passed within a few weeks, gradually getting better a bit at a time. My psychiatrist adjusted my meds. to my pre-preg levels which helped, too. :) My inclination during that period was to draw inward but I forced myself to lay it out there. So in addition to crying around whoever was in my house at the time, if I needed to cry while I was feeding Thomas or changing him or whatever, I just did. I would hold him tight and tell him that I had big feelings sometimes but no matter what he's always be loved and be safe. It made me feel better and I hope it helped him, too. He thinks I'm pretty much the coolest thing now (at 9 months old) so I think he understood. :)

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  8. What you describe seems to have been more than what's usually called the "baby blues"-- I just point this out so readers will realize that misery that intense and prolonged does need treatment.

    You had a lot of courage and insight to be able to consider your baby's needs when your own were so strong, and it sounds as if everything worked out. You were able to look to your psychiatrist for help, too.(I don't want to sound as if I think mothers who can't cope are cowardly or unempathic-- these things can be more than anyone can deal with-- and not everyone gets good psychiatric help.)

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  9. You are right, Jean. It was much more than 'baby blues'. In fact, take away the mental preparation I had made for PPD, a supportive and vigilant family and great psychiatric care, it would have lasted much longer. It's very important to make that distinction because I believe I'm in the minority, sadly. To maneuver through acquiring awareness, support and quality care in the midst of PPD is a heavy burden to carry. Even as prepared as I was, it was horrible. If there was one thing I could pass on to women in the same place, it would be that the mere step of making an appointment to get help made me feel better. It's like turning on the light when you think there's a monster in the closet. Even if there's a monster, at least you know what you're dealing with. Everything thing seems worse in the dark.

    Also, there are going to be women that won't feel the same connection to their babies that I still did in the midst of my despair. That's not to say I hit the acceptable bottom while they've passed a shameful line. It's not good or bad, it's just the truth. There's nothing special about me that kept me from feeling apathetic towards my son. To admit feelings like that is honorable. At least, that's my laymen's opinion. :)

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  10. I hope your comments are read by the newly pregnant or those planning pregnancy-- you're so right that awareness and knowing who to call can make all the difference. Why don't we teach these things in so-called "family education" in high school?! They're even more important than knowing how to balance the checkbook, and far more so than carrying a bag of flour around with you (if they still do that).

    Your last paragraph is especially important. How far these problems go isn't about anyone's goodness or badness, but can be affected by many details of a situation, very much including the baby's characteristics and those of other family members-- as well as those "ghosts in the nursery" that come from memories from our distant pasts.

    Thanks for your contribution-- Jean

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