Dealing with pregnancy-related depression, or the 'baby blues'

As distressing as it is for many women, postpartumobsessive-compulsive disorder (PPOCD) is still one of the mostunderreported and underdiagnosed of the postpartum mood disorders.In addition, women with PPOCD are at an increased risk of sufferingfrom postpartum depression. Some studies show that almost 40% ofwomen with PPOCD go on to become clinically depressed.

Symptoms of PPOCD

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And according to Shoshana Bennett, Ph.D., a psychologist in private practice in the San Francisco Bay area, at least 3%-5% of new mothers develop obsessive symptoms. Bennett is also coauthor, with Pec Indman, Ed.D., MFT, of Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression.

What is PPOCD?

PPOCD, an obsessive-compulsive spectrum disorder, is seen in women who, shortly after giving birth, become consumed with certain thoughts and images. According to Elizabeth Goldman, M.D., a psychiatrist in private practice in Bryn Mawr, Pa., and a consultant to the Postpartum Stress Center in Rosemont, Pa., these thoughts are often visual and impulsive and concern harm coming to the baby at the hands of its mother.

The difference between PPOCD and OCD, Goldman explained, is, of course, recent new motherhood, along with the predisposition in women who develop PPOCD to focus their obsessive thoughts on their baby and various aspects of baby care (e.g., diapering and feeding). She noted that women may get compulsive urges and try to relieve the anxiety they have about their obsessive thoughts. They may, for example, continuously sterilize bottles because they have images of their baby becoming ill from a contaminated bottle.

PPOCD also differs from OCD in that PPD is almost always obsessive/obsessional, observed Valerie Raskin, M.D., a psychiatrist in private practice in the Chicago area who specializes in reproductive psychiatry. And the obsessive images characteristic of PPOCD provoke extreme anxiety for women, she said. Raskin is coauthor, with Karen Kleiman, MSW, of This Isn't What I Expected: Recognizing and Recovering from Depression and Anxiety After Childbirth.

"All new mothers feel overwhelmed, and to have horrifying images of harm coming to your baby is anxiety-provoking and shameful," she said.

The causes of PPOCD remain elusive. While no one knows the exact root of any psychiatric illness, PPOCD is thought to result from a combination of genetic predisposition and environmental stress.

"I have yet to see a woman with PPOCD who doesn't have a personal or family history of OCD," said Bennett, who is also the president of Postpartum Support International.

Although PPOCD can actually begin during pregnancy, it is known that the hormonal fluctuations inherent in childbirth can trigger it. Another trigger, indicated Raskin, is sleep deprivation, which begins during pregnancy and becomes even more prevalent during the postpartum period. "Yet the final common pathway is serotonin," she noted. "We know that if we treat women with selective serotonin reuptake inhibitors [SSRIs], they feel better."

Effective treatment is available

According to Goldman, the initiation of an SSRI, combined with talk therapy, often provides women with significant relief. In addition to an SSRI, pharmacotherapy for PPOCD can also include the short-term use of a benzodiazepine. She went on to explain that lorazepam, oxazepam, and temazepam are safe to use in breastfeeding women because they undergo only one phase of hepatic metabolism; thus, they do not overtax neonates' immature liver.