The darkness behind a new mom's smile

The tragic case of the mother who admitted to drowning her five children has shone a light on postpartum depression. But rather than raise public awareness of the problem, some worry it may skew the facts.

Andrea Yates, 36, was a stay-at-home mom in a quiet neighbourhood in Houston, Texas. Her children ranged in age from six months to seven years. Neighbours say she was quiet and rarely went outside.

Last week they received the shock of their lives when Yates was charged with capital murder, multiple counts, after police came to her home and found her children dead. Yates admitted to drowning them in the bathtub. She is said to have suffered from postpartum depression. She had been treated a few years ago at a psychiatric hospital after trying to kill herself.

This type of violent behaviour is at the extreme end of the postpartum depression scale, said Sharon Dore, clinical nurse specialist for women's health in the Women's Health program at Hamilton Health Sciences Centre.

"I worry that women who are expecting are going to be concerned that this is how they're going to feel," said Dore.

The most common symptoms of postpartum depression are exhaustion, anxiety and teariness. They may surface three or four days after giving birth or as long as 12 months later. The symptoms are brought on by hormonal changes that occur after childbirth which can make a woman feel as if she's on an emotional roller coaster.

Other factors can predispose a woman to postpartum depression, such as lack of social support, marital strife, history of depression and prenatal anxiety or feelings of uneasiness or apprehension over the pregnancy.

Dore said a new parent's expectations around having a baby also add to the stress. We expect to feel nothing but happiness after our child is born then feel let down if it doesn't live up to our expectations.

"People come for a visit and see this healthy baby and say, 'you must be so happy' and that's how (new mothers) think they're supposed to feel."

What they really feel is total exhaustion. The house is turned upside down, the baby cries all the time and mom is completely exhausted.

"I think people spend a lot of time preparing for the physical experience of becoming a parent but perhaps they don't spend enough time preparing for the emotional experience," said Dore.

Another problem, said Dore, is lack of family support. Many families don't have the level of support as previous generations did because people move around more today. Yet new mothers still have the same expectations of being the perfect mother.

Dore said it's important for women to know the difference between simply feeling tired and suffering from postpartum depression. A certain level of fatigue is to be expected after having a baby. But when you start to feel overwhelmed and panicky, as if life will never be the same, you could be suffering from postpartum depression. Dore said the key thing is to evaluate whether it's interfering with normal functioning.

There's no one answer to the problem of postpartum depression just as there is no single form of treatment. Dore said a combination of medication and counselling is usually most effective.

"If things seem more negative than positive then it's time to get help."

Life after baby needn't be blue

Many years ago (27, to be exact) I suffered a severe postpartum depression after the birth of my second child. I was fortunate in that I had a very supportive husband and very lucky to have been referred to an excellent psychiatrist who diagnosed and treated me. I feel strongly that not only do young mothers need to be aware of what postpartum depression is all about, but that their husbands and families must also be knowledgeable. - Been there, done that, survived; Proud Mother of Two/ Proud Grandmother of Two

You have shown that postpartum depression can be beaten.

Postpartum depressive feelings can be of three types:

- Baby blues.

- Postpartum depression.

- Postpartum psychosis.

Baby blues are low feelings that last only two weeks or so. The mom can shake the feelings. Baby blues is common, occurring in 50 per cent or more of new moms.

Postpartum depression lasts for months and is more severe and longer lasting than baby blues. About 15 to 20 per cent of women have postpartum depression.

There are two questions a woman can ask herself. In the past month:

- Have you often been bothered by feeling down, depressed, or hopeless?

- Have you often had little interest or pleasure in doing things you usually enjoy?

A yes answer to either of these questions means she is likely depressed.

Postpartum depression is often overlooked. Women may think they are just tired or having baby blues. Some think it will just go away. Sometimes the partner and family think all the woman has to do is try harder. None of these are true.

Depression may get better on its own, but it will take many months. Just trying harder is not a treatment for depression.

No one says, "If only she tried harder, that broken arm would get better."

It is the same with depression.

Many women feel guilty and blame themselves for the depression.

But depression is not the fault of the mother.

Depression is a complex brain disorder and is not caused by laziness or self-indulgence.

Some women are afraid that child-protection authorities will take their baby from them if they admit they have depression. Children are only removed when there is immediate danger. Having postpartum depression is not a reason for removing a child.

Postpartum depression is treatable. There are two types of treatment that work: anti-depressant medication, such as Prozac, Celexa or Paxil, or cognitive behaviour therapy, in which women learn to change their thinking and behaviour.

Most women have few side-effects with modern antidepressants. The drugs are quite safe, even if breastfeeding.

Any mom who suspects she has postpartum depression should talk to her doctor. There is a specialized unit at the IWK, reproductive mental health service (902-470-8098).

Family Help, the research group I head, is also studying the use of cognitive behavioural therapy by distance for postpartum depression. You can call us at 1-866-470-7111 or visit our website www.bringinghealthhome.com for information.

Postpartum psychosis is quite different. It is rare, occurring in one or two mothers per thousand.

There can be delusions and hallucinations.

Delusions are false beliefs. Hallucinations are, most commonly, hearing voices.

So for example, a mother might become very agitated or feel that their baby is a product of the devil or may hear a voice telling her to harm the baby.

Postpartum psychosis is a medical emergency and needs immediate medical help for the mother's and baby's safety. It is quite rare, but very treatable.

If you have a friend or family member who appears to be suffering postpartum depression, urge her to get help.

She, too, deserves to say, "Been there, done that, survived."

Interviews

PRINGLE: Well, that was Russell Yates talking about his wife Andrea who is the woman in Texas facing murder charges now for allegedly drowning her five children. Yates says his wife suffered from severe postpartum depression, the same condition that we saw in a story in Toronto not long ago, a professional named Suzanne-Killinger Johnson killed herself and her baby by jumping in front of a subway train. Many, many women affected by this.

And with us now: Dr. Gail Robinson, an expert in postpartum from the University of Toronto. And Marisa Wilson who's here to talk about her personal experiences with this.

When you heard about Andrea Yates, when you heard about Suzanne Killinger-Johnson, what did you think, Marisa?

WILSON: I just felt extreme sadness and a sense that it didn't have to happen and that these women for some reason -- we don't know what their personal situations were -- that they were under- diagnosed and there's a whole aspect of not taking the illness seriously. And I was saddened.

PRINGLE: Well, Gail, same response? Just preventable, or not?

ROBINSON: The illness is not necessarily preventable. Ten to 15 percent of women get a serious depression postpartum. But one should certainly be able to pick it up early and treat it properly. I think even though this woman was in treatment it sounds as if it wasn't taken seriously enough, that nobody really knew how ill she was getting.

PRINGLE: Well, I guess that's the issue. You know, Suzanne Killinger-Johnson was a professional herself. People should know, presumably, when it's really serious. And why don't they? And what symptoms should they be looking for to move it from concern to alarm?

ROBINSON: Well, one of the difficulties of course is that the person who's ill often doesn't have insight into her illness. She may feel a depressed mood for over two weeks, or a loss of interest in usual activities. One of the things that you see is that there's a lack of reactivity. So that means that even if things are going well in her situation and the baby is fed and friends are over, she still doesn't feel better during that time. She can also feel generally exhausted.

And one of the things that happens is people feel an unreasonable guilt. So they may feel that they're terrible mothers or that they can't look after their children properly. And they don't want to tell anybody about this.

PRINGLE: Well, Marisa, was it after your third?

WILSON: It was after my third child. I had had four pregnancies and miscarried earlier. And I was a total of a year and a half before I was properly diagnosed.

My symptoms came across more as anxiety symptoms than what we would typically think as depressive symptoms. Like, I had heart palpitations, exhaustion, dizziness, loss of memory. And I was sent to all kinds of specialists. And it was a year and a half of going from one doctor to another. And after a year I started feeling more depressive symptoms because I didn't have answers. And I started not enjoying things I used to love doing.

PRINGLE: What helped you?

WILSON: Well, the family doctor I was with at the time after a year -- and he was very frustrated with me. I had asked him outright, "Could I be suffering postpartum?" He said, "No, there's nothing wrong with you. You're older. This is your third child." The last visit I had with him he had sat me down, fed up with me and he said, "Do you have any idea how much you've cost the health- care system?" I was devastated and humiliated because --

PRINGLE: "Thanks for your help."

WILSON: Exactly. And I went to another family doctor and basically fell apart in her office and said, "This is what's been happening to me." And she was wonderful. She sat and listened. And she prescribed antidepressants. And all my physical symptoms within three weeks to a month started disappearing.

PRINGLE: Did you ever think about harming your children?

WILSON: No, never. I felt immense guilt.

PRINGLE: [to Dr. Robinson] Is that common? People's hearts break, they can't imagine that.

ROBINSON: Well, what happens though is people don't want to hurt their children. They may feel that the world is a terrible place. In this case in Texas she developed the belief apparently that her children were developing abnormally, that they were all going to be deformed and disabled. So when people harm their children they're really trying to protect them.

PRINGLE: So, your best advice? Because both of you talk about this publicly. And I'll give you about 35 seconds to do this.

WILSON: My best advice -- I'm now president of PASS-CAN, Postpartum Adjustment Support Services. And we do a lot of counselling. And you can check our website at www.passcan.ca. And we have a wonderful conference next year coming up to hopefully bring medical professionals.

My best advice is: Don't give up. And really have a sense that what you're experiencing is real. It might manifest itself in physical symptoms. But if you don't feel yourself, and there's a huge change, pursue it and --

PRINGLE: And people outside. I guess your friends and family should look for the same.

ROBINSON: I think people should recognize this is a very common complication of delivery and know the early signs so that they go for help rather than just feel that they're a terrible person.

PRINGLE: Thank you both.