TMC PULSE

t m c » p u l s e | m a y 2 0 1 8 34 Postpartum Depression Prior to Giving Birth Some patients are affected while pregnant B y B r i t n i N . R i l e y W hen Christine Sherman learned she was pregnant with her first child, she and her husband were over the moon with excitement. But her joy didn't last long. A crushing sadness hit the expectant mother, then 36, just seven weeks into her first trimester. "I went from feeling normal and fine to almost an instant depres- sion," Sherman said. "I was very scared and anxious. I had a hard time getting out of bed and I was very worried about what was hap- pening to me. I had no appetite and began losing weight like crazy." Friends and medical profes- sionals told Sherman it was way too early in her pregnancy to be having these issues. "I kept thinking, 'I can't be the only woman this has ever happened to,'" Sherman said. "I literally could not find a doctor that would treat me. … I had been to multiple doctors. Multiple psychiatrists. I even had two tell me to terminate my preg- nancy to save my life." After five weeks of discourag- ing appointments with specialists, Sherman and her husband finally met with Lucy J. Puryear, M.D., med- ical director of The Women's Place— Center for Reproductive Psychiatry at Texas Children's Hospital. That's when her symptoms were diagnosed as postpartum depression. Postpartum depression, as its name suggests, is typically expe- rienced by mothers after the birth of a child. But the condition can manifest during pregnancy. "One of the reasons we start screening during pregnancy is that some of the data shows postpartum depression can start in the third trimester of pregnancy," Puryear said. "If women are starting to have symptoms before they deliver—if we can intervene before the baby gets here—then maybe we can stop it from occurring or being as bad." That's exactly how Puryear helped Sherman. "She didn't look at me like I was crazy or say that I was making it up in my head," Sherman recalled. "We sat on her couch and I remem- ber she looked at me and said: 'I'm going to get you better and you're going to be OK.'" According to the U.S. Centers for Disease Control and Prevention, as many as 1 in 5 new mothers experi- ence postpartum depression. "We call it postpartum depres- sion, but really, it can be many different types of mental health symptoms, like anxiety—women feeling overly anxious, not able to sleep, because they are checking on the baby every 10 minutes," Puryear said. "They are worried that some- thing awful is about to happen to them or the baby, up to the point of having panic attacks." Sleep deprivation, a common situation for new parents, can trig- ger depression and anxiety. With the physical and lifestyle changes a new mother experiences, in addition to the steep drop in hormone levels after delivery, nearly 80 percent of women with infants experience "baby blues"—a very different phenomenon than postpartum depression. "Baby blues" usually subside within a couple of weeks after giving birth, but some new mothers do not recover from the emotional slump and experience postpartum depression. "It's supposed to be fun—and a lot of it is fun—but it's also over- whelming," Puryear said of wel- coming a new baby. "As each week goes by, it's supposed to get easier because you kind of figure out what is going on, you develop a little rhythm and the baby starts to make a little more sense. But for moms with postpartum depression, it just continues to feel overwhelming." Once a woman comes to Puryear for help, treatment can begin. "By the time they end up seeing someone, they are feeling pretty badly," Puryear said. "I think the desire to not have something wrong—you've just had a baby and you're supposed to be excited and everyone else is excited—you just keep hoping that it is going to get better." At The Women's Place, a patient visits with a psychiatrist who will determine if medication is needed. A new mother also is referred to a therapist for support. Puryear explained that lots of different therapies work well for postpartum depression symptoms. Sometimes, talking to someone about how to get the baby to sleep better or how to manage the relationship with a spouse yields positive results. "For moms with anxiety disor- ders, there is cognitive behavioral therapy that teaches you how to do what a mom without anxiety Christine Sherman spends time at home with her children, Dylan, 5, and Zachary 3. I literally could not find a doctor that would treat me. … I had been to multiple doctors. Multiple psychiatrists. I even had two tell me to terminate my pregnancy to save my life. — CHRISTINE SHERMAN

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