Feeling sad or even despondent from time to time is an occurrence that is well within the normal variation of human feelings. The notion of depression as a clinical disorder is quite different than the feelings of being sad and blue that all people experience as a result of living in the world. Normal variations in mood do not satisfy the specifications for a clinical disorder, and most people will never be diagnosed with a psychiatric/psychological disorder even though most of the recognized disorders have elements in their presentation that are similar to everyday experiences. The difference between the symptoms of a formal mental disorder and those of normal experiences depends on the level of the intensity of the person’s feelings, how they affect the person’s functioning, and their duration.
What Is Postpartum Depression?
Postpartum depression technically refers to the onset of a clinical depressive disorder following the birth of a child; however, the American Psychiatric Association (APA) recognizes that the actual depression can begin before the birth of the child. APA specifies that the depression can occur within four weeks following the delivery or during pregnancy in order to be diagnosed as a major depressive disorder with peripartum onset (the term postpartum depression and the APA’s designation represent the same diagnosis, and the two terms will be used interchangeably throughout this article). The diagnostic criteria for this disorder are the same diagnostic criteria that are used in diagnosing clinical depression or major depressive disorder, except that there are the added criteria of the depression occurring during pregnancy or within four weeks following the birth of the child.
Because the diagnosis of major depressive disorder with peripartum onset is a clinical disorder, it is not similar to what many people term “the baby blues.”
The person must meet at least five of the nine diagnostic criteria consistently for a period of two weeks and must also suffer serious ramifications from their depression that affect their ability to function.
Postpartum depression occurs in women equally across ethnic backgrounds, income levels, and age. It is far more likely to develop in women who have a history of major depressive disorder or bipolar disorder. An increased risk for postpartum depression also appears in women who:
- Experience stressful events before the birth of their child
- Perceive a lack of support from their family regarding their pregnancy
- Have mixed feelings about being pregnant or having a child
According to the book Postpartum Depression: Causes and Consequences, some women diagnosed with major depressive disorder with peripartum onset may also display psychotic behaviors, such as hallucinations and delusions or mood swings, that appear to mimic bipolar disorder.
There is no known cause associated with postpartum depression. Certainly, genetic factors interact with environmental factors as well as fluctuating levels of hormones and neurotransmitters during pregnancy to increase susceptibility to this form of depression. Prevalence rates for postpartum depression have been quoted as being as high as 15 percent. Obviously, individuals who have experienced postpartum depression during a previous birth are at a high risk to experience it again.
Substance Abuse and Postpartum Depression
When someone receives a diagnosis of a mental health disorder and a substance use disorder at the same time, the situation is often referred to as a dual diagnosis or co-occurring disorders. As an overall rule, it is fairly safe to say that at least 15-20 percent of individuals diagnosed with a major depressive disorder will also be diagnosed with a substance use disorder. Likewise, at least 20-25 percent of all individuals diagnosed with a substance use disorder will also be diagnosed with major depressive disorder.
Women diagnosed with postpartum depression are noted to have a significantly higher risk for the development of a co-occurring diagnosis than women who are pregnant or have given birth and did not experience postpartum depression. Studies indicate significantly higher rates of alcohol abuse in recent mothers with depression as well as higher rates of the abuse of other drugs compared to new mothers without depression. Often, when either the depressive symptoms or the substance abuse issues are addressed, both disorders improve.
No causal associations can be identified between the increased risk of substance abuse and the diagnosis of major depression; however, a number of different theories have been discussed. There is a still popular notion that individuals with depression self-medicate with alcohol and drugs; however, this notion has never been clinically verified. Individuals who are extremely depressed often exacerbate their symptoms with the use of alcohol and drugs instead of alleviating them. Some may self-medicate, but self-medication alone cannot explain the development of an addiction in someone.
The more likely explanation is that because many mental health disorders and substance use disorders share numerous commonalities, such as genetic associations, neurobiological associations, environmental experiences such as abuse, and other factors, the vulnerability to develop one type of mental health disorder also increases the vulnerability to develop other psychological/psychiatric disorders, including substance use disorders.
Treating Co-Occurring Postpartum Depression and Substance Use Disorders
Postpartum depression is treated similarly to the way major depressive disorder is treated. This can be accomplished by using medications, therapy, or a combination of medications and therapy. In addition, certain alternative treatments, such as engaging in meditation, exercise programs, social support, and other therapies can be added to the normal treatment regime.
When someone is diagnosed with postpartum depression and a substance use disorder, both disorders must be treated at the same time. Attempting to treat one disorder while ignoring the other, or trying to hold the other disorder in check, will not be successful for treating either disorder. Research has indicated that using an integrated treatment approach is preferred when treating individuals who have multiple mental health disorders.
The team works together to bring the individual to as functional a level as the individual is capable of and then to provide long-term aftercare support for the individual to maintain their autonomy.
In some cases, therapy may not be beneficial regarding the mother’s desire to keep the child, increase her ability to care for the child, or may not result in an advantageous situation for the child. In cases where there may be neglect or abuse of a child, the child’s safety should the primary consideration, and every effort to keep the child healthy and safe should be made.