When the ‘Baby Blues’ Turn Into Black Moods

When Anaheim obstetrician and gynecologist Alfred Sloan asks new mothers to “keep in touch” long after their babies have been delivered and their stitches have healed, he isn’t just trying to be friendly.

“I tell them, ‘Don’t forget me. Bring the baby back to see me.’ And if they don’t come in, I call them,” he says.

Sloan’s manner may be casual, but his motives are medical. He is monitoring his patients for signs of postpartum depression, a complication of pregnancy that can strike weeks or even months after birth.

He knows that the tears of joy on many a woman’s face in those first exhilarating moments of motherhood can become tears of sadness or rage later on.

Postpartum depression is hardly new, but the malady has made headlines recently with the murder trial of Sheryl Massip of Anaheim, who killed her colicky 6-week-old son by running over him with the family car, then pleaded not guilty by reason of insanity when charged with first-degree murder. At her trial, Massip’s defense attorney claimed that she was suffering from postpartum psychosis, a rare and severe manifestation of the so-called “baby blues.”

Although Massip’s case is unusual, postpartum depression itself is fairly common, experts say. In most cases it shows up with only mild and fleeting symptoms, but for some the problem goes far beyond crying jags and exhaustion. Depression hits some mothers so hard they literally can’t get out of bed for days. Other women simply reject their children. When the depression becomes psychosis, mothers may fantasize about harming themselves, their husbands or their children.

“I recently had a patient who was literally going nuts,” says Roger E. Schlesinger, an obstetrician and gynecologist with offices in Fullerton and Anaheim. “She told me she would sit up all night thinking about killing her husband with a knife. And she was having delusions about things that were told to her in the recovery room--she believed someone had injected her and the baby with AIDS virus.

“Who knows where that line is when you don’t just look at your husband, but you pick up the knife and act on it? It does happen.”

“Every woman who gives birth to a child is vulnerable to developing a postpartum depression,” says Newport Beach psychiatrist Noel Drury, assistant clinical professor of psychiatry at UC Irvine.

Experts aren’t sure how many women are affected by it, but Stanley Lubell, a Santa Ana obstetrician and gynecologist, says “probably 50% of mothers experience mild symptoms of depression following delivery. They’re able to cope, but maybe they’re a little weepy.

“A small percentage, about 1% of those, will have more severe symptoms. Of that group, about 1% will require either outpatient medications or hospitalization. It’s rare, but it’s still a pretty significant number when you have 4 million deliveries a year in this country.”

Doctors are also not sure what causes the disorder. Women go through tremendous physical changes during pregnancy and childbirth but, Drury says, those changes alone can’t be the sole cause of the problem because “every mother goes through a major biological shift.”

To Schlesinger, postpartum depression “has always seemed fairly logical. You come off this high of pregnancy when you’ve been the center of attention, and suddenly you’re not only not the center of attention, but you’re caring for this totally demanding person who could care less about your needs.”

Drury says there are two major categories of postpartum depression, one biological, the other psychological. Sometimes the two forms are combined, he says.

The biological form, he says, “appears to have something to do with chemicals--neurotransmitters--that assist the brain in conducting electrical energy from one nerve cell to another.”

Antidepressant drugs that affect that chemical process can be helpful in those cases, Drury says. “Generally speaking, it’s a treatable condition. Early detection and management is the best safeguard.”

In the psychological form, “the problem may be a result of conflict related to some aspect of the pregnancy or a new child. For example, a mother who was physically abused herself may be so frustrated by the non-responsiveness of a colicky baby that she becomes very angry, but she may take that anger and turn it against herself.”

Psychotherapy can help in those cases, he says, maybe in only a few visits.

Lubell, who also runs a premenstrual syndrome treatment center, uses hormonal therapy similar to his PMS treatments for some postpartum depression patients. He cites a study by a British physician which found that the female hormone progesterone reduced or eliminated symptoms in women with a history of postpartum depression with previous births.

So far, researchers haven’t identified any particular type of woman--young mothers, first mothers, older mothers--as being more susceptible to postpartum depression, except for those with previous histories.

But Schlesinger and Sloan say they have seen some patterns in their own practices.

“My impression is that these patients are generally not getting very much support,” Schlesinger says. “There are no grandparents around, the father is not helping, so the total burden is on the mother.”

He also says “yuppie moms” may be more susceptible because they expect everything to be perfect, and it just doesn’t happen that way. They don’t have as much control over the situation as they are used to. And sometimes career women who plan to go back to work 2 weeks after the birth are being very unrealistic.

Sloan says he sits down with each new mother at the 6-week checkup for “a talk about our society and the great emphasis we place on being superwoman these days. Women are expected to be wife, career woman, super mom, and it just can’t be done. When we have high expectations that we just can’t meet, that’ll develop the mind-set for depression.”

“It’s very common for a woman to have thoughts of, ‘I can’t take care of this baby anymore,’ ” Schlesinger says. “But they need to know they’re not the only woman in the world who wanted to strangle their kid. They shouldn’t feel guilty about it. I would bet, frankly, that most women feel that way at some point.”

“There are aggressive impulses and feelings that come up inside any human being,” Drury says. “But sometimes the usual human mechanisms for dealing with those impulses start to dissolve. You see this also in other situations where humans are in chronic duress: lifeboats, concentration camps, soldiers in the field.”

“If I’ve been up all night delivering babies, I’m going to be short-tempered too,” Schlesinger says. “But I’m used to it. For a new mother, it may be difficult to understand exactly what’s happening.”

Next Saturday: Women who fantasized about killing or hurting their babies during bouts with postpartum depression and psychosis.

The Baby Blues

Has postpartum depression touched you or your family? Tell us about your experience.

Auntie (and Uncle) Matters

For Dorothy, it was Auntie Em. What about you? Do you have a favorite aunt or uncle? Tell us about her or him. And if you are an aunt or uncle, tell us about your special relationship with your nieces and nephews--whether or not you have children of your own.

Don’t Fight It

Admit it. Every family has fights. How do you handle yours? Mom and Dad, do you argue in front of the kids? And what’s the best way to react when the children go at it with each other? Tell us about the family fights that turned out to be constructive, as well as the ones that had the opposite effect.

COMMON SYMPTOMS OF POSTPARTUM DEPRESSION

Insomnia

Change in appetite, particularly loss of appetite

Loss of energy

Loss of motivation and drive

Trouble experiencing pleasure

Difficulty with or loss of sexual drive

Difficulty concentrating

Trouble with memory

Rejection of child

Delusions and hallucinations (in postpartum psychosis)

Source: Newport Beach psychiatrist Noel Drury