Depression in New Mothers : Causes, Consequences and Treatment Alternatives

305 Pages·2017·19.59 MB·English

by  Kathleen A Kendall-Tackett

Depression in New Mothers

Maternal depression is the number one cause of disability in developed countries and
results in adverse health outcomes for both mother and child. It is vital, therefore, that
health professionals are ready and able to help those women that suffer from perinatal
and postpartum depression (PPD).
Now in its third edition, Depression in New Mothers provides a comprehensive
approach to treating PPD in an easy-to-use format. It reviews the research and brings
together the evidence base for understanding the causes and for assessing the different
treatment options, including those that are safe for use with breastfeeding mothers. It
incorporates a new psychoneuroimmunology framework for understanding postpartum
depression and includes chapters on:
• negative birth experiences
• infant characteristics
• psychosocial factors
• antidepressant medication
• therapies such as cognitive-behavioral therapy
• herbal medicine and alternative therapies
• suicide and infanticide.
This new edition incorporates new research findings on risk factors, the use of antidepres-
sants, and complementary and alternative medicines, as well as updated, international
perspectives and research into ethnic minority differences. Rich with case illustrations
and invaluable in treating mothers in need of help, this practical, evidence-based guide
dispels the myths that hinder effective treatment and presents up-to-date information on
the impact of maternal depression on the mother and their infants alike.
Kathleen A. Kendall-Tackett is a health psychologist and International Board Certified
Lactation Consultant, and the Owner and Editor-in-Chief of Praeclarus Press, a small
press specializing in women’s health. Dr. Kendall-Tackett is Editor-in-Chief of two
peer-reviewed journals: Clinical Lactation and Psychological Trauma. She is a Fellow
of the American Psychological Association in Health and Trauma Psychology, Past
President of the APA Division of Trauma Psychology, and a member of the Board for
the Advancement of Psychology in the Public Interest. Dr. Kendall-Tackett is Clinical
Professor of Nursing at the University of Hawaii at Manoa and Clinical Associate
Professor of Pediatrics at the Texas Tech University School of Medicine, USA.
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Depression in New Mothers

Causes, consequences and treatment alternatives
Third edition
Kathleen A. Kendall-Tackett
Third edition published 2017
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
711 Third Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2017 Kathleen.A. Kendall-Tackett
The right of Kathleen A. Kendall-Tackett to be identified as author of this work has
been asserted by her in accordance with sections 77 and 78 of the Copyright,
Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or
utilized in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in
any information storage or retrieval system, without permission in writing
from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered
trademarks, and are used only for identification and explanation without intent
to infringe.
First edition published 2005
Second edition published 2009
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloguing in Publication Data
Names: Kendall-Tackett, Kathleen A., author.
Title: Depression in new mothers : causes, consequences and
treatment alternatives / Kathleen A. Kendall-Tackett.
Description: Third edition. | Abingdon, Oxon ; New York, NY : Routledge, 2016. |
Includes bibliographical references and index.
Identifiers: LCCN 2016010204 | ISBN 9781138120754 (hardback) |
ISBN 9781138120778 (pbk.) | ISBN 9781315651521 (ebook)
Subjects: | MESH: Depression, Postpartum–etiology | Depression,
Postpartum–diagnosis | Depression, Postpartum–therapy |
Maternal Welfare–psychology | Risk Factors | Socioeconomic Factors
Classification: LCC RG852 | NLM WQ 500 | DDC 618.7/6–dc23
LC record available at http://lccn.loc.gov/2016010204
ISBN: 978-1-138-12075-4 (hbk)
ISBN: 978-1-138-12077-8 (pbk)
ISBN: 978-1-315-65152-1 (ebk)
Typeset in Times New Roman
by Out of House Publishing
Contents

Foreword by Penny Simkin x

Preface xiii

Part I
Symptoms, incidence, and consequences 1

1 Depression in new mothers: myth vs. reality 3

Myths about postpartum depression 3

Symptoms of depression 4

Incidence and prevalence of depression in new mothers 7

Summary 13

2 Conditions comorbid with postpartum depression 15

Postpartum anxiety disorders 15

Posttraumatic stress disorder 20

Eating disorders 22

Substance abuse 22

Postpartum psychosis 22

Summary 24

3 Why depression is harmful for mothers 25

Depression is not benign 25

Summary 31

4 Why maternal depression harms babies and children 33

The impact of untreated depression on fetal development 33

Effects of maternal depression on infants 39

Effects of maternal depression on toddlers and preschoolers 41
Contents
Effects on school-age children 43

Effects on young adults 44

The interaction styles of depressed mothers 45

Infanticide 47

Conclusion 48

5 Assessment of postpartum depression 51

Challenges to assessing postpartum depression 51

Screening for depression 53

Screening and assessment scales 56

Additional factors to assess 63

Conclusion 64

Part II
Risk factors 67

6 Physiology of postpartum depression I: inflammation
and psychoneuroimmunology 69

How humans respond to a perceived threat 69

Why inflammation is particularly relevant to depression in new
mothers 72

Physical and psychological stressors that increase inflammation
and risk of depression 73

Hormonal influences 75

Conclusions 79

7 Physiology of postpartum depression II: breastfeeding
and mother–infant sleep 81

Breastfeeding confers survival advantage by protecting
mothers’ mental health 81

Depression and breastfeeding cessation 84

Sleep, feeding method, and maternal mental health 89

Conclusions 102

8 Traumatic birth experiences 105

Incidence and prevalence of traumatic birth experiences 105

Diagnostic criteria for PTSD 107

Characteristics of traumatic birth experiences 121

vi
Contents
Human rights in childbirth 122
Possible interventions for traumatic birth experiences 122
Conclusion 124

9 Infant temperament 127

Infant crying and colic 128

Summary 132

10 Prematurity, infant health problems,
and disability 133

Prematurity 133

Infant disability or chronic illness 143

Summary 145

11 Psychological risk factors I: attributional style,
self-esteem, and psychiatric history 147

Attributional style 147

Self-esteem, self-efficacy, and personality traits 148

Psychiatric history 150

Disaster and postpartum mental health 151

Loss 153

Summary 154

12 Psychological risk factors II: violence
against women 155

Adverse childhood experiences 155

Intimate partner violence 158

Abuse and the inflammatory response 159

Abuse history and parenting difficulties 160

Summary 161

13 Social risk factors 163

Immigration 163

Maternal age 165

Socioeconomic status 166

Maternity leave and employment 168

Social support 168

Summary 175

vii
Contents
Part III
Treatment options 177

14 Complementary and integrative treatments I:
omega-3s, SAMe, and exercise 179

Omega-3 fatty acids 179

S-Adenosyl-L-methionine (SAMe) 186
Exercise 187

Summary 191

15 Complementary and integrative therapies II: bright
light therapy, vitamin D, St. John’s wort, and
emerging therapies 193

Bright light therapy 193

Vitamin D 197

St. John’s wort 198

Emerging therapies 202

Conclusion 204

16 Community interventions 205

Peer support 205

Healthcare provider support 206

Home visiting 206

Education 207

Summary 208

17 Psychotherapy 209

Cognitive-behavioral therapy 209

Interpersonal psychotherapy 212

Anti-inflammatory effects of psychotherapy 215

Summary 216

Trauma-focused treatment 216

Conclusions 221

18 Antidepressants in pregnant and breastfeeding women 223

Helping mothers weigh their options 223

Types of antidepressants 225

Breastfeeding and medications 232

viii
Contents
The anti-inflammatory effects of antidepressants 234

Phases of depression management with medications 235

Conclusions 237

Epilogue: some final thoughts 239

Listen to mothers 239

Let mothers know about factors that might be influencing
their emotional state 239

Offer specific suggestions that can help 239

Help her mobilize her own support system, including offering
referrals to people or organizations that can offer
long-term support 240

Conclusions 240

References 241

Index 284

ix