Women and Depression

Studies of both psychiatric patients and the general population indicate that depression is more common among women than men. According to a report in the Stanford Observer, women suffer from serious depression at about twice the rate of men. Further, one of every four American women will be affected by depression at some time in her life. Of all the women who get depressed, probably no two have exactly the same circumstances, and they experience a wide variety of feelings, thoughts, and behaviors.

   Many don't even know they're depressed and suffer through life with rather severe penalties from a personal and social point of view. They are probably shunned and don't have many friends because of their frequent depressions. If depression is now at epidemic proportions in our culture in general, it's especially true for women.

   Clearly, we need a better understanding of the unique depressions that affect women.

WHY DO WOMEN GET DEPRESSED MORE OFTEN THAN MEN?

   There's a lot of argument about why that is. Many theories have been proposed, ranging from social conditions and income differences to biological reasons and hormones. No single theory is more correct than another. They're probably all correct to some extent and together explain it better than by themselves.

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   Before I go any further, let me first address the validity of the statistic that women get depressed twice as often as men. Some have challenged it on the grounds that there is a bias in the reporting and gathering of data from women. Many believe depression labels are used more frequently with women than with men. There's no doubt in my mind that in times past, and probably to some extent today, there has been a negative bias toward women when it comes to psychological or psychiatric diagnosis. Women are more likely to be diagnosed as severely disturbed than men, often by predominantly male mental health workers.

   In recent years, however, that bias has been corrected by the consciousness raising of those who have tried to make the system more fair toward women. Further, the mental health profession is now well populated with women. Yet the statistic that women are more prone to depression still exists.

WHAT ARE THE BASIC CAUSES OF DEPRESSION IN WOMEN?

   I'll provide a brief overview of the major causes and then pick up on the more serious ones in detail through the rest of the chapter.

1. Social Factors

   For a long time, social conditions and attitudes in our culture have worked to the disadvantage of women. Girls were taught to be dependent and submissive, and a unique state of helplessness was fostered. Depression, for many women, has had to become a survival strategy. In other words, when living conditions are intolerable, many women retreat into depression, show an indifference to their environment, and become passive and helpless as the only way they can cope.

   This is particularly true when physical abuse is present. Current estimates are that somewhere between 2 and 6 million women in the United States are battered annually. A high percentage of those women are victims of incest. Further, large numbers of women are raped and/or killed by their husbands or boyfriends. Such social conditions clearly have a serious impact on the state of mind of the average woman, and depression is often the only way these women can deal with their situations.

2. Role Changes Affecting Women

   Many role changes are taking place for women. They are increasingly assuming leadership positions in government, industry, business, and even the church. More and more are becoming the primary breadwinners in their families. It's not uncommon to encounter women who are earning significantly more than their husbands. The family's

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financial well-being is thus more and more dependent on the wife's income. With the increasing incidence of divorce, ever more women find themselves as the sole support of a family of children, so they must be more than just mothers. The daily work load and stress of playing these many roles can take their toll in the form of biological and emotional breakdowns.

3. Problems with Self-Esteem

   The connection between diminished self-esteem and depression has long been known. Depression not only causes low self-esteem, but anyone whose esteem has been eroded is likely to be more prone to depression as well. In our culture, women clearly tend to experience lower self-esteem than men.

   Partly this is because while there are greater opportunities for success, women are less likely to be successful. Partly it's due to the lower social status of women, who tend to earn less money for equivalent types of work. But largely it's due to being female in a male-dominated culture. Maleness is preferred over femaleness in many sectors of our society, and this bias is even greater against women of color.

   Of course, changes are taking place. In many sectors of society, opportunities for women have increased dramatically. But it's still going to be several generations before we see a change in stereotypes and basic attitudes toward women that won't work to erode their self-esteem and put them at greater risk for depression.

4. Biological Factors

   The reproductive function of women has contributed heavily to their greater incidence of depression. Not that all the consequences related to the reproductive function are biological. Problems with infertility, singleness (and thus not being able to bear children), and trying to find the right partner in life are all tied to some extent to the reproductive burden of the female and are likely to cause serious psychological deficits.

   By far the more serious and common consequence of the reproduction function lies in the complex hormonal and physiological changes that support it. The two most serious biological consequences are PMS and menopause. They will be given careful attention later in this chapter.

   Some people emphatically reject the biological explanation for depression in women. They don't deny that some women have serious problems with hormones, but they insist that hormones don't influence moods in most women. They would also argue that men and women are equally susceptible to depression but that depression in

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males often takes the form of acting out behaviors such as passivity, crying, or even alcoholism, and that this accounts for the apparent difference.

   We certainly need more research before we can make categorical statements about how biological factors contribute to depression proneness. For now, there seems to be sufficient evidence to suggest that at least for a percentage of American women, biological factors do play a major role in their emotions.

WHAT ARE SOME OF THE RISK FACTORS FOR WOMEN?

   Whether a particular form of depression is entirely psychological and caused by social factors or biological and caused by hormonal changes, significant factors can make the risk for depression greater. In other words, psychological and biological factors often work in tandem to produce a given state of depression. What are these risk factors?

1. Living Alone

   According to the 1980 U.S. census, almost 11 million women over 14 years of age live alone (i.e., with no other adult). Of those, more than 8 million are single mothers who live with their 11 million children. Clearly, these are courageous, skillful, flexible, and resourceful women. They live highly stressed and demanding lives. They have to be breadwinner, parent, homemaker, and friend, and then try to find a little time to take care of themselves. Most of these women, whether rich or poor, regardless of race or profession, are in some kind of pain. Living alone, according to statistics, doubles the risk of depression.

   To avoid being at increased risk for depression, single women and especially single mothers need to develop an adequate base of friendships and social contacts. Isolation fosters too much introspection and does not provide enough balancing distraction to control moods. Women tend to pay more attention to their feelings and are more likely to ruminate about the possible causes of their moods. Isolation only makes matters worse.

   Overall, men seem to have better social support systems than women. When depressed, men tend to engage in activities designed to distract themselves from their moods, whereas women tend to engage in activities that might intensify their moods.

   Even married women can be socially isolated. I have received numerous letters from women who say that even though they're married, they're extremely lonely. Their husbands hardly ever talk to them and seldom take them out to social events. Such women, like single women, can be at increased risk for depression unless they build an adequate network of friends and participate in regular social activities outside the home.

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2. Sexual Desirability

   Since our culture primarily puts the responsibility on women to be attractive to men in order to date and marry, many women are at increased risk for depression if they don't see themselves as sexually desirable. That leads to an increased preoccupation with their bodies, appearance, and how they're perceived by men. Eating disorders in women can often be traced to concerns about weight and negative feelings toward the body. Indirectly, this also affects self-worth and perceptions of one's desirability.

3. Lack of Identity

   For many women, especially those who don't develop careers of their own, their identities become too wrapped up in the roles of mother and housewife. If anything happens to disturb those roles or to take them away, depression can be a serious problem.

   Our egos become defined by what we do. A good mother who takes care of her children, teaches them good manners, and finally delivers them into adulthood as successful people will find her identity seriously diminished when they're gone. We call this the "empty nest syndrome," but it's more than just an empty nest that puts this type of mother at risk for depression. It's the sense of emptiness and lack of fulfillment that sets in when she's no longer needed. Suddenly she finds herself all alone, adrift in a huge ocean with no direction and no sense of accomplishment. That increases the risk of depression. It's also about this time that menopause sets in to further complicate the picture.

   Women who divorce later in life also experience this reaction of isolation and abandonment. When you've spent 20 or 25 years of your life building a home for your husband and children so they can retreat from their busy and stressed lives to a harbor of peace and contentment, the rejection is devastating. When you have provided meals, nursed a sick husband and children through critical illnesses, and then suddenly find yourself cast aside, the depression you experience is more than just the loss of a marriage. It's the loss of identity. Your very essence is destroyed.

   The sad thing about this is that it can be prevented. While I highly value the role of motherhood and of building and maintaining a happy home, women need to develop a stronger sense of their own identity outside the home. They need other levels of competence besides that of homemaking.

   My wife, Kathleen, is a good example of this. She has provided me and our three daughters with a wonderful home. She has served us diligently, and she has besides all that, worked hard to develop her own self and achieve a feeling of

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competency that complements being a good mother and housewife.

   After raising three children, Kathleen began to look around for other opportunities for fulfillment. She also felt a need to do something of her own choosing. So she enrolled in Fuller Seminary to take a few courses. She didn't want the pressure of pursuing a degree, but she did want to enhance her spiritual growth.

   When she completed those courses, she began working part-time for a missionary organization, developing a project for starving children in Africa. That project gave her a great sense of fulfillment, and it also helped her realize where her gifts lay: she felt called to work with other women. At the same time, God opened an opportunity for her to start a weekly Bible study and prayer meeting with seminary students' wives, and she's been doing that with joy for the past six years. In addition, she now speaks with me at seminars, and she also has four grandchildren to love.

   Every husband owes it to his wife to foster such development, and certainly every woman owes it to herself to claim it. Without an identity broader than simply taking care of home and husband, any woman is at greater risk for depression. That's not to say women must live in fear of being abandoned. I certainly pray you will never experience the rejection of your spouse. But there are some events in life over which a woman has no control. Her children will leave her one day, and her spouse may succumb to disease. But even if her children never leave and her husband outlives her, she needs a clear sense of her own identity and a feeling of competence so she can define who she is out of a much broader base.

HOW CAN I DO THIS?

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HOW DOES THE PREMENSTRUAL SYNDROME AFFECT WOMEN?

   For the last ten of her 28 years, Paula has lived a split life. Half of every month, she's an attractive, intelligent, well-adjusted, and happy woman. But for the two weeks preceding her menstrual period, she's a physical and emotional wreck. In particular, she experiences extreme mood swings that cause dramatic personality changes.

   During the "good" part of her month, she is composed, competent at her job as a social worker, and easy to get along with. She and her husband hardly ever fight. During the second half of her month, she becomes wildly irrational, deeply depressed, and aggressive. She picks a fight over anything, has put her fist through several doors, has tried to slash her wrists, and has had one serious car accident.

   Paula suffers from a common form of depression, the one that accompanies the premenstrual syndrome (PMS). Of Course, PMS has many other accompanying physical and emotional problems as well. But for Paula, the experience of depression is the dominant symptom and the one that causes her the greatest amount of distress. It's one of the forms of depression that is unique to being a woman.

   Many women have learned to accept and live with PMS. Others have had to resort to hysterectomies, while still others need intensive treatment for its many symptoms.

   Premenstrual syndrome is probably the most common cause of biological depressions in women. In recent years, many studies have turned up helpful facts about it, and whereas years ago doctors suggested that the problem was mainly psychosomatic and aggravated by neurotic tendencies, no one believes that anymore. It is a real problem, and its cause is primarily, if not exclusively, biological.

   As recently as 1981, the American Journal of Obstetrics and Gynecology reported that between 20 and 40 percent of American women were afflicted with some mental or physical incapacity during their menstrual periods. How many of those women had PMS? Dr. Katharina Dalton, a London physician who has been treating PMS for 30 years, believes as many 5.5 million American women (about 10% of the population of childbearing age) have the disorder to a degree that calls for medical help.1 For some, it is so severe that their violent mood swings can disrupt their lives and the lives of their families.

   Since the early 1980s, of course, we have made even greater strides toward understanding and treating PMS. Gone are the days, we hope, when doctors, psychiatrists, and psychologists tell women with PMS that there's nothing wrong with

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them and that all they need to do is pull themselves together. There is something wrong. They are not neurotic. They have a real physiological disorder that needs consistent and aggressive treatment just like any other.

   The emotional effects of PMS that accompany the physical (e.g., headaches, clumsiness, pain, and even seizures) are primarily depression, fatigue, tension, anxiety, and irritability. I want to focus primarily on depression, since that's the main focus of this book and is often overshadowed by the more dramatic symptoms of anger and irritability.

   Because no woman has all the symptoms associated with PMS, periods of depression can often be overlooked as a significant feature of the disorder, which is rapidly becoming stereotyped as a problem of tension and anger. As one patient described it, "It's like being possessed, I guess. Whenever I'm close to my period I fly off at my husband, I lash out at my children, I rip clothing, smash glasses, throw crockery, and even take a hammer to my prized vases. I feel totally out of control, and when it's all over I feel so ashamed."

WHAT ARE THE OTHER SYMPTOMS?

   Many women experience sadness and depression — significant enough to impair their lives. They feel listless and without energy. They lose all interest in normal activities, and they begin to think about themselves in self-demeaning terms. They cry excessively and then start to entertain thoughts of taking their own lives. Death wishes are extremely common during these periods.

   Such an unpleasant mood can precipitate other problems, such as drug abuse and alcoholism. Many turn to alcohol, for instance, as a way of numbing their feelings and taking away their emotional pain. The depression as well as the other symptoms of PMS can lead to marital discord and child abuse and can make the sufferer prone to accidents.

WHAT CAUSES PMS?

   It is generally agreed that the primary cause of PMS is an insufficiency of the female hormone progesterone, normally produced by the ovaries to prepare the lining of the uterus for pregnancy. The primary medical treatment, therefore, is to replace the deficient progesterone, a strategy that has taken a long time to become accepted in the United States. Many clinics are now available to provide this treatment, and many physicians offer it as well.

   If you suffer from severe depression as a result of PMS, therefore, your first

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response should be to seek treatment for this underlying deficiency. Attention also has to be given to blood-sugar fluctuations and vitamin deficiencies, and treatment invariably includes some education about stress management and preventive strategies.

HOW DOES PMS DIFFER FROM PMT (PREMENSTRUAL TENSION)?

   Not every woman suffers acutely enough from PMS to need progesterone supplement treatment. It's important to distinguish between the severe form of the disorder, which has clear clinical manifestations both physically and emotionally, and "premenstrual tension" or distress. This latter term describes the discomfort some women feel during their menstrual cycle that tends to get worse around the time of menstruation but in which the hormonal balance is quite normal and so progesterone does not help at all.

   In other words, premenstrual tension is a minor form of PMS and is probably a lot more common than we realize. For instance, I've seen women in therapy who have never thought of themselves as having a PMS problem yet who say they become significantly depressed at some time in the month. Because it never coincides exactly with menstruation, they have never seen it as being connected in any way. Generally they are able to control their emotions, and it seldom gets beyond being a personal discomfort. Family members don't notice it particularly, but the sufferer experiences a fair degree of misery.

HOW CAN I TELL IF MY DEPRESSION IS RELATED TO PMT?

   How can a woman know whether she experiences this milder form of PMS? The only effective way I know is to keep a daily "mood diary" and carefully chart how you're feeling. For instance, you could think of a scale from 0 to 10 for your general feeling of well being. A 0 would mean you're feeling absolutely terrible, down in the dumps, extremely depressed, whereas 10 is the highest feeling of well being you've ever experienced when you're free of all sadness and life seems to be happiest. A 5 would be somewhere in between, where you feel neither extremely happy nor very depressed.

   At the end of each day, give yourself a rating between 0 and 10 for how you felt most of the day. If anything particularly devastating or disappointing has happened, make a note of it as well, because that may account for why your mood is down. If nothing significant has happened, your rating is more likely to reflect accurately your general mood as determined by your body's chemistry.

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   Whenever you have a period, mark the starting and ending dates in your diary. After several months of keeping such a diary, it should become clear at what time of the month your depression sets in, as well as how long it lasts. Knowing there's a connection between your depression and your body chemistry can free you from a lot of false blame and avoid the unnecessary searching of your environment for explanations. This keeps the depression at its lowest common denominator, namely as a biological one. It does not exaggerate it or produce other, secondary psychological reactions that can make it worse.

CAN YOU SUGGEST SOME SELF-HELPS?

   What can you do for yourself when you realize you're in a period of depression tied to premenstrual variations? Here are some suggestions:

1. Life-Style Changes

   The unpleasant physical symptoms of your PMS can be relieved by minor changes in life-style. For example, bloating, painful breasts, weight gain, and headaches often result from water retention. They cause enough discomfort to add extra pain to the emotional depression you already feel. By minimizing the bloating with, for example, a diet low in carbohydrates and salt, you can reduce the amount of water held in the body. That reduces the physical discomfort and may help to improve your mood. You might want to discuss with your doctor whether a mild diuretic (this removes water from the body), taken a week or so before your expected premenstrual emotional change, can be helpful

2. Dietary Changes

   Changes in diet can help significantly in lowering your mood swings. Stimulants such as those contained in caffeine-based foods, coffee, tea, colas, and chocolate will help to reduce tension and anxiety. Some have also found it helpful to eat more but smaller meals each day during the premenstrual period, keeping the calorie intake the same but not loading the gastrointestinal system with large meals. This helps to balance blood-sugar levels that bring on headaches when they drop suddenly.

   Although there is no scientific proof of its usefulness, some have found vitamin B6 to be helpful as well.

   3. Exercise

   Regular exercise clearly benefits women with PMS in any of its forms, because it

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helps to tone up the body and aids in relaxation. It also helps to burn off surplus adrenaline, thus lowering stress levels.

   4. Stress Control

   Stress significantly aggravates the problem of PMS. Not only do the hormonal deficiencies associated with PMS reduce your tolerance for stress, but prolonged and chronic stress also affects the endocrine system and will aggravate any existing deficiency. The body cannot fight all its battles at the same time. During times of high stress, adrenaline levels increase, muscle tension goes up, and blood volume is shifted within the body to those regions that require it for the emergency response (the brain, the stomach, the muscles, and the lungs).

   Those changes, taken together, will reduce the body's ability to cope with the primary hormonal deficiency that underlies PMS. Stress will, therefore, make matters worse. Good stress management is thus essential, as is learning an effective relaxation exercise that will help to lower the body's adrenaline level and reduce its emergency mode.

CAN YOU SUGGEST A GOOD RELAXATION EXERCISE?

   Relaxation can be achieved by spending a minimum of 30 minutes a day in a quiet place, totally relaxing your body and mind. Start at the bottom of your body with your feet; tense the foot muscles for five seconds, and then relax them. Move to your calves, and do the same. Proceed up the body and through the various muscle systems, first tensing them for five seconds and then relaxing them, until you have covered the whole body.

   Having done that, remain immobile for the balance of the relaxation time. Try not to move any muscle. It helps to set a timer for 20 or 30 minutes and to put a "Do not disturb" sign on your door. You certainly can't relax while you have small children running around or teenagers barging in and asking for favors. Even your spouse needs to stay away. At the end of your relaxation time, take a few deep breaths, and then go about your business.

   Other activities, such as slow swimming or lying in a Jacuzzi, can also help to create a more relaxed body.

   Stress management is mostly a matter of "filtering" your stressors and trying to concentrate only on essential issues. Many helpful resources are available, and I would refer the reader to my book Adrenalin and Stress,2 which provides some strategies for doing this.

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HOW DOES MENOPAUSE RELATE TO DEPRESSION?

   Perhaps you have just encountered the depression of menopause, suffering from it yourself or knowing someone who does. Maybe your first thought is How could this happen to me? Let me immediately assure you that of all the depressions afflicting women, this is one of the most common. It comes in all sizes, from just minor sadnesses to major melancholy. It's associated with the change of life, and, not surprisingly, it affects both men and women. However, since it is more serious in women, I'll focus my discussion on them.

   There's nothing unnatural about menopause. It's not a disease, and it's not a sign of weakness. Instead, it is the perfectly natural cessation of the reproduction process provided by creation. It serves an important function, namely, to prevent the birth of an unhealthy or deficient child to a woman whose body and hormones are probably not adequate to produce a healthy child. It also ensures that the child is not born to someone too elderly to take adequate care of him or her. It's all part of an intelligent creation.

   For a long time, it was believed that no woman should expect discomfort or emotional upheaval during menopause. The problem was thought to be purely psychological, and it reflected an inadequate earlier adjustment in life. I don't believe that to be true. Most menopausal problems are entirely biological and have to do with the natural decline of estrogen and the cessation of child-bearing ability.

   Menopause typically begins sometime after age 40, although there is evidence that the age has been dropping, just as the age of puberty has dropped over the past 75 or 100 years. About 50 percent of women experience significant depression during the menopausal period, and for some this process of change can drag on for a long time.

   Physicians have a list of dreadful symptoms that may accompany menopause: hot flashes due to instability of the circulatory system; palpitations, or forceful beating of the heart, which may produce shortness of breath; stomach and bowel upsets; headaches; arthritis; fatigue; and even diabetes.

   By the time of menopause, many women are worried about being overweight. Instead of switching to a sensible diet, they often take to some fad diet that deprives their bodies of adequate nutrition. That can significantly aggravate menopausal symptoms. Others may drink large quantities of coffee, and I mean the real strong stuff, in the hopes that it will suppress hunger pangs. They skip breakfast and generally ignore the rules for good eating.

   Deficiencies produced by these habits can also aggravate menopausal symptoms, as well as produce significant vitamin deficiencies, especially in vitamin E and the B

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complexes. This almost guarantees increased nervousness, digestive disorders, headaches, and fatigue.

HOW LONG DOES MENOPAUSAL DEPRESSION LAST?

   The depression of menopause can be quite variable. It can last just a few days and then go away as mysteriously as it came, or it can last for months and even extend into years. I have seen cases where the biological stress of menopause has triggered a full-blown, major depression requiring intensive therapy and extensive medication. Fortunately, we have effective treatments for the variety of depressions experienced during menopause, so a sufferer needs to be encouraged right at the outset to seek appropriate treatment.

   Remember, it's not just your imagination. You're not exaggerating your ailments, God has not abandoned you, and you certainly are not failing as a Christian. Those ideas are ridiculous, and any attempt to blame yourself for your unpleasant and sad feelings will only contribute to further depression by creating more losses. If your depression is incapacitating, you should seek out an understanding doctor to help you immediately.

SHOULD I SEE MY FAMILY DOCTOR, OR DO I NEED A SPECIALIST?

   Not all doctors are good at treating menopausal depression. You may need to go to someone other than your regular family doctor. You should first consult a gynecologist, since this physician is especially trained to deal with the problems of menopause. If, after the first visit, you don't feel comfortable with the gynecologist you have selected, move on quickly to try someone else. You may also need to see a psychiatrist. Many gynecologists are extremely good at treating biological aspects of menopause but may not be very understanding or skilled at treating the emotional components.

   Be frank with your doctor. Ask whether he or she can adequately treat your depression. In severe cases, it may be necessary for the gynecologist to consult with a psychiatrist to find the right balance of medication. Of course, don't wait until you have a full-blown depression before you seek help. As soon as you begin having hot flashes, heart palpitations, prolonged insomnia, extreme irritability, painful joints, vaginal dryness, excessive or irregular vaginal bleeding, or chronic fatigue even though you've had sufficient rest, consult your physician right away.

   In treating menopausal depression, two important aspects must constantly be borne in mind. There's the biological aspect, the diminished estrogen and other female

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hormones. Then there's the psychological aspect. In other words, the underlying primary biological depression can have a significant overlay of reactive, or psychological depression.

   After all, we don't enjoy growing old, and the menopause can signal the loss of many significant aspects of a woman's life. It means the end of childbearing, so a woman who was hoping to have another child could become depressed because of that. For many women, the loss of childbearing ability also represents a significant loss of meaningfulness. These and many other losses can accompany the realization that menopause is the end of a period of life and contribute additional depression.

   It is very possible, therefore, that your treating physician may suggest you seek counseling or psychotherapy as a part of the treatment package. If your physician recommends that, or if you feel a lot of your depression is being caused by losses you aren't coping with satisfactorily, seek out a counselor or psychologist to help you. I strongly recommend that you begin by talking to your pastor for a referral. Here again, the key to prompt recovery is to seek out treatment promptly. That's true for all depressions.

IS THERE ANYTHING ELSE I CAN DO?

   Adjusting to a new stage of life can mean the opening up of whole new areas of exciting adventure. You need to look on the bright side of these transitions in life. They may represent the loss of some things, but they're also the beginning of many new experiences. A readjustment of your attitude and elimination of irrational beliefs about being a childbearer can help to speed your recovery.

   In addition to the treatment the physician may prescribe, such as estrogen replacement therapy, it may be necessary to add an antidepressant for the more severe cases of depression. You may want to try the estrogen replacement therapy first, but don't wait too long. Antidepressant medications are not addicting, nor do they cause any harm if you take them and don't really need them. Generally I advise women to at least try an antidepressant early in the treatment process. If you don't get the biological depression under control, it will likely exacerbate any psychological depression caused by the menopause.

   If your physician has recommended against estrogen replacement therapy because of the risk of tumors, high blood pressure, diabetes, or other disorders, you may need to rely upon the antidepressant to help you through your depression.

   There's one comforting thought you can hold on to: all menopausal depressions ultimately come to an end. You can look forward to a point in the future when your

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discomfort will be behind you. Menopause is only a milestone in your life, not the whole journey. It can be a time to rededicate yourself to a more-purposeful and productive life in Christ. It is certainly not the time for self-pity or self-punishment. Turn your temporary affliction into an opportunity for growth.

WHAT IS POSTPARTUM DEPRESSION?

   A special form of depression women are prone to is the one that follows childbirth. Commonly it is known as the "baby blues," but technically it's postpartum depression. Like menopause, this depression was viewed for a long time as a neurotic disorder, and women were blamed for not being adequately prepared for motherhood. They were, supposedly, afraid of the responsibility. In a few cases that might be true, but for the majority of cases, the problem is again biological. Most mothers embrace their children and become bonded in such a way that makes for a happy child-rearing reaction.

   The intensity of the postpartum depression can vary from mild, where one may just feel a little down for a few days, to severe psychosis, where one is incapable of taking care of the child. The more severe the depression, the more clearly it is caused by biological factors. But even milder forms can be caused by fatigue and the hormonal changes that accompany childbirth. Postpartum depression is not confined to first-time mothers, either. Some women have a period of depression following the birth of each child. Others only have it sometimes.

   Almost every mother goes through a few "low" days after the birth of a child. This coincides roughly with the time it takes for the breasts to begin to produce milk. Many more women, however, experience a more severe depression when they leave the hospital. Sometimes this is due to just being physically run down, but often it's caused by the hormonal changes that follow childbirth.

DOES POSTPARTUM DEPRESSION REQUIRE TREATMENT?

   Only the severest depressions require treatment. Among the most common feelings experienced in postpartum depression are insecurity, fear of inability to cope with the baby, disappointment about the child's sex or appearance, confusion, general fears, and anxiety. Young mothers with postpartum depression need to resist believing there is something wrong with them. Certainly, there may be something wrong with their hormones, but that doesn't reflect on them as people.

   Questioning your ability to be a loving and caring mother or feeling guilty about not being the perfect mother will certainly aggravate your depression. To help you limit those thoughts and control your feelings, a brief period of counseling may be extremely

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helpful. Ask your pastor or physician for a referral to a competent therapist, preferably a woman who can help you sort out your feelings and prevent you from creating further losses. If you can receive emotional support and reassurance from your family friends, mother, or counselor, the chances are that the depression will quickly pass and your recovery will be complete.

   Whatever you do, don't overglorify motherhood. Being a mother is hard work, and not every baby is the perfect child. Just accept the reality of what it takes to be a mother and you'll cope a lot better. In a short while, your feelings will return to normal.

———

1. Family Circle, June 4, 1982, p. 28.

2. Archibald D. Hart, Adrenalin and Stress (Dallas: Word, 1986).

Chapter 4  ||  Table of Contents