Postpartum Depression:Not just “Baby Blues”

Brooke Shields

Biography: Brooke Shields, born May 31, 1965 in New York City; has been in the public eye since before her she reached age 1 Mother—Teri Shields—small time actressFather—Francis Shields (deceased in 2003 from prostate cancer 3 weeks before the birth of Rowan)Parents divorcedOnly childModel, actress, wife, motherGraduate of Princeton University—French literatureMarried Chris Henchy (TV writer/producer) in 2001First born daughter—Rowan Francis—born May 15, 2003Second Daughter—Grier Hammond—born on April 18, 2006

One big happy family…

Above: Brooke and her daughters, Rowan and GrierMiddle: Brooke and mother Teri Shields

Above: Brooke and her husband Chris Henchy

In the public eye…•Movies/TV: most well-known movies include: “Pretty Baby” (1978)“The Blue Lagoon” (1980), “Endless Love”(1981). Star of the sitcom “Suddenly Susan”(1996) and appeared on “Nip/Tuck Season 4” (2006) •Magazines: has been featured on over 300 magazine covers between 1980-1985•Model: Calvin Klein (6’0”)•Broadway: Grease, Cabaret, Chicago•Media icon—named one of the 50 most beautiful people in the world by People Magazine (‘96 and ‘00)

First record of Depression:

• Hippocrates in the 4th century provided the first description of depression

• He called it “melancholia”• Believed it was caused by excess black

bile in the brain• (Areti & Bemporad, 1978)

What is Postpartum Depression?• Postpartum depression: a mood disorder that

commences after giving birth. • It can occur anytime within the first year

after childbirth; it usually occurs within the first couple weeks and adversely affects the mother’s ability to function.

• Many suffer for up to 6 months and about ¼ of sufferers still experience symptoms after a year if left untreated.

Symptoms: How do I know?

Typical depressive features:• Sadness• crying • insomnia• a lot of sleeping, • low mood/energy • loss of appetite• agitation• self-critical thinking (p. 47)

Anxiety component:• Anxiety• OCD symptoms• Sometimes these occur with little depression Be aware of suicidal ideations, and also fantasies about injuring the baby.•--”…I sat holding my newborn & could not avoid the image of her flying through the air & hitting the wall in front of me. I had no desire to hurt my baby & didn’t see myself as the one throwing her…the wall morphed into a video game, and in it her little body smacked the surface & slid down onto the floor…the image all but destroyed me…” (Shields, 71)

LOSS: major issue in PPD(Nicholson)

Loss of Autonomy Loss of TimeLoss of AppearanceLoss of FemininityLoss of SexualityLoss of Occupational identity

“In my mind, having the baby had made my life hopeless and meant that nothing would ever be the way it used to be” –Brooke Shields “Down Came the Rain”

Loss of Autonomy & Time•Autonomy—personal freedom•The women feel that they just can’t pick up and leave whenever they wish (vacation, hanging out with friends)•They have to tend to the baby instead of just themselves•Being a parent is a “24 hour, full-time job”•In a case study done, several women were interviewed on this subject. One woman said that the “new baby’s arrival eliminated time for her and her husband to be on their own together for at least 18 [more] years. • “I longed for the freedom to pick up and go to the movies or on a hike or on a trip out of the country…” (Shields, 70)

Loss of Appearance• Anxiety about the loss of their former appearance• Time plays into trying to keep up personal looks• They don’t feel comfortable with the changes in their

bodies after having a baby• They don’t like the fact they can’t wear the same

clothes or the same type of clothes as they once did before being pregnant.

• Developed anxiety about their appearance—saw the changes as negative

• “You think you’ll never get your body back together really” (Hilary, interview 2)

Loss of Femininity & Sexuality• Because of the anxiety about their appearance and

the shape of their body after pregnancy they do not feel that their spouse would be attracted to them as much.

• Worried about body size/shape• Self-image changed• Had to think of themselves are more motherly

beings than sexual beings• “Like on Saturday---I wanted to wear my leather

mini-skirt. But I had second thoughts…I’m a mother now” (Natasha, interview 3)

Loss of Occupational Identity

•The women have feelings of loss concerning:•--loss of power•--loss of opportunity•--loss of relationship w/ partners, friends•--loss of finances• “I feel I’m not contributing to the finances” (Sylvia, interview 3)

•Debate whether or not to go back to work or to stay at home with the child•Many have feelings of guilt

Motherhood:• Most people would think of having a child and becoming a

mother to be a “happy event”.• Motherhood has, is, and will be central to the female

identity and role in society.• Society/culture portrays this happy, healthy, perfect family

of the American Dream/Pleasantville society—places a lot of pressure

• If the women don’t feel this way right away they feel like failures and wring in their feelings.

• Brooke felt that people would see her only now by the role of being a mother and not by being an actress anymore

• --Defined herself and identity through her work and success.

The Perfect Candidate:• Parents divorced at very young age• Dealt with alcoholism on both sides of her family• Father diagnosed with prostate cancer and died 3 weeks before the

birth of her child• Her dear friend David committed suicide a couple years prior• Defined herself by her success in her job• Physical problems in terms of being able to get pregnant—short

cervix, In vitro fertilization, miscarriage; Had an emergency C-Section

• Her health was in danger after giving birth—herniated uterus• Rowan had to wear a harness for her jaundice• Traveling back and forth from NY to LA—new apartment• Didn’t have a baby nurse• Her and Chris were inexperienced parents

Possible Causes:• Emotional/Biological Changes: --Hormone

fluctuations (drop in estrogen levels)• Physical Changes: --sleep deprived,

exhausted –• Lifestyle Changes: --having the responsibility

for this little, fragile baby --added stress of routines changing –financial shifts –difficulty breastfeeding –lack of family/social support

Potential Risk Factors:• Previous history/predisposition to depression• Experienced Premenstrual Distress Disorder

(PMDD)• Stressful events occurring during pregnancy• Difficulty in marriage• Feelings of loss (occupational, physical,

social)• Child was unplanned/unwanted

More Risk Factors:•Caesarian birth•History of infertility/fertility

treatments• Illness in the infant• Isolation from family and friends, a

poor match in temperament between mother and child.• Thyroid problems

Levels of PPD:• 1.) Postpartum “Baby Blues—

less severe, most common. • 2.) Postpartum Depression—

moderately severe• --affects app. 8%-20% of

women• 3.) Postpartum Psychosis—

most severe

Level 1—”Baby Blues”

–Few days after childbirth–Sadness–Tearfulness–Irritability–Hormonal changes (like PMS)–If persistent can develop into

PPD• --Affects app. 80% of women

Level 3—Postpartum Psychosis•Postpartum psychosis – not PPD•Loss of reality testing•Delusions and/or hallucinations•Much less prevalent than PPD•Requires prompt consultation•Also institution of anti-psychotic meds, and sometimes hospitalization

Possible Treatments©Psychological:©--Cognitive-Behavioral Therapy—trying to get

rid of the negative thoughts of self, world and future and adding reinforcement (Craig & Dobson 1995) (Beck, Rush, Shaw, Emery, 1979)

©--Family Therapy©--Interpersonal therapy©“Talk” Therapy/Social Support Groups

Medical:©--Drug Therapy—anti-depressant drugs (i.e.

SSRIs such as Paxil or Prozac and other Tricyclic medications)

©--Hormone therapy—Estrogen reaplacement©--Sleep aids©Antidepressant drugs are less expensive than

psychotherapy (Beck, 1979)©“Can’t stop cold-turkey!” –Brooke did at one

point.

Paxil: Anti-depressant

http://www.youtube.com/watch?v=hfQUTHrWnRk

Brooke Shields personally takes the anti-depressant Paxil to help her postpartum depression.

The drug Paxil has been controversial in terms of the side effects and long term effects once someone decides to stop taking the drug

Personal Help/Self-Management Treatments

©Regulation and management toward a long-term goal/change

©Many focus on the negative events rather than the positive

©--spend time alone with husband/partner and the baby before having visitors

Treatment Effectiveness:

• With adequate treatment, PPD generally leaves after a few months.• Some women, however, may have chronic

symptoms.• Most effective treatment combines the medical,

psychotherapeutic, and social support aspect of treatment.• Pharmacotherapy—Medication paired with therapy• Medication has side effects and sometimes requires

a change/termination• --still having the therapy maintains progress

Q: True or False-- PPD is just for mothers

• A: FALSE—fathers can also develop a form of PPD because they also have to adjust to a new lifestyle with the addition of a new baby into the family.

• They are affected by the emotional state of the mother and also have an added responsibility to care for the child while the mother is suffering.

Dads cry too…• In Shields’ book, she recounts of a moment that

he husband Chris broke down:• “Chris went out to the store to buy a changing

table…He came back sooner and without the table…He looked up at me, his eyes filled with tears, and broke down…’There were women in the store who were happy, Brooke! They were smiling and happy to have their babies! What’s wrong with you? Why aren’t you happy? You don’t look at Rowan or sing to her or talk to her. Why? What’s happening?”

Q: True or False: The child of a parent with PPD is unaffected.

• A: False—Some studies have shown that the child/children of parents who have or are suffering from PPD are directly affected.

• An infant of a PPD mother can have irregular sleep, more depressed affect, higher norepinephrine levels, and a lower vagal tone (which indicates that the infant is undergoing stress and the body is reacting by releasing norepinephrine and the heart rate actually is slower in order for the body to deal with stressful activities—heart rate decreases and sympathetic activity increases.

• When toddlers these children are associated with having delays in verbal skills, having behavior problems, and the school-readiness skills lack.

• When the children get older they tend to develop some behavioral/emotional problems—this puts them at a higher risk for developing depression themselves.

• (Clark, Tluczek, Wenzel 2003

Public Criticism• One of the major

players in the criticism of Brooke’s treatment for her PPD has been Actor and recent Scientologist Tom Cruise.

http://www.youtube.com/watch?v=cc_wjp262RY However, on August 31, 2006,

Tom Cruise went to Brooke Shields’ home and personally apologized to her for his remarks.

Public Support

• Many other celebrities have extended their support for Brooke Shields. For instance, Oprah Winfrey, comedian Tom Arnold, Rosie O’Donnell, and Matt Lauer

• Rosie says, “After watching Tom on Oprah and then everything else in the free world, I think I may need to up my meds. Shout out to Brooke. You saved a lot of women by telling the truth.”

• Tom Arnold says, “I just think he’s [Cruise] is ignorant…I thought that Brooke Shields is very brave, because celebrities, we want to look cool, and (admitting) you wanted to kill yourself and maybe your baby is a very vulnerable thing for her to do…I think Tom is a little out of touch.”

“Down Came the Rain” “At long last, her dream of being a mommy had come true. But instead of being relieved and happy, all she could do was cry.

: “At first I thought what I was feeling was just exhaustion, but with it came an overriding sense of panic that I had never felt before. Rowan kept crying, and I began to dread the moment when Chris would bring her back to me. I started to experience a sick sensation in my stomach; it was as if a vise were tightening around my chest. Instead of the nervous anxiety that often accompanies panic, a feeling of devastation overcame me. I hardly moved. Sitting on my bed, I let out a deep, slow, guttural wail. I wasn't simply emotional or weepy (pg.65)

Taking Action

Sen. Robert Mendez & Brooke Shields

Press Conference for Mother’s Act on May 11, 2007

Above: from left to right) Former First Lady Mary Jo Codey, Senator Menendez, Brooke Shields, Sylvia Lasalandra and Susan Dowd Stone

New Legislature• Mothers Act: The Moms Opportunity to Access Help,

Education, Research and Support for Postpartum Depression Act (S. 1375)

• Endorsed by Senators Menendez and Durbin (NJ)• “M. President, in the United States, ten to twenty percent of women suffer from a

disabling and often undiagnosed condition known as postpartum depression. Unfortunately, many women are unaware of this condition and often do not receive the treatment they need. That is why I am introducing the MOTHERS Act, so that women no longer have to suffer in silence and feel alone when faced with this difficult condition” --Senator Robert Mendez--NJ

• This new act will require hospitals to educate the parents and families before they leave the hospital on the possibility of developing PPD after childbirth & give screenings for symptoms.

Further Progress and Recent News• October 15, 2007—Melanie Blocker Stokes Act

passed in US House by a vote of 382 to 3! Postpartum Research and Care Act.

• On October 20, 2007, Postpartum Support International (PSI) will be holding a fundraiser in New Jersey—which has also been designated as Postpartum Depression Awareness Day in NJ (Both Sen. Menendez and Brooke Shields will be honored)

• October 24, 2007 is BlogHers Day to support the MOTHERS Act• write a blog or call your local senator to show support.

“Out Came the Sun…”“Rowan remembers every motion to every portion of the song. I stare in amazement as her chubby baby hands with their dimpled knuckles intertwine while she pretends to be the spider climbing up the water spout. I can’t help myself and, plopping myself down in front of her, I quickly join in the song…With tears filling my eyes, we both reach up our hands and float them down like raindrops in front of us. As our fingers touch, I whisper, ‘Down came the rain and washed the spider out. Out came the sun and dried up all the rain, and the itsy bitsy spider went up the spout again.’” (Shields, 222)