About postpartum depression, in dialogue with meseriadeparinte.ro
Hi Mihaela, thank you very much for agreeing to do this interview. For starters, please tell us a few words about yourself.
I greet the readers of the blog "Parent's job" and thank you for this interview, I am glad to be able to discuss together some of the difficult situations that parents can go through before or after the birth of a child.
I am a psychiatrist: after graduating from the Carol Davila Faculty of General Medicine in Bucharest, I did a residency in psychiatry at Obregia Hospital and EPSAN Hospital in France.
I am a psychotherapist and associate member of the International Association of Psychoanalysis (IPA) - Romanian Study Group (2007-2011), Bucharest. I work individually, in an integrative approach to medication and psychotherapy; empathy, tolerance, respect and responsibility towards my patients are the values that define my practice.
I will start with the simplest question and probably the one you meet most often :). What is the difference between a psychologist and a psychiatrist?
The psychiatrist is a doctor, he graduated from medical school (6 years), then he did a 5-year residency in psychiatry and deals with the diagnosis and treatment of mental disorders. The psychiatrist evaluates, identifies and treats mental disorders with the help of pharmacotherapy. Only a psychiatrist can prescribe medication, so in major psychiatric disorders (schizophrenia, bipolar disorder, major depression, etc.), the presence of a psychiatrist is absolutely necessary.
The psychologist graduated from the faculty of psychology and obtained the certificate of free practice in a branch of psychology (work psychology, clinical psychology, educational psychology, etc.). Only clinical psychologists evaluate patients with psychiatric disorders. The psychologist evaluates human thinking, affect and behavior and intervenes with the help of counseling or psychotherapy.
The psychotherapist is either a psychiatrist or a psychologist, who besides the faculty of medicine and specialization in psychiatry, respectively the faculty of psychology, did a training in a school of psychotherapy. There are several schools of psychotherapy, all having in common the relationship with the client (the psychotherapist has clients, not patients).
When is it important to see a psychiatrist? Can we be aware of this need ourselves or is it necessary to be referred by a family doctor or other specialist?It is important to turn to a psychiatrist when we feel we need help, when things get out of hand, when the intensity of the suffering is too great, when the suffering causes a significant deterioration in our social, family or professional functioning.
There are emergency situations when consulting a psychiatrist is absolutely necessary: when there are thoughts or attempts to self-harm or harm others, when the perception of reality is distorted and the patient has auditory or visual hallucinations, when he has bizarre beliefs or delusional ideas, in states psychomotor agitation, or severe depression, etc.
Sometimes people realize for themselves that something is wrong and turn to the family doctor, who makes the referral to a psychiatrist, other times the family, the entourage is the one who notices the mental suffering of the patient. There is also the situation in which the referral is formulated by the doctor from other medical specialties, when the patient accesses various medical services, but the underlying problem is of a mental nature.
Are there situations that can occur during a pregnancy, when the intervention of a psychiatrist is useful?Prenatal mental illness is a common and underdiagnosed problem with varied and complex consequences for both the mother and the baby. The most common problems are minor prenatal anxiety and depression (between 7-26% of pregnant women go through it, more frequently in the first and third trimesters) or major (affects between 3-11% of pregnant women).
Depressive symptoms in pregnancy may occur outside of risk factors, but they are more common when there is a personal or family history of depression, when there are financial, marital or relationship difficulties, when the pregnant woman does not have a support circle: friends, parents, family with whom she can share the emotions that sometimes overwhelm her. Special situations of infertility, IVF, previous miscarriages, somatic complications of pregnancy, have an increased risk for depression in pregnancy.
Whatever the symptoms, women can generally hide their mental suffering until very late from the desire to "give well", to present themselves in congruence with social expectations, often hiding their difficulties from both families and professionals: gynecologists, midwives, doctors. family, etc.
If we are talking about a mild depression, the intervention of a psychologist or psychotherapist, support, counseling, supportive therapy may be sufficient. In case of severe depression, the intervention of a psychiatrist is necessary. There are also emergency situations, in which hospitalization is needed, when suicidal ideation or risky behaviors occur.
That is why early detection and psychiatric surveillance are important and any pregnant woman should go through a screening for depression during pregnancy. A very important role is played by supporting the pregnant woman, especially in connection with the concerns / questions - natural, by the way - regarding her ability to be a mother.
But after birth? We all know that many women are affected by postpartum depression but unfortunately very few know that it exists and can be treated.It is true that the risk of experiencing emotional difficulties after giving birth to a child is higher than at any other time in a woman's life: depression occurs in 10-15% of women who have given birth in the first year after the baby is born. At 5 weeks after birth, the risk of depression is 3-5 times higher than the general population, and at 3 months after birth, the incidence is about 15%.
After the baby is born, most women experience anxiety, excessive worry, sadness, helplessness, fear, guilt, sleep disorders (even when the baby is sleeping). It is a natural reaction, considered normal, which occurs in 50-80% of women, which resolves spontaneously in 10-12 days after birth, which we call postpartum blues.
If the symptoms persist after this period, then a psychiatrist should be consulted to evaluate and possibly treat the mother, who in addition to her depressive mood, is caring for a baby who asks for her. Therefore, postpartum depression should not be neglected by family or medical staff, especially since it can be easily detected. In general, it is observed by the family doctor, who notes the large number of consultations for major or minor problems of the mother or child. Sometimes close friends are the ones who often observe the mother's condition and encourage and support her in asking for help, which is why the support network for a slum is extremely important.
Untreated, depression can last for months without spontaneous improvement and risks becoming chronic, complications occur, significantly compromising both the woman's life and the quality of the mother-baby relationship in the first year of life.
The treatment is all the more difficult as the entourage refuses to recognize this condition, the greater the stigma in the family environment, and the mother, concerned about caring for the baby is less willing to talk about her problems.
There are also rarer situations (0.1-0.2% of the population) of psychotic decompensation of the mother, which endanger the life of the newborn and which represent a psychiatric emergency, which is hospitalized, due to the high risk for the mother and newborn.
Are men also affected by the "shock" of the appearance of a new family member?
I'm glad you asked me this question, because if something is known about mothers' feelings, with the onset of pregnancy, dads and their feelings are often forgotten, ignored or even worse, condemned.
Yes, the birth of a baby in the world upsets the family, parents, grandparents, aunts, so absolutely the father. The construction of the father-baby connection is mentally prepared during pregnancy. In order to be able to build a new family, the future father (like the future mother) will relate to his family of origin, to his own childhood, to his past, to his origins and attachments. Later, he will try to separate, in order to become the father's son, and head of the family.
The prospect of this change can mobilize new anxieties: fear of the unknown, fear of the future, fear of losing one's freedom. Each member of the couple sees himself as a parent to the extent that he has been given implicit permission and the blessing of his own parents.
Let's remember the wonderful movie Bambi, by Walt Disney, a movie loved equally by children and parents. For Bambi's father, access to fatherhood is not very simple, he needs the owl - a kind of mother of the forest, the sage of the village - to confirm him, to invest him in his role of father: «only you are the father … .and in the end who could take better care of the little prince than the big prince himself? ». The owl makes a transmission, a recognition and an investment of the filiation.
There is a lot of talk about women's hormonal storms during pregnancy, but few know that in men, there is a pattern of hormonal changes similar to that of her pregnant partner: a one-third drop in testosterone in men immediately after birth. baby, just to facilitate the mothering process of the baby and the partner.
However, the disorders that appear in men are often more insidious, both due to their increased tendency to hide, and due to social pressure and stigmatization.
If there is a history of mental suffering, then the risk of a perinatal disorder is increased. Sometimes trivial and transient, however, they can become much more serious in some vulnerable men. During this period, the following may occur with increased frequency: 1. Psychosomatic disorders (affects 8-10% of dads): insomnia, gastrointestinal disorders, high weight gain especially towards the end of pregnancy, dental pain, appetite disorders, dermatological disorders, low back pain. 2. Risk behaviors: beatings, quarrels, car accidents, increased aggression, alcoholic impregnation, marital escapes, or their equivalent. 3. Depression, fears and phobias of all kinds, etc.
The job of a parent is a very difficult one for which unfortunately no one prepares us. It adds to the long list of responsibilities, jobs, stress and daily worries. What are the most common conditions in parents, in which case it is important to consult a psychiatrist?Stress, depression and anxiety are the problems of modern man and their risk is even higher in the perinatal period. Psychosomatic disorders, substance use (alcohol, drugs), risk behaviors, and impulse control disorders such as gambling may occur more frequently during this period.
Many times the couple's relationship comes out very wrinkled after the appearance of a child in the family. How can we find ourselves as a couple and save our family? How can you help a couple in difficulty? Pregnancy and postpartum are a period of maximum vulnerability for partners, in which both can develop psychological and relationship problems. The vast majority of mothers and fathers struggle with their emotions during pregnancy and after the arrival of the baby, absolutely natural phenomena in a period of transformations and psychological adjustments.
If the parents feel anxious, stressed or depressed, it can be very difficult to give the child the care and love he needs. This is very disturbing for parents; Numerous studies have shown that such parental difficulties can have long-term negative effects on the baby's emotional, cognitive and social development. So that specialized help as early as possible can only be beneficial for both parents and children by improving the mental health of both parents and children.
Regarding pre- and postnatal problems, the latest guidelines in ante- and postnatal mental health consider early psychotherapy as the choice of choice.
If we have a problem and we know for sure that we can't solve it ourselves, that we need the help of a specialist, but we don't know where to go, can we turn to you? Could you guide us based on a message or a short email if it is a situation of competence of a psychologist or a psychiatrist?Sure, but I always do this assessment in the office, during a consultation, never by phone or email, facebook, etc. It takes a framework, space and time, for the meeting (be it a psychiatric consultation or counseling, psychotherapy) with a psi professional to take place and be beneficial to people.
Where do we find you and what are the problems you can help us with?You can find me at my office and in my virtual space: www.mihaeladumitru.ro, where you find all the necessary information to be able to make an appointment and more! For medical consultations and reimbursed prescriptions, a referral ticket (usually from the family doctor) and a health card are required.
Mihaela, thank you very much for this very interesting interview, if you agree, I would like you to make some more articles together in the future in which to deepen some of the situations mentioned by you above.
And I thank you! And I look forward to any topic you want to discuss!
My dear ones, I hope this article was useful to you, if you have questions for which you have not found answers and you think that Mihaela can be of help to you, you can confidently send her your messages to the email address above. And if you have topics about which you would like to know more details, I am waiting for your messages by email or in comments.
Dr. Mihaela Dumitru, psychiatrist, interview www.meseriadeparinte.ro, July 2015