Postpartum Depression in the Bronx community

Introduction

Postpartum depression is a major depression whose diagnostic principles are similar to those of the common mental depressive disorder, but whose symptoms set in within four weeks after delivery. The window period for postpartum depression has however been prolonged to a year after giving birth (David, Cheryl, Ye, Kellerman, & Silverman, 2011). PPD is therefore a critical health condition that needs serious investigation and management to avoid progression to a deleterious state. PPD has no specific etiology therefore choices made by healthcare providers in the management of PPD depend on their perceived theory related to the condition.

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Theories related to PPD and appropriate interventions

Biological Theories

These are the basis of the medical model, which takes PPD as an illness and a medical condition independent of social or environment factor. Women with PPD are therefore passive, with no control over their illness. Such factors as gonadal hormone levels before and after birth are believed to induce changes. Estrogen, progesterone, beta-endorphin, cortisol and human chorionic gonadotropin increase during the gestation period and their levels fall sharply after birth. Such sudden shifts in hormonal levels after delivery have been associated with PPD in the majority of cases. The withdrawal of these hormones could lead to decreased levels of central and peripheral monoamines (substances that control mood) and the result is depression.

The most appropriate intervention from this perspective is therefore the use of anti-depressant drugs that inhibit the uptake of monoamines into nerve endings both peripherally and into the central nervous system. This increases the circulating levels of these neurotransmitters hence their mood stabilizing effect is achieved (Abdollahi, Lye, & Zarghami, 2016)

Psychosocial theory

Generally, depression results from physiological and chemical changes in neurons, especially those of the central nervous system. Such changes result to an imbalance in levels of neurotransmitters that regulate mood and the result is a depressive disorder. External stressors and personal occurrences may trigger these changes. Factors such as lack of social support and love, marital conflicts, childhood experiences and desire to become better as well as unrealistic expectations after delivery are just but a few of the psychosocial aspects that may stimulate anxiety and depression in new mothers (Abdollahi, Lye, & Zarghami, 2016). Intervention of choice is psychotherapy and goals of management include creating support groups, increasing coping thresholds and positivity. The Bronx community has made quite a commendable progress in this through engagement of prenatal and postpartum psychotherapists who collectively walk pregnant and new mothers through pregnancy and motherhood (Sussex Directories Inc., 2017)

Both theories link PPD to some physiological changes. Therefore, based on these two theories, PPD results directly from bodily changes. The difference is however, the trigger factors for the changes. In the biological theories, changes result from internal physiological factors, hormonal imbalances that lead to neurotransmitter deficits. The weakness of this theory is that for some patients it may portray a negative image of sickness. Some mothers may feel humiliated and less sufficient by the fact that an event supposedly to bring joy makes them depressed. It would need an effective therapist to convince them that it is not their fault but rather a normal response to change. External factors, especially stressors, on the other hand induce physiological changes that lead to depression. Patient- clinician relationship is a critical aspect in both type of interventions. Issues about compliance to antidepressants, normality of hormonal imbalances, benefits of coping positively despite changes, and the impact of PPD on the well-being of both the mother and child should be discussed in depth.

Given a chance, I would choose the interventions linked to the biological theory, that is, antidepressants use. This is because the whole idea is to curb depression. Therefore, whether it is from external or internal triggers, these drugs would work wonders for the patient. External triggers could be prevented but effects resulting from hormonal imbalances are beyond an individual’s control. I would focus on what the patient cannot change.

 

References

Abdollahi, F., Lye, M.-S., & Zarghami, M. (2016, June). Perspective of Postpartum Depression Theories: A Narrative Literature Review. North American Journal of Medical Sciences, 8(6), 232-236.

David, A. S., Cheryl, R. S., Ye, F., Kellerman, L., & Silverman, M. (2011, June). The Epidemiology of Hospitalized Postpartum Depression in New York State, 1995–2004. Ann Epidemiol, 21(6), 399-406.

Sussex Directories Inc. (2017). Pregnancy, Prenatal, Postpartum Therapists in Bronx, NY. Retrieved April 26, 2017, from Psychology Today: https://therapists.psychologytoday.com/rms/prof_results.php?sid=1493192134.8154_3725&city=Bronx&state=NY&spec=578&rec_next=1&tr=BackResults