Postpartum Psychosis (PP) Resources

by Aunt Becky | Apr 30, 2019

What Is Postpartum Psychosis (PP)?

Postpartum Psychosis (PP) is a severe, yet treatable, form of postpartum mental illness that occurs to some women after they’ve had a baby. It can happen to women without previous experience of mental illness, and usually begins in the first few days to weeks after childbirth. About half of women who experience it have no risk factors; but women with a prior history of mental illness, like bipolar disorder, a history of prior episodes of postpartum psychosis, or a family history are at a higher risk. Postpartum psychosis is different from postpartum depression and the Baby Blues Baby blues is common 2-3 days after childbirth but should pass. In some cases, the depressed mood lingers for more than 2 weeks and months after the labor, when some women receive a diagnosis of postpartum depression.

Postpartum Psychosis is a rare mental illness, compared to the rates of postpartum depression or postpartum anxiety. It occurs in approximately 1 to 2 out of every 1,000 deliveries, or approximately .1 -.2% of births. The onset is usually sudden, most often within the first two weeks postpartum, Unlike the Baby Blues symptoms, postpartum psychosis is treated as a medical emergency and requires urgent treatment. Most women get committed to a mental hospital, residing either in Mother and Baby units, at the general psychiatric ward, or in postpartum depression treatment centers.

Postpartum psychosis can worsen extremely quickly and should always be treated as a medical emergency. Most women need to be treated with medication and admitted to hospital for emergent care to treat the woman for the symptoms of this frightening mental illness.

Of the women who develop a postpartum psychosis, research has suggested that there is approximately a 5% suicide rate and a 4% infanticide rate associated with the illness. This is because the woman experiencing psychosis is experiencing a break from reality. In her psychotic state, the delusions and beliefs make sense to her; they feel very real to her and are often religious. Immediate treatment for a woman going through psychosis is imperative.

It is also important to remember that many survivors of postpartum psychosis never experience delusions that give violent commands. Delusions can take many forms, and not all of them are destructive. Most women who experience postpartum psychosis do not harm themselves or anyone else. However, there is always the risk of danger because psychosis includes delusional thinking and irrational judgment, and this is  illness must be quickly assessed, treated, and carefully monitored by a trained mental healthcare team.

Postpartum psychosis is temporary and treatable with professional help, but it is an emergency and it is essential that you receive immediate help. If you feel you or someone you know may be suffering from this illness, know that it is not your fault and you are not to blame. Call your doctor or an emergency crisis hotline right away so that you can get the help you need.

Fortunately, with  the right treatment, women with PP can and do make a full recovery. Recovery takes time and the journey may be tough. The illness can be frightening and shocking for both the woman experiencing it and her partner.  Women do return to their normal selves, and are able to regain the mothering role they expected. There is no evidence that the baby’s long term development is affected by Postpartum Psychosis.

What Are Postpartum Mood Disorders?

Postpartum mood disorders can include severe depression (sometimes mixed with anxiety), as well as other seriously disabling problems labeled with terms such as anxiety/ \panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and, very rarely, psychosis. Postpartum depression is by far the most common of postpartum mood disorders, affecting about one in seven new mothers. It can start anytime in the first year after giving birth. Symptoms of postpartum depression can include hopelessness, suicidal thoughts, sleep and eating problems, inability to feel good or be comforted, and withdrawing into oneself. A woman experiencing postpartum depression may have a hard time caring for her baby or meeting the other demands of daily life.

Besides postpartum depression, women sometimes experience other postpartum mood disorders. Feelings of intense anxiety, fear, or panic, along with rapid breathing, an accelerated heart rate, hot or cold flashes, chest pain, and shaking or dizziness are symptoms of an anxiety/panic disorder. Recurrent frightening thoughts, including obsessing over the baby’s health or acting out repetitive behaviors such as compulsive hand washing, are symptoms of an obsessive-compulsive disorder. A combination of depression with anxiety/panic disorder or obsessive-compulsive disorder is also possible.

Postpartum Psychosis is the label used by most professionals for an episode of mania or psychosis that occurs soon after childbirth. However, other names can be used, including: Puerperal Psychosis; Postnatal Psychosis; Mania or Bipolar Disorder triggered by childbirth (this doesn’t necessarily mean that your partner will develop ongoing Bipolar Disorder); Schizoaffective Disorder with onset following childbirth (this doesn’t necessarily mean that you will develop ongoing Schizoaffective Disorder); Postnatal Depression with psychotic features.

While there appears to be a strong link between postpartum psychosis and bipolar disorder, it’s estimated that about half of women who present with postpartum psychosis have no psychiatric history prior to delivery, making it difficult to identify women who are at greatest risk for this illnessThere are many other mental health conditions that occur following childbirth, including Postpartum Depression, Postpartum Anxiety, and Postpartum Obsessive Compulsive Disorder (P-OCD). It is important that these conditions are not grouped under the term Postpartum Depression. PPD is much more common than PP, but tends to require different treatments and has different causes and outcomes.

Help is available

You’re not alone. 

What Are The Causes Risk Factors For Postpartum Psychosis?

If you’re at high risk of developing postpartum psychosis, you should have specialist care during pregnancy, though about half of women who experience postpartum psychosis have no risk factors. While research into Postpartum Psychosis is ongoing, we still have much to learn about this serious mental illness. What is currently known about Postpartum Psychosis is this:

• Lower birth weight increases the risk of postpartum psychosis, whereas gestational diabetes and birth weight were associated with a reduced risk of first-onset psychoses during the postpartum period.
• Older mothers (over 35 years) are about 2.4 times as likely to experience postpartum psychosis than younger mothers (under 19 years).
• PP is not your fault. It is not caused by anything you or your partner have thought or done.
• Relationship problems, family, money troubles, or an unwanted baby do not cause PP.
• The dramatic changes in hormone levels following birth are thought to trigger PP, but studies have not yet identified how these factors are involved.
• For a woman with no history of mental illness who has a close relative (a mother or sister) who had postpartum psychosis, the risk is about 3%
• The first month after delivery is the time of greatest risk for psychotic illness.
• Genetic factors are thought to play a role. Women are more likely to have PP if a close relative has had PP. There may be a genetic component; while mutations in chromosome 16 and in specific genes involved in serotoninergic, hormonal, and inflammatory pathways have been identified, none had been confirmed as of 2019
• Women with a history of Bipolar Disorder or schizophrenia are at very high risk of PP.
• Disrupted sleep patterns may cause PP for some
• Women who already have a diagnosis of bipolar disorder, schizoaffective disorder, schizophrenia, or another psychotic illness are considered to be at a higher risk for developing postpartum psychosis.
• Women with a history of bipolar disorder, schizophrenia, prior episode of postpartum psychosis, or a family history of postpartum psychosis are at high risk; about 25-50% of women in this group will have postpartum psychosis.
• After one episode of postpartum psychosis, the risk for additional episodes of postpartum psychosis increases to 30-50%.
• There is mixed evidence about whether the type of delivery or a traumatic delivery plays a role. It is possible that there are overlaps with physical illnesses that occur during childbirth, such as pre-eclampsia and infection..

What Are The Symptoms of Postpartum Psychosis?

Symptoms of postpartum psychosis usually start suddenly within the first two weeks after giving birth. Rarely, they can develop several weeks after the baby is born. For some women, Postpartum Psychosis may develop very quickly and become obvious that something is wrong. For other people, symptoms may emerge more gradually. This can be difficult to determine if the symptoms are part of the natural childbirth process, or if it’s an actual emergency. When in doubt, call for help.

The symptoms vary and can change quickly. The most severe symptoms last from 2 to 12 weeks, and recovery usually takes 6 months to a year.

Postpartum Psychosis is a medical emergency and must be treated immediately.

Women with Postpartum Psychosis experience some or all of the following symptoms:

• Excited, elated, or feeling “high”
• Depressed, anxious, or confused.
• Excessively irritable or changeable in mood (also called mood lability)

Postpartum Psychosis must also include one or more of the following:

• Strange beliefs that could not be true (delusions).
• Hearing, seeing, feeling or smelling things that are not there (hallucinations).
• High mood with loss of touch with reality(mania).
• Severe confusion.

These are also common symptoms:

• Being more talkative, sociable, on the phone an excessive amount.
• Having a very busy mind or racing thoughts.
• Feeling very energetic and like Super Mom
• Agitated and restless.
• Having trouble sleeping, or not feeling the need to sleep.
• Behaving in a way that is out of character or out of control.
• Feeling paranoid or suspicious of people’s motives.
• Feeling that things are connected in special ways or that stories on the TV or radio have special personal meaning.
• Feeling that the baby is connected to God or the Devil in some way.

The majority of postpartum survivors rarely or never experience violent tendencies and delusions. The vast majority of women who survive postpartum psychosis won’t harm themselves or the baby. However, staying quiet about the debilitating condition, the loneliness deprives both mother and child of bonding and forming the strong connection that would otherwise occur.

Suicide and infanticide, the most devastating outcomes of severe postpartum psychosis, occur in between 4 and 5% of women afflicted with the illness. Tragic outcomes happen when the symptoms in a mother worsen to the point of detaching from reality. Mothers become deeply affected by irrational, paranoid ideas that make sense to them.

Most often, infanticide takes place when the mother believes that the child is in danger, often from supernatural forces, so ending the baby’s life looks like the only remaining option. Tragic outcomes can only be avoided through urgent medical treatment.

How is Postpartum Psychosis Diagnosed?

Diagnosis of postpartum psychosis always requires hospitalization, where treatment is antipsychotic medication, mood stabilizers, and, in cases of strong risk for suicide, electroconvulsive therapy. Women who have been hospitalized for a psychiatric condition immediately after delivery are at a much higher risk of suicide during the first year after delivery.

The rapid and accurate diagnosis of postpartum psychosis is essential to expedite appropriate treatment and to allow for quick, full recovery, prevention of future episodes, and reduction of risk to the mother and her children and family.

How Is Postpartum Psychosis Treated?

Postpartum Psychosis is a psychiatric EMERGENCY and must be treated immediately.

Call 911 or your doctor.

Treatment of Postpartum Psychosis has no official guidelines. Once tests are administered and all the proper medical causes have been excluded from the diagnosis then the proper treatment is given based on the symptoms. Before the mother is released from the hospital, the team that administered treatment will work with the mother and her family to create a discharge plan that will strengthen her support, along with close follow-up, and prevent stressors that will risk the mother relapsing. Also, for future pregnancies, the mother’s primary care provider is advised to work jointly with other specialists on her care team giving her care in thought of anti-manic prophylaxis during pregnancy or after childbirth.

The mother may not recognize that she has anything wrong with her, so it may be up to the family to insist upon proper psychiatric care. At no time should the mother be left alone with the child until it is determined that the mother is being properly treated and the mother and child are both safe. It is vital that there be a supportive network of family and friends to care for both the mother and the baby.

The mother should be thoroughly evaluated by a doctor both during the episode and for some time afterwards. Symptoms may reappear within a year or two postpartum. Hospitalization is required in order for the mother’s treatment, particularly any medication regimens, to be properly administered and monitored. Women do return to their normal selves, and are able to regain the mothering role they expected. There is no evidence that the baby’s long term development is affected by Postpartum Psychosis.

Note: It is not uncommon for people to think the term postpartum schizophrenia is interchangeable with the diagnosis of postpartum psychosis. Postpartum schizophrenia is not a real diagnosis. Schizophrenia itself is a different diagnosis than psychosis. The disease of schizophrenia is treatable, but not curable. Postpartum psychosis, on the other hand, is both treatable and curable.

Admission To The Hospital:

As Postpartum Psychosis is an actual emergency, the very best and safest place for someone who has PP is in the hospital, which can cause major feelings within the family. Often, people don’t want to go or stay in the hospital for treatment, but as PP can lead to murder, suicide, and infanticide, ensuring your safety is the most important goal. In the hospital, you will be treated using a variety of different medications, other therapies, and therapy.

If you’re the partner of someone who has postpartum psychosis, it’s very likely that you may have to involuntarily to commit your loved one – for the safety of all involved. The length of time for hospital admission is highly individual. An average stay for PP is around 8 –12 weeks, but some women are admitted for only 2 weeks and some for much longer

Partners say that seeking treatment can bring about a vast array of difficult emotions – feelings of disloyalty, guilt, relief, helplessness, stress and frustration. The health system can be hard to navigate, and a great deal of tenacity is sometimes needed.

Before you is discharged from the hospital, you and your partner should ask for help in making a plan of action with your treatment team in case she gets ill again. The plan should include:

• Triggers that may make you more vulnerable to high or low moods, such as stress.
• Early warning signs to look out for, such as sleeplessness.
• Which treatments or medications, and what doses, have worked well in the past.
• Any medications you’d like to avoid.
• Where you would like to be treated if you were to go back into a hospital.
• The phone numbers of any health professionals and services you’ll need.
• Activities you find helpful to your recovery.

Medication For Postpartum Psychosis:

You may only be in hospital for a short time, but it’s likely that you’ll probably need to take medication for a longer period after being discharged from hospital.

Different medications and dosages work for different people and it’s hard to find the right balance of psychiatric medications, so you may have to change medications and treatment at any time. Many medications used to treat Postpartum Psychosis have some side effects, so be sure to continue to chat with your treatment team about your treatment, including any side effects you are experiencing. Dosage can be changed or taken at different times of the day depending upon the side effects.

Many medications for postpartum psychosis can take 3 – 4 weeks to have an effect, which can cause major anger and frustration for all involved. Your doctors will be keeping an eye on how you and may change medication as needed. Be sure to ask the doctors and nurses any questions you have about your medications.

It’s very likely that your treatment team will use some of the medications listed below. It’s important to note that some of the medications for PP may have some unpleasant side effects for some, people, particularly when just starting to take them. Make certain to report any and all side effects to your treatment plan.

• Antidepressants are used to help improve low mood and are often used alongside a mood stabilizer.
• Antipsychotics are used to help treat psychotic symptoms such as unusual beliefs (delusions) and seeing or hearing things that are not there (hallucinations). They can also help to reduce anxiety and high mood (mania). At higher doses, many antipsychotics can cause you to feel sleepy and unmotivated, but remember that you may need these higher doses to fully recover.
• Benzodiazepines may be used to help to reduce agitation and anxiety.
• Mood stabilizers may be used to treat high mood (mania), low mood (depression) and dramatic changes in mood.
• Sleeping medications can be used in the short term to help regain normal sleeping patterns.
• ECT (Electroconvulsive therapy) In some cases, severe symptoms of Postpartum Psychosis persist even when you’ve been taking medication for quite awhile.If this is the case, or if the illness is particularly severe, the psychiatrist treating your partner may recommend that you consider ECT. ECT can be an effective treatment for PP.
• Other types of therapies may also be used to help you, including psychological therapy. As you move forward with your recovery, you will receive a referral to a therapist for therapy.

Most women who have recovered say that taking medication was vital to their recovery as medications help bring the symptoms of psychosis under control and to stabilize your mood.You may feel, however, that medication only helps with half the problem – symptoms but not self confidence. It is important to use more active recovery methods alongside medication to help with self confidence and the social side of recovery.

The great majority of women with postpartum psychosis make a full recovery as long as they receive the right treatment.

The Aftermath of Postpartum Psychosis:

You and your family should have emergency contact numbers for local crisis services, if you, your partner, or family think you are becoming unwell. If you think you are becoming unwell again, don’t wait to seek help.

Postpartum psychosis can go undetected and pass spontaneously in many women. Considering the risks, the best way to help yourself is to surround yourself with support. Being open and honest about your feelings, thoughts and fears will help your family and friends understand your condition better.

In the early days after being diagnosed and/or receiving treatment in hospital you may feel a sense of confusion about the events of your baby’s birth and your illness. Many women find it hard to remember the exact sequence of events. Some of the following ideas may help you to piece together what happened:

• Ask your treatment for a summary of events and your treatment.
• Talk to your partner or family about what happened – but some people find this very hard and need time to recover first.
• Write your story as you can remember it.
• Use photos or memories to put together a timeline of events. This can help you look back on your baby’s first days even though they weren’t how you expected them to be.
• Read other women’s stories Many women behave in ways that are really out of character during an episode of Postpartum Psychosis. It may help just to know that these experiences are usual symptoms of the illness.

These ideas may help you learn to cope with what has happened:

• You may feel let down, angry, and/or unhappy about the way treatment was started, especially if you had to go to hospital under an involuntary admission.Remind yourself that these were symptoms of the illness and not a permanent change in you.
• It is very common during PP to become angry, excitable, use inappropriate language, be overfamiliar with strangers, or believe you have special insight or powers.
• Distressing thoughts about harming yourself or your baby are also common, though very upsetting. It is very normal to feel embarrassment or shock at the things you did when unwell.
• Talk through upsetting symptoms with your partner.
• Ask to speak to a health professional (such as a support worker, specialist midwife, community psychiatric nurse, or another member of the your treatment team) about how you feel about your symptoms.
• A psychologist or counsellor (particularly one with specialist knowledge of postnatal illness) may be able to help you talk through your experiences.

It’s normal to feel a whole range of emotions when you begin to recover from Postpartum Psychosis (PP). Below are some common emotions:

• Shock
• Embarrassment
• Why me?
• Anger
• Exhaustion
• Guilt
• Worries and anxiety about bonding with your baby, your relationships, and your future health.

People recover from distressing experiences in different ways. Some need to talk about it, others may find that they’d like to face recovery in a different way, and you may find that you and your partner are dealing with the impact of PP in the same way, or in very different manners. This is where you and your partner must work together, be patient with each other, provide support and love, and don’t hesitate to ask the treatment team if what you’re experiencing is normal.

Here are some of the things you can do to cope with postpartum psychosis:

• Be open about your thoughts, fears, and doubts. The postpartum period is always a rocky emotional and mental journey and a time of great mental adjustment.
• Beat fear and shame. Most women who experience aggressive or irrational thoughts about themselves and their babies feel ashamed of talking about it. Sharing your thoughts with close ones helps them help you. Once you’ve experienced and received support, you will feel more confident in your recovery and gradually regain faith in your own judgment.
• Be kind to yourself and understand that postpartum psychosis doesn’t define you. You’re no less of a mother because you have a mental illness. You didn’t choose to get sick, and you are equally valuable to your baby and your family regardless of your mental state.
• Follow your care plan. Stay devoted to taking medication as prescribed and keeping up with appointments. At times, you might too tired or drowsy to stay on schedule. Make sure to have a backup plan to meet all of your appointments, including someone to drive you and someone to stay with the baby.
• Focus on rest, recovery, and bonding with your child. Recovery from postpartum psychosis isn’t the time to worry about housework. Rely on friends and relatives to help as much as possible so that you can spend plenty of time resting and bonding with the baby.

Many women who have been through PP find that there are ups and downs in their mood over the first year of recovery, which can lead to feelings of a relapse or setback, if things have been otherwise going well. Having another bout of anxiety, depression, and other symptoms can make women feel as they’ll never recover. An episode of postpartum psychosis is sometimes followed by a period of depression, anxiety and low confidence.

It might take a while for you to come to terms with what happened. Some mothers have difficulty bonding with their baby after an episode of postpartum psychosis, or feel some sadness at missing out on time with their baby. With support from your partner, family, friends, and your mental health team, you can overcome these feelings.

Neither you or your partner can make this mental illness get better by toughing it out. It’s something that must be closely monitored and treated and watched and talked about. Try to have a discussion about PP at least every day.

Set small achievable goals. As you monitor your progress you’ll see that every setback doesn’t take you back to square one. It’s important for you to see how far you’ve come.

Keep a mood diary, which can help you track triggers for high and low moods. This is handy to bring to the treatment team, so they can best monitor and treat your mental illness Partners may want to keep a mood diary of their own. Getting to know yourself better allows you to notice any things you do which particularly affect the mood at home, for better or worse.

Make a a list of things that make you feel happy, and try them out when you’re feeling down and make a list of things that help you feel calmer and more relaxed, use them to try something from it if you’re feeling stressed or high.

What Are The Outcomes For Women Who Have Postpartum Psychosis?

The most severe symptoms of PP usually last from 2 to 12 weeks; it can take between six months and a year to recover – every woman is different in her recovery. Women often experience low self-esteem and difficulties as they recover, but most women fully recover. Many women who have PP  have a hard time bonding with their child as they recover, but end up with healthy relationships with their babies.

Postpartum psychosis can disappear gradually in the months after labor, but can also linger for years. Women who choose to speak openly about the illness and seek help often find that antepartum psychiatrists and medication have a beneficial long-term impact.

About half of women who experience postpartum psychosis have further experiences of mental illness unrelated to childbirth; further pregnancies do not change that risk. Women hospitalized for a psychiatric illness shortly after giving birth have a 70 times greater risk of suicide in the first 12 months following delivery.

Should I Have Another Baby?

Making the decision to have another baby isn’t straightforward. Thinking about it might bring a lot of worries – will you and your partner go through the same painful experiences all over again? The more you can both share about your
hopes and fears, the easier it will be to make an informed decision together.

Many women who have had Postpartum Psychosis go on to have more children, and about 50% do not experience PP again after the birth of another baby. With the right care, if your partner does have another episode, you should be able to spot the signs, get help before it becomes too severe, and recover more quickly the second time around.

You can plan as many children as you want, even with history of postpartum psychosis. However, you will have to set up a support system and be prepared for the illness right after childbirth. Those with high risk from postpartum psychosis should have a support team monitoring their state during the pregnancy and after childbirth. If you’re expecting to experience postpartum psychosis after childbirth, specialist care during the pregnancy, as well as consultations with a psychiatrist are a good way to support mental health.

At around 32 weeks of pregnancy, everyone involved with your care, including family and friends, midwife, GP, and obstetrician, should meet to exchange information and agree on the postpartum care plans. In some maternity units, you may see a psychiatrist or mental health nurse before you leave hospital, even if you are well. This is to check that you are well at the time you go home. They should also check the plan made at your pre-birth planning meeting. They can make sure you have any medication you need and set up any support services as possible.

You should get a copy of your written care plan. This should include early warning symptoms and a plan for your care. There should also be details of how you and your family can get help quickly if you do become unwell.

The best solution for your postpartum care is to define the treatment course after the delivery. Some women have symptoms so severe that they need to be admitted to the psychiatric ward right after the childbirth. Others rely on the help of friends and family with housework and the baby. In some cases, mothers are under constant supervision from family members and never left alone with the baby. Though it might seem unsettling to know you can’t be alone with your child, this is the only way to ensure the safety of both of you. When someone is always present to help out with the baby, you are left with more time to recover and bond with the child.

You should discuss:

• The risk of developing postpartum psychosis.
• Risks and benefits of medication in pregnancy and after birth. This should give you the information you need to make decisions about your treatment.
• The type of care you can expect in your local area from perinatal mental health and maternity services and how professionals work together with you and your family.
• If you are at high risk of postpartum psychosis, you should have specialist care in pregnancy, If you are already under the care another mental health service they can work together

Postpartum Mood Disorders

by Aunt Becky | Apr 28, 2019

What Are Postpartum Mood Disorders?

Pregnancy is a whirlwind of tons of emotions and sensations – our body is ever changing as well as our wishes, dreams, plans, hopes, and expectations that come at us both from every direction. It’s completely normal to feel overwhelmed by the idea of bringing a new life and person into the world, while strangers and loved ones alike bombard you with their experiences and ideas.

Most pregnant women feel their appetite increase, an eager anticipation of the new life to come, and sleep should be good (excepting getting comfortable, which is always a challenge during pregnancy). Normal worries and concerns will be sprinkled throughout the pregnancy experience, but they shouldn’t dominate our days or nights.

Ask yourself, “Do I emotionally feel like ‘me’ most of the day?” “Can I to sleep at night?” “Am I mostly excited about the baby coming?,” and “Am I eating enough?”

All of the above should be answered with a resounding “YES.”

If you’re not, it’s time to seek out a specialized health care practitioner who can help understand what’s happening with you

Depression and anxiety affect just as many pregnant women as new mothers, and can happen to the strongest, most intelligent, and loving moms. If you experience depression during your pregnancy, speak to your obstetrician – this is called antepartum depression, and it affects a great many men and women during pregnancy. There are a number of ways you can get help, and not all of them involve medications.

Every trimester you should either be given a formal screening or simply asked a few key questions to determine how you’re doing emotionally.  Receiving the right help during pregnancy will not only be best for you and your entire family, it will help you minimize the risk of postpartum depression.

Several days to weeks after giving birth, some mothers and fathers notice that they’re experiencing some strange symptoms, (most commonly) sadness, and/or anxiety after the birth of their child.

An estimated 1 out of every 6 women and 1 out of every 10 men experiences troubling depression or anxiety after the birth or adoption of a child, and in most people, these feelings are generally transient in nature. Given the tremendously stressful period of learning to live life with a newborn or new child is tremendously stressful to all involved, which is why we now recognize then men can also have postpartum mood disorders.

During the postpartum period, about 85% of women experience some type of mood disturbance. Generally, these symptoms are mild and short-lived; however, 10 to 15% of women and men go on to develop more significant symptoms of depression or anxiety. Postpartum psychiatric illnesses are typically divided into categories:

• Antenatal/Antepartum Depression
• Postpartum Baby Blues
• Postpartum Depression
• Postpartum Anxiety Disorders
• Postpartum OCD
• Postpartum Psychosis

It may be useful to conceptualize these disorders as existing along a continuum, where postpartum blues is the mildest and postpartum psychosis the most severe form of postpartum mood disorders.

Postpartum mood disorders are often characterized by despondency, emotional instability, anger, guilt, tearfulness, worrying, anxious thoughts or images, feelings of inadequacy and the inability to cope. It may occur shortly after the arrival of a new baby or many months later. For some, symptoms may begin in pregnancy; which is called or Antenatal Depression. The types of postpartum mood disorders generally lay on a spectrum.

Risk Factors for Developing Postpartum Mood Disorders:

Some things can make you more likely than others to develop postpartum mood disorders, including PPD. These are called risk factor. and having a risk factor or a few doesn’t mean for sure that you’ll have any problems with your mental health during or after pregnancy, but these risk factors, may increase your chances. Talk to your health care provider to see if you’re at risk for a postpartum mood disorder.

Your health care provider should assess you for PPD at your postpartum care checkups, including questions about your risks, feelings, stress level, as well as your moods.

Risk factors for postpartum mood disorders include:

• Depression during pregnancy (Antenatal depression) or you’ve had major depression or another mental illness before
• Family history of depression or mental health disorders.
• You’ve been physically or sexually abused in your life
• Problems with your partner, including domestic violence (also called intimate partner violence or IPV).
• Extra stress in your life, such being separated from your partner, the death of a loved one, or an illness that affects you or a loved one.
• Unemployed or have low income, little education, or little support from family or friends.
• Pregnancy is unplanned or unwanted, or you’re younger than 19.
• You have diabetes. Diabetes can be pre-existing diabetes (also called pre-gestational diabetes) or it can be gestational diabetes.
• Pregnancy complications such as premature birth, birth before 37 weeks of pregnant
• Multiples (twins, triplets) pregnancy
• Pregnant with a child who has been diagnosed birth defects
• Experiencing pregnancy loss.
• You have trouble breastfeeding or caring for your baby.
• Infant is sick or has ongoing health conditions.
• Negative thoughts about being a mom and/or having trouble adjusting to being a parent.

Negative thoughts and feelings about being a mom may include:

• Doubts that you can be a good mom
• Pressure to be a perfect mom
• Feeling that you’re no longer the person you were before you had your baby
• Feeling that you’re less attractive after having your baby
• Having no free time for yourself
• Feeling tired and moody because you aren’t sleeping well or getting enough sleep

What is Antenatal Depression?

Depression during pregnancy, or antepartum depression, is a mood disorder just like clinical depression as far as symptoms are concerned. Mood disorders are biological illnesses that involve changes in brain chemistry and men and women who suffer from major depression are at a higher risk for developing antenatal depression.

During pregnancy, as I’m sure you’re aware, hormone changes affects the chemicals in your brain, including those that tell you to eat, sleep, and rest. Some of the other hormone changes are directly related to Antenatal Depression and Antenatal Anxiety. Unfortunately, these hormones can be exacerbated by difficult life situations, stress, and other factors which can result in depression during pregnancy.

Women with Antepartum Depression tend experience some of the following symptoms for at least two weeks:

• Persistent sadness
• Problems concentrating
• Sleeping too little or too much
• Loss of interest in activities that you usually enjoy
• Recurring thoughts of death, suicide, or hopelessness
• Anxiety without a trigger
• Feelings of guilt or worthlessness
• Change in eating habits

What Are The Postpartum Baby Blues?

Specialists believe that approximately 50 to 85% of women and men experience postpartum blues during the first few weeks after delivery; part of it is related to wildly changing hormone levels, the stress of having a new person to care for, and not feeling as though they’ll be able to manage. As this type of mood disorder is common – even expected, it can be more accurate to consider The Baby Blues as a normal experience following childbirth rather than a psychiatric illness.

Rather than feelings of sadness, men and women with The Baby Blues more commonly report mood lability, tearfulness, anxiety, and/or irritability. These symptoms typically peak on the fourth or fifth day after delivery and may last for a few hours or a few days, remitting spontaneously within two weeks of delivery.

While these symptoms are unpredictable and often unsettling, they do not interfere with a woman’s ability to function. No specific treatment is required; however, it should be noted that sometimes The Baby Blues heralds the development of a more significant mood disorder, particularly in women who have a history of depression.

If symptoms of depression persist for longer than two weeks, you should be evaluated to rule out a more serious postpartum mood disorder.

What Is Postpartum Depression (PPD)?

PPD tends to emerge over the first two to three months postpartum but can occur at any point after delivery. Some men and women actually note the onset of milder depressive symptoms during pregnancy. Postpartum depression is clinically indistinguishable from depression occurring at other times during a woman’s life.

In women and men who have milder cases of PPD, it can be quite difficult to detect postpartum depression because many of the symptoms used to diagnose depression (such as sleep and appetite disturbance, fatigue) also occur in postpartum women in the absence of depression.

The Edinburgh Postnatal Depression Scale is a 10-item questionnaire that may be used to identify women who have PPD.

On this scale, a score of 12 or greater or an affirmative answer on question 10 (presence of suicidal thoughts) raise concern and indicate a need for more thorough evaluation.

Some of the symptoms of postpartum depression include:

• Depressed or sad mood
• Persistent sadness not otherwise explained
• Tearfulness
• Loss of interest in usual activities
• Feelings of guilt
• Feelings of worthlessness or incompetence
• Fatigue
• Sleep disturbance
• Change in appetite
• Poor concentration
• Suicidal thoughts

What Causes Postpartum Depression?

The postpartum period is characterized by a rapid shift in the hormonal environment. Within the first 48 hours after delivery, estrogen and progesterone concentrations fall dramatically. As these gonadal steroids modulate neurotransmitter systems involved in the regulation of mood, many investigators have proposed a role for these hormonal shirts in the emergence of postpartum affective illness.

While seems as if there is no consistent correlation between serum levels of estrogen, progesterone, cortisol, or thyroid hormones and the occurrence of postpartum mood disturbance, some investigators hypothesize that there is a subgroup of women who are particularly sensitive to the hormonal changes that take place after delivery. This population of women may be more vulnerable to PPD and to other hormonally driven mood disturbances, such as those occurring during the premenstrual phase of the menstrual cycle or during the perimenopause.

Other factors may play a role in the development of PPD. One of the most consistent findings is that among women and men who report marital dissatisfaction and/or inadequate social supports, postpartum depressive mental illnesses is more common. Several investigators have also demonstrated that stressful life events occurring either during pregnancy or near the time of delivery appear to increase the likelihood of postpartum depression.

While all of these factors may act together to cause PPD, the emergence of this disorder probably reflects an underlying vulnerability to affective illness. Women with histories of major depression or bipolar disorder are more vulnerable to PPD, and women who develop PPD will often go on to have recurrent episodes of depression unrelated to pregnancy or childbirth.

Who is at Risk for Postpartum Depression?

All women are vulnerable to postpartum depression, regardless of age, marital status, education level, or socioeconomic status. While it is impossible to predict who will develop PPD, certain risk factors for PPD have been identified, including:

• Previous episode of PPD
• Depression during pregnancy (antenatal depression)
• History of depression or bipolar disorder
• Recent stressful life events
• Inadequate social supports
• Marital or family issues

What Is Postpartum Anxiety?

Recent research suggests that 6% of pregnant women and 10% of postpartum women develop significant anxiety disorders. Sometimes these men and women experience anxiety alone, and sometimes they experience it in addition to postpartum depression. You do not have to be diagnosed with OCD to experience these common symptoms of perinatal anxiety

Generalized anxiety is common in both the general population and the postpartum period, however some women may also develop more challenging types of anxiety, such as panic disorder, and/or hypochondriasis in the postpartum period. Postpartum obsessive-compulsive disorder has also been reported, in which women report disturbing and intrusive thoughts of harming their infant.

• Constant worry
• Feeling that something bad is going to happen
• Racing thoughts
• Disturbances of sleep and appetite
• Inability to sit still
• Physical symptoms like dizziness, hot flashes, and nausea

Risk factors for perinatal anxiety and/or panic disorder may include a personal or family history of anxiety, previous perinatal depression or anxiety, or thyroid imbalance; however, many men and women develop Postpartum Anxiety without any risk factors.

Postpartum Panic Disorder is a form of anxiety with which the sufferer feels very nervous and has recurring panic attacks after the birth or adoption of a baby or child. During a panic attack, he or she may experience any or all of the following:

• Shortness of breath
• Feeling of someone sitting on his or her chest
• Chest pain
• Claustrophobia
• Dizziness
• Heart palpitations
• Numbness and tingling in the extremities.

Panic attacks seem to go in waves, but it is important to know that they will pass and will not hurt you.

What Is Postpartum Obsessive-Compulsive Disorder?

Postpartum Obsessive-Compulsive Disorder (OCD) is probably most misunderstood and misdiagnosed of the perinatal mood disorders. It is estimated that as many as 3-5% of new mothers and some new fathers will experience some of these symptoms. The repetitive, intrusive images and thoughts are very frightening and can feel like they come “out of the blue.” Fortunately, postpartum OCD is temporary and treatable with professional help. If you feel you may be suffering from one of this illness, know that it is not your fault and you are not to blame.

Research has shown that these images are anxious in nature, not delusional, and have very low risk of being acted upon. It is far more likely that the parent with this symptom takes steps to avoid triggers and avoid what they fear is potential  harm to the baby.

Some women and men do not have OCD but are bothered by obsessive-compulsive symptoms.

Symptoms of Postpartum Obsessive-Compulsive symptoms can include:

• Obsessions, also called intrusive thoughts, which are persistent, repetitive thoughts or mental images related to the baby. These thoughts are very upsetting and not something the woman has ever experienced before.
• Compulsions, where the mom may do certain things over and over again to reduce her fears and obsessions. This may include things like needing to clean constantly, check things many times, count or reorder things.
• A sense of horror about the obsessions
• Overly occupied with keeping your baby safe
• Compelled to do certain things over and over again to help relieve her anxiety and fears–This can include counting things, ordering things, listing things, checking and rechecking actions already performed, and cleaning repeatedly. This may manifest itself in cleaning, feeding, or taking care of the baby.
• May recognize these obsessions but feels horror and shame associated with them
• Obsessions or thoughts that are persistent, are repetitive and can include mental images of the baby that are disturbing
• Fear of being alone with the baby
• Women who suffer from PPOCD often know that these thoughts, actions, and feelings are not normal and do not act on them. But the obsession can get in the way of a mom taking care of her baby properly or being able to enjoy her baby. With the right treatment, women with PPOCD can experience freedom from being controlled by these obsessions and compulsions
• Fear of being left alone with the infant
• Hypervigilance in protecting the infant

Moms with postpartum OCD know that their thoughts are bizarre and are very unlikely to ever act on them.

Risk factors for postpartum OCD include a personal or family history of anxiety or OCD.

Given the potential adverse effects of untreated mood and anxiety symptoms in either the mother, father, careful screening and early recognition of anxiety symptoms during the postpartum period is recommended. Antepartum anxiety are temporary and treatable with professional help. If you feel you may be suffering from one of these illnesses, know that it is not your fault and you are not to blame.

What Is Postpartum Post-Traumatic Stress Disorder (PPTSD)?

Postpartum post-traumatic stress disorder (P-PTSD) often affects women who experienced a real or perceived trauma during childbirth or immediately after the baby was born.

P-PTSD is not a well-researched postpartum mood disorder, but for the estimated 3 to 16 percent of new moms and dads who suffer from it, this postpartum mood disorder is very real and incredibly frightening. P-PTSD can greatly impact the way they experience parenthood and care for their new baby.

For most women, the safe delivery of a healthy baby is moment remembered with great happiness. But not every new mom’s birth experience is a joyful one. In fact, more than a third of recently delivered moms describe their birth as traumatic, and the American College of Obstetricians and Gynecologists estimate that 3 to 16 percent display severe traumatic stress responses in the postpartum period. Like war veterans who suffer from PTSD – intrusive memories and flashbacks after suffering traumatic experiences on the battlefield – moms with P-PTSD look at their childbirth experience as a source of pain and anxiety and suffer from very similar post-traumatic symptoms.

P-PTSD is triggered by a traumatic event or events – real or perceived –– during pregnancy, labor, delivery, or during the postpartum period.

A mom-to-be may experience a traumatic event, such as severe morning sickness, fertility treatments, or serious pregnancy complications. Some women might experience trauma during childbirth if their labor was long and painful, if there was a cord prolapse, shoulder dystocia, a severe tear, previously undiscovered birth defects, hemorrhage, or an emergency C-section.

Trauma may result from a home birth that resulted in a transfer to a hospital due to complications; it could be from a planned hospital delivery that ended up unexpectedly at home. Trauma may develop if someone who’d wanted an intervention-free birth ends up requiring life-saving interventions.

Postpartum traumas may include having a premature baby, a baby who needs to be in the NICU, breastfeeding difficulties, or worse, a stillbirth or loss of a child early on.

Often the trauma is an emotional one: feelings of being powerless, of not being listened to, of not having adequate support during childbirth.

It’s important to remember that postpartum PTSD can develop after a real or perceived threat of death of the mother, father, or baby.

Traumas that may cause postpartum post-traumatic stress (P-PTSD) disorder include:

• Unplanned or emergency C-section
• Emergency complication such as prolapsed umbilical cord
• Birth that requires invasive interventions such as vacuum extractor or forceps
• Baby requiring a NICU stay
• Lack of support and assurance during the delivery
• Lack of communication from the birth and support team
• Feelings of powerlessness

Symptoms of P-PTSD may include:

• Nightmares and flashbacks to the birth or trauma
• Anxiety and panic attacks
• Feeling a detachment from reality and life
• Irritability, sleeplessness, hyper-vigilance, startles more easily
• Avoidance of anything that brings reminders of the event such as people, places, smells, noises, feelings
• May begin re-experiencing past traumatic events, including the event that triggered the disorder

Women who are experiencing PPTSD need to talk with a health care provider about what they are feeling. With the correct treatment, these symptoms will lessen and eventually go away.

What Is Postpartum Psychosis?

Postpartum Psychosis (PP) is a severe, but treatable, form of mental illness that occurs after having a baby. It can happen ‘out of the blue’ to women without previous experience of mental illness. There are some groups of women, women with a history of bipolar disorder for example, who are at much higher risk. PP normally begins in the first few days to weeks after childbirth. It can get worse very quickly and should always be treated as a medical emergency. Most women need to be treated with medication and admitted to hospital.

Postpartum psychosis is the most severe form of postpartum mood disorders and is extremely – extremely dangerous. Postpartum Psychosis is a medical emergency. If you believe a friend or loved one is suffering from Postpartum Psychosis, don’t wait: call 911. This is an emergency.

Fortunately, postpartum psychosis It is a rare postpartum mood disorder that occurs in approximately 1 to 2 per 1000 women after childbirth.

The presentation is often dramatic, with onset of symptoms as early as the first 48 to 72 hours after delivery. The majority of women with puerperal psychosis develop symptoms within the first two postpartum weeks.

With the right treatment, women with PP do make a full recovery. Recovery takes time and the journey may be tough. The illness can be frightening and shocking for both the woman experiencing it and her family. Women do return to their normal selves, and are able to regain the mothering role they expected. There is no evidence that the baby’s long term development is affected by Postpartum Psychosis.

There are a large variety of symptoms that women with PP can experience. Women may be:

• Excited, elated, or ‘high’.
• Depressed, anxious, or confused.
• Excessively irritable or changeable in mood.

Postpartum Psychosis includes one or more of the following:

• Strange beliefs that could not be true (delusions).
• Hearing, seeing, feeling or smelling things that are not there (hallucinations).
• High mood with loss of touch with reality (mania).
• Paranoia
• Attempts to harm the child or herself
• Severe confusion.

These are also common symptoms:

• Being more talkative, sociable, on the phone an excessive amount.
• Having a very busy mind or racing thoughts.
• Feeling very energetic and like ‘super-mum’ or agitated and restless.
• Having trouble sleeping, or not feeling the need to sleep.
• Behaving in a way that is out of character or out of control.
• Feeling paranoid or suspicious of people’s motives.
• Feeling that things are connected in special ways or that stories on the TV or radio have special personal meaning.
• Feeling that the baby is connected to God or the Devil in some way.

It appears that in most cases, postpartum psychosis represents an episode of bipolar illness; the symptoms of puerperal psychosis most closely resemble those of a rapidly evolving manic (or mixed) episode. The earliest signs are restlessness, irritability, and insomnia. Women with this disorder exhibit a rapidly shifting depressed or elated mood, disorientation or confusion, and erratic or disorganized behavior. Delusional beliefs are common and often center on the infant.

Auditory hallucinations that instruct the mother to harm herself or her infant may also occur.

Risk for infanticide, as well as suicide, is significant in this population.

How Are Postpartum Mood Disorders Treated?

Postpartum depression presents along a continuum, and the type of treatment selected is based on the severity and type of symptoms present. However, before initiating psychiatric treatment, any medical causes for mood disturbances (including thyroid dysfunction and/or anemia) must be excluded. Initial evaluation of a man or woman for postpartum mood disorders should always include a thorough and complete history, a physical examination, as well as routine laboratory tests.

Non-pharmacological therapies are often useful in the treatment of postpartum depression. It has been wildly demonstrated that short-term cognitive-behavioral therapy (CBT) was as effective as treatment with fluoxetine in women who have postpartum depression. Interpersonal therapy (IPT) has also been shown to be effective for the treatment of women with mild-to-moderate postpartum depression. Not only is IPT effective for treating the symptoms of depression, women who receive IPT may also benefit from significant improvements in the quality of their interpersonal relationships.

These non-pharmacological interventions may be particularly attractive to those patients who are reluctant to use psychotropic medications (such as women who are breastfeeding) or for women who have milder forms of depressive illness. Women with more severe postpartum depression may choose to receive pharmacological treatment, either in addition to or instead of these non-pharmacological therapies.

Only a few studies have systematically assessed the pharmacological treatment of postpartum depression.

Conventional antidepressant medications (fluoxetine, sertraline, fluvoxamine, and venlafaxine) have shown efficacy in the treatment of postpartum depression, standard antidepressant doses were both effective and well tolerated. The choice of an antidepressant should be guided by the woman’s prior response to antidepressant medication and side effect profile. Specific serotonin reuptake inhibitors (SSRIs) are ideal first-line agents, as they are anxiolytic, non-sedating, and well-tolerated.

For women who cannot tolerate SSRIs, bupropion (Wellbutrin) may be an alternative; although one pilot study suggests bupropion may not be as effective as SSRIs

Tricyclic antidepressants (TCAs) are frequently used and, because they tend to be more sedating, may be more appropriate for women who present with prominent sleep disturbance. Given the prevalence of anxiety symptoms, adjunctive use of a benzodiazepine (including clonazepam, lorazepam) may be very helpful to help ease anxiety and allow for relaxation.

While it’s difficult to reliably predict which women in the general population will experience postpartum mood disorders, it is possible to identify certain subgroups of women (such as men and women with a history of mood disorders) who are more vulnerable to postpartum affective illness.

Current research indicates that prophylactic interventions may be instituted near or at the time of delivery to decrease the risk of postpartum illness. Several studies demonstrate that women with histories of bipolar disorder or puerperal psychosis benefit from prophylactic treatment with lithium instituted either prior to delivery (at 36 weeks gestation) or no later than the first 48 hours postpartum.

Women and men with postpartum psychiatric illness are offered a variety of services by clinicians with particular expertise in these areas:

• Clinical evaluation for postpartum mood and anxiety disorders
• Medication management
• Consultation regarding breastfeeding and psychotropic medications
• Recommendations regarding non-pharmacological treatments
• Referral to support services within the community

Puerperal psychosis is considered a psychiatric emergency that typically requires inpatient treatment.

Acute treatment with either typical or atypical anti-psychotic medications is indicated. Given the well-established relationship between puerperal psychosis and bipolar disorder, postpartum psychosis should be treated as an affective psychosis and a mood stabilizer is indicated.

Electroconvulsive therapy (ECT) is well-tolerated and rapidly effective for severe postpartum depression and psychosis.

Can I Take Medications While Breastfeeding?

The nutritional, immunologic and psychological benefits of breastfeeding have been well-documented. Women who plan to breastfeed must be informed that all psychotropic medications, including antidepressants, are secreted into the breast milk, though concentrations in the breast milk appear to vary widely throughout the day The amount of medication to which an infant is exposed depends on several factors including, dosage of medication, rate of maternal drug metabolism, and frequency and timing of feedings.

Over the past five years, we’ve learned more regarding the use of various antidepressants during breastfeeding. Available data on the tricyclic antidepressants, fluoxetine, paroxetine, and sertraline during breastfeeding have been encouraging and suggest that significant complications related to an infant’s exposure to these medications in breast milk appear to be rare. While less information is available on other antidepressants, there have been no reports of serious adverse events related to infant exposure to these medications.

Women who have bipolar disorder may discover breastfeeding may be much more problematic. The first concern is that on-demand, around-the-clock breastfeeding may significantly disrupt the mother’s sleep, which can increase her vulnerability to a relapse of bipolar disorder during the postpartum period. Second, there have been reports of toxicity in nursing infants who have been exposed to various mood stabilizers in the breast milk, including lithium and carbamazepine. Lithium, a gold standard in management of bipolar disorder, is excreted at high levels in the mother’s milk, so infant serum levels of Lithium are relatively high, which brings an increased risk of neonatal toxicity. Exposure to carbamazepine and valproic acid in the breast milk has also been associated with hepatotoxicity (liver toxicity) in a nursing infant.

If you’ve been diagnosed and treated for bipolar disorder, the very best thing that you can do for yourself and your infant is to develop a postpartum plan with your psychiatrist and your OB, based on the symptoms you experienced before you were pregnant. In this plan, you can address your postpartum concerns and ways to manage these concerns.

Additional Things You Can Do To Help Postpartum Mood Disorders:

Postpartum Depression Resources

by Aunt Becky | Mar 20, 2019

Postpartum psychosis should be considered a medical emergency requiring immediate medical attention. Call 911 if you or someone you love is experiencing postpartum psychosis.

What is Postpartum Depression?

If you’ve just had a baby, you understand the mood swings that go along with your postpartum hormones. No matter how you love your child, how long you’ve wanted a baby, a new baby is stressful. Period. Lack of sleep, new important responsibilities, and a distinct lack of personal space and time to yourself, both parents can experience the baby blues. It’s extremely normal, but once symptoms of the baby blues last for a few weeks or worsen, you may be coping with postpartum depression.

Approximately 15% of new mothers and fathers will experience what is classified as postpartum depression (PPD). Symptoms may occur a few days after delivery or sometimes as late as a year later. People who experience postpartum depression will have alternating good days and bad days. Symptoms can be mild or severe, usually lasting for over 2 weeks.

There are lots of ways to help women suffering from postpartum depression, and remember that this is common, and you are never alone, no matter how you feel.

Is This Postpartum Depression or Is This The Baby Blues?

We know that you’ve just had a baby, and you’re expecting to be basking in the glory of a new life into this world. You thought you’d be celebrating with loved ones and enjoying every single second. But you’re not. In fact, you feel like crying or hiding away.

You thought you’d be joyous and excited, not weepy, exhausted, and anxiety-ridden. While you may not have intended this, you should know that mild depression, anxiety, and mood swings are totally normal. So normal that we can refer to them as the Baby Blues.

Approximately 50% to 75% of all new mothers will experience some negative feelings after giving birth. Normally these feelings occur suddenly four to five days after the birth of the baby.

Most women – to a greater or lesser extent – experience some symptoms of the baby blues after giving birth; the hormones that kept you pregnant are replaced by new hormones, lack of sleep, delivery, social isolation, major sleep loss, and stress, and it’s natural to notice them. Some women report that they feel emotionally fragile, sad, and overwhelmed. Generally the Baby Blues occur within a couple days of your delivery, last a week, and taper off by the second postpartum week.

What Are The Symptoms of Postpartum Depression?

In stark contrast from the baby blues, postpartum depression is a serious medical issue that should not be ignored. But how do you know the difference between postpartum depression and the Baby Blues?

PPD, as it’s often abbreviated, can look like the baby blues, so much so that they share many of the same symptoms, however the symptoms of postpartum depression last longer and are more severe. You may also feel hopeless and worthless, and lose interest in the baby. You may have thoughts of hurting yourself or the baby. Very rarely, new mothers develop something even more serious – postpartum psychosis –  may have hallucinations or try to hurt themselves or the baby. They need to get treatment right away, often in the hospital.

The difference is that with postpartum depression, the symptoms are more severe (such as suicidal thoughts or an inability to care for your newborn) and longer lasting. Symptoms of postpartum depression begin either during pregnancy or within four weeks after having a baby.

The symptoms of postpartum mood disorders don’t differ from the non-postpartum mood disorders except that the feelings of guilt and inadequacy about being an incompetent mother feed a person’s worries about being less than an adequate parent.

• You might find yourself withdrawing from your partner or being unable to bond well with your baby.
• You might find your anxiety out of control, preventing you from sleeping—even when your baby is asleep—or eating appropriately.
• You might find feelings of guilt or worthlessness overwhelming or begin to develop thoughts preoccupied with death or even wish you were not alive.
• Feelings of profound sadness, emptiness, emotional numbness, irritability, or anger.
• A tendency to withdraw from relationships with family, friends, or from activities that are usually pleasurable for the PPD sufferer
• Constant fatigue or tiredness, difficulty sleeping, overeating, or loss of appetite
• A strong sense of failure or inadequacy
• Intense concern and anxiety about the baby or a lack of interest in the baby
• Thoughts about suicide or fears of harming the baby
• People with postpartum depression feel guilty about being depressed at a time when they are supposed to be happiest and may be reluctant to discuss their feelings.
• People with postpartum depression often experience a loss of appetite, leading to extreme weight loss.
• People with postpartum depression often report an increased yearning for sleep, sleeping heavily, but awakening (and unable to get back to sleep) the moment their baby makes a noise.
• The distinguishing feature in postpartum depression is irritability. Episodes of irritability may be unprovoked or provoked by the slightest infraction. These episodes of irritability are often directed at the significant other or baby and may escalate to violent outbursts or uncontrollable sobbing.
• People with severe postpartum depression often have terrible panic attacks, severe anxiety, and spontaneous crying, long after the duration of the “baby blues.”
• These people with PPD may feel jealous of their infant and have difficulties bonding with their babies.

These are all red flags for postpartum depression.

The Edinburgh Postnatal Depression Scale is a screening tool designed to detect postpartum depression. Follow the instructions carefully. A score greater than 13 suggests the need for a more thorough assessment because you could have postpartum depression.

If you’re a new mother or father, please don’t hesitate to bring up these feelings with your doctor. Don’t let your doctor brush it off. If s/he does, find another doctor.

Signs And Symptoms of Postpartum Psychosis:

Postpartum psychosis is a rare, but extremely serious disorder that can develop after childbirth, characterized by loss of contact with reality. Because of the high risk for suicide or infanticide, hospitalization is usually required to keep the mother and the baby safe.

Postpartum psychosis (PPP) is the most severe form of postpartum depression, but fortunately it is the rarest form. It occurs in 1 to 2 out of every 1,000 pregnancies. The onset is very sudden and severe, normally within 2 to 3 weeks after giving birth. Postpartum psychosis develops suddenly, usually within the first two weeks after delivery, and sometimes within 48 hours. 

Symptoms are characterized by a loss of touch with reality and can include:

• Bizarre, erratic behavior
• Thoughts of hurting the baby
• Thoughts of hurting yourself
• Rapid mood swings
• Hyperactivity
• Hallucinations (seeing things that aren’t real or hearing voices)
• Delusions (paranoid and irrational beliefs)
• Extreme agitation and anxiety
• Suicidal thoughts or actions
• Confusion and disorientation
• Inability or refusal to eat or sleep
• Thoughts of harming or killing your baby

Postpartum psychosis should be considered a medical emergency requiring immediate medical attention. Call 911 if you or someone you love is experiencing postpartum psychosis.

What Causes Postpartum Depression?

Just as in all types of depression, there is no single reason to point to as the definitive cause of postpartum depression. A variable combination of lifestyle, physical, and emotional factors can all play a part.

There’s no single reason why some new mothers develop postpartum depression and others don’t, but a number of interrelated causes and risk factors are believed to contribute to the problem.

• Hormonal changes. After childbirth, women experience a big drop in estrogen and progesterone hormone levels. Thyroid levels can also drop, which leads to fatigue and depression. These rapid hormonal changes—along with the changes in blood pressure, immune system functioning, and metabolism that new mothers experience—may trigger postpartum depression.
• Physical changes. Giving birth brings numerous physical and emotional changes. You may be dealing with physical pain from the delivery or the difficulty of losing the baby weight, leaving you insecure about your physical and sexual attractiveness.
• Stress. The stress of caring for a newborn can also take a toll. New mothers are often sleep deprived. In addition, you may feel overwhelmed and anxious about your ability to properly care for your baby. These adjustments can be particularly difficult if you’re a first-time mother who must get used to an entirely new identity.

Risk Factors For Postpartum Depression:

Several factors can predispose you to postpartum depression:

• The most significant is a history of postpartum depression, as a prior episode can increase your chances of a repeat episode to 30-50%.
• Mood Disorders: A history of non-pregnancy related depression or a family history of mood disturbances is also a risk factor.
• Addiction: People with any history of depression, anxiety, alcohol or another substance use disorder prior to the pregnancy are at risk for developing depression during the pregnancy or within a few weeks after delivery.
• Prenatal depression – Depression during pregnancy may be the strongest predictor for later suffering from PPD.
• Prenatal anxiety
• History of previous depression – Although not as strong a predictor as a depressive episode during the pregnancy, it appears that women with histories of depression previous to conception are also at a higher risk of PPD than those without
• Examples of specific illnesses that have been associated with being associated with the potential to develop postpartum depression include any form of major depression, such as premenstrual dysphoric disorder, bipolar disorder, and generalized anxiety disorder.
• Maternity blues – Especially when severe, the blues may herald the onset of PPD.
• Recent stressful life events
• Inadequate social supports
• Poor marital relationship – One of the most consistent findings is that among women who report marital dissatisfaction and/or inadequate social supports, postpartum depressive illness is more common.
• Low self-esteem
• Childcare stress – Difficult infant temperament

In addition, three factors are less definitively predictive, but still arise consistently as factors that increase a woman’s risk of PPD, especially in combination with one or more of the factors listed above:

• Single marital status
• Unplanned or unwanted pregnancy
• Lower socioeconomic status

What Is The Treatment For Postpartum Depression?

Postpartum depression (PPD) sometimes goes away on its own within three months of giving birth. But if it interferes with your normal functioning at any time, or if “the blues” lasts longer than two weeks, you should seek treatment. About 90% of women who have postpartum depression can be treated successfully with medication or a combination of medication and psychotherapy. Participation in a support group may also be helpful. In cases of severe postpartum depression or postpartum psychosis, hospitalization may be necessary. Sometimes, if symptoms are especially severe, electroconvulsive (ECT) therapy may be used to treat severe depressions with hallucinations (false perceptions) or delusions (false beliefs) or overwhelming suicidal thoughts

Untreated postpartum depression can affect your ability to parent. You may:

• Not have enough energy
• Have trouble focusing on the baby’s needs and your own needs
• Feel moody
• Not be able to care for your baby
• Have a higher risk of attempting suicide

Feeling like a bad mother can make depression worse. It is important to reach out for help if you feel depressed.

Researchers believe postpartum depression in a mother can affect her child throughout childhood, causing:

• Delays in language development and problems learning
• Problems with mother-child bonding
• Behavior problems
• More crying or agitation
• Shorter height and higher risk of obesity in pre-schoolers
• Problems dealing with stress and adjusting to school and other social situations

Postpartum depression, like other mental illnesses, presents along a continuum, and the type of treatment selected is based on the severity of the depression and type of symptoms present.  However, before beginning psychiatric treatment, medical causes for mood disturbance (such as, thyroid dysfunction, anemia) must be excluded. Initial evaluation should include a thorough history, physical examination, and routine laboratory tests.

Non-pharmacological therapies are useful in the treatment of postpartum depression, including CBT, ITP, and couples counseling.

In a randomized study, it was shown that short-term cognitive-behavioral therapy (CBT) was as effective as treatment with fluoxetine (Prozac) in women with postpartum depression.

Interpersonal therapy (IPT) has also been shown to be effective for the treatment of women with mild to moderate postpartum depression. Not only is IPT effective for treating the symptoms of depression, women who receive IPT also benefit from significant improvements in the quality of their interpersonal relationships

These non-pharmacological interventions may be particularly attractive to those reluctant to use psychotropic medications (such as women who are breast-feeding) or for people with milder forms of depressive illness. Women with more severe postpartum depression may choose to receive pharmacological treatment, either in addition to or instead of, these non-pharmacological therapies.

Only a few studies have systematically assessed the pharmacological treatment of postpartum depression. Conventional antidepressant medications have shown efficacy in the treatment of postpartum depression at standard antidepressant doses were effective and well tolerated.

The choice of an antidepressant should be guided by the person’s prior response to antidepressant medication and a given medication’s side effects.

• Specific serotonin reuptake inhibitors (SSRIs) are ideal first-line agents, as they are anxiolytic, non-sedating, and well tolerated (examples include: fluoxetine, sertraline, fluvoxamine, and venlafaxine)
• For women who cannot tolerate SSRIs, bupropion (Wellbutrin) may be an alternative; although one pilot study suggests bupropion may not be as effective as SSRIs.
• Tricyclic antidepressants (TCAs) are frequently used and, because they tend to be more sedating, may be more appropriate for women who present with prominent sleep disturbance.
• Given the prevalence of anxiety symptoms in this population, adjunctive use of a benzodiazepine (e.g., clonazepam, lorazepam) may be very helpful.

Can I Breastfeed My Child If I’m On Medication?

The nutritional, immunologic, and psychological benefits of breastfeeding have been well documented. Women who plan to breastfeed must be informed that all psychotropic medications, including antidepressants, are secreted into the breast milk. Concentrations in the breast milk appear to vary widely. The amount of medication to which an infant is exposed depends on several factors, including dosage of medication, rate of maternal drug metabolism, and frequency and timing of feedings (Llewelyn and Stowe).

Over the past five years, data have accumulated regarding the use of various antidepressants during breastfeeding (reviewed in Newport et al 2002). Available data on the tricyclic antidepressants, fluoxetine, paroxetine, and sertraline during breastfeeding have been encouraging and suggest that significant complications related to neonatal exposure to psychotropic drugs in breast milk appear to be rare. While less information is available on other antidepressants, there have been no reports of serious adverse events related to exposure to these medications.

For women with bipolar disorder, breastfeeding may be more problematic.

First is the concern that on-demand breastfeeding may significantly disrupt the mother’s sleep and thus may increase her vulnerability to relapse during the acute postpartum period. Second, there have been reports of toxicity in nursing infants related to exposure to various mood stabilizers, including lithium and carbamazepine, in breast milk. Lithium is excreted at high levels in the mother’s milk, and infant serum levels are relatively high, about one-third to one-half of the mother’s serum levels, increasing the risk of neonatal toxicity. Exposure to carbamazepine and valproic acid in the breast milk has been associated with liver damage in the nursing infant.

Can We Prevent PPD?

While it is difficult to reliably predict which women in the general population will experience postpartum mood disturbance, it is possible to identify certain subgroups of women (i.e., women with a history of mood disorder) who are more vulnerable to postpartum affective illness. Current research indicates that prophylactic interventions may be instituted near or at the time of delivery to decrease the risk of postpartum illness.

Several studies demonstrate that women with histories of bipolar disorder or puerperal psychosis benefit from prophylactic treatment with lithium either prior to delivery (at 36 weeks gestation) or no later than the first 48 hours postpartum.

For women with histories of postpartum depression, several studies have described a beneficial effect of prophylactic antidepressant (either TCAs or SSRIs) administered after delivery. Patients with postpartum psychiatric illness are offered a variety of services by clinicians with particular expertise in this area:

• Clinical evaluation for postpartum mood and anxiety disorders
• Medication management
• Consultation regarding breastfeeding and psychotropic medications
• Recommendations regarding non-pharmacological treatments
• Referral to support services within the community

Coping With Postpartum Depression:

The most important task of infancy is the bonding process between the infant and parents, as the success of this wordless relationship enables a child to feel secure enough to develop fully, and affects how the child will interact, communicate, and form relationships throughout life.

A secure attachment between parent and child is formed when the parent responds warmly and consistently to your baby’s physical and emotional needs. When your baby cries, you quickly soothe him or her. If your baby laughs or smiles, you respond in kind. You and your child are in synch. You recognize and respond to each other’s emotional signals.

Postpartum depression can interrupt this bonding. Depressed parents may be loving and attentive sometimes, but others may react negatively or not respond at all. Sadly, parents with postpartum depression tend to interact less with their babies, and are less likely to breastfeed, play with, and read to their children. They may also be inconsistent caregivers.

However, learning to bond with your baby not only benefits your child, it also benefits you by releasing endorphins that make you feel happier and more confident as a parent.

Make yourself and your baby the priority. Give yourself permission to concentrate on yourself and your baby – there is more work involved in this 24/7 job then in a full-time job.

Try to remember that we, as human beings are naturally social. Positive, happy, and supportive social contact relieves stress faster and more efficiently than any other means of stress reduction. Historically and from an evolutionary perspective, new parents received help from those around them when caring for themselves and their infants after childbirth. In today’s world, new mothers often find themselves alone, exhausted, and lonely for supportive adult contact.

When you’re feeling depressed and vulnerable, it’s more important than ever to stay connected to family and friend – even if you’d rather be left alone. Isolating yourself will only make your situation feel even bleaker, so make your adult relationships a priority. Let your loved ones know what you need and how you’d like to be supported.

In addition to the practical help your friends and family can provide, they can also serve as a much-needed emotional outlet. Share what you’re experiencing – all of it – with at least one other person, preferably face to face. It doesn’t matter who you talk to, so long as that person is willing to listen without judgment and offer reassurance and support.

Even if you have supportive loved ones, you may want to consider seeking out other women who are dealing with the same transition into motherhood. It’s very reassuring to hear that other mothers share your worries, insecurities, and feelings. Good places to meet new moms include support groups for new parents or organizations such as Mommy and Me. Ask your pediatrician for other resources in your neighborhood.

Additional Resources For Postpartum Depression:

Postpartum Health Alliance is a non-profit organization dedicated to raising awareness about perinatal mood and anxiety symptoms and disorders and providing support and treatment referrals to women and their families.

• If you are struggling or have questions, please call our warmline at 619-254-0023. Our trained volunteers can provide you with support and referrals.
• If you need immediate support please call the San Diego Access and Crisis Line at 1-888-724-7240. The toll-free call is available 24-hours a day, 7-days a week

Postpartum Depression International: source of great information about all types of Postpartum Mood Disorders and also offers women resources for where to go for local help. Call or Text our HelpLine

• They offer online support groups for mom’s and dad’s with PPD.
• Call 1-800-944-4773 (4PPD)
  English and Spanish
• Text 503-894-9453
• Available 24 hours a day, you will be asked to leave a confidential message and a trained and caring volunteer will return your call or text. They will listen, answer questions, offer encouragement and connect you with local resources as needed.

Pet Loss Resources

by Band Back Together | Sep 6, 2018

Just this side of heaven is a place called Rainbow Bridge. 

When an animal dies that has been especially close to someone here, that pet goes to Rainbow Bridge. 
There are meadows and hills for all of our special friends so they can run and play together. 
There is plenty of food, water and sunshine, and our friends are warm and comfortable. 

All the animals who had been ill and old are restored to health and vigor; those who were hurt or maimed are made whole and strong again, just as we remember them in our dreams of days and times gone by. 
The animals are happy and content, except for one small thing; they each miss someone very special to them, who had to be left behind. 

They all run and play together, but the day comes when one suddenly stops and looks into the distance. His bright eyes are intent; his eager body quivers. Suddenly he begins to run from the group, flying over the green grass, his legs carrying him faster and faster. 

You have been spotted, and when you and your special friend finally meet, you cling together in joyous reunion, never to be parted again. The happy kisses rain upon your face; your hands again caress the beloved head, and you look once more into the trusting eyes of your pet, so long gone from your life but never absent from your heart. 

Then you cross Rainbow Bridge together.

Author unknown 

What Is Pet Loss?

For many of us, a pet is not “just a dog” or “just a cat,” but rather a beloved member of our family, bringing companionship, fun, and joy to our lives. A pet can add structure to your day, keep you active and social, help you to overcome setbacks and challenges in life, and even provide a sense of meaning or purpose. So, when a beloved pet dies, it’s normal to feel a painful sense of grief and loss.

While we all respond to loss differently, the level of grief you experience will often depend on factors such as your age and personality, the age of your pet, and the circumstances of their death. Generally, the more significant your pet was to you, the more intense the emotional pain you’ll feel. The role the animal played in your life can also have an impact. For example, if your pet was a working dog, service animal, or therapy animal, then you’ll not only be grieving the loss of a companion but also the loss of a coworker, the loss of your independence, or the loss of emotional support. If you lived alone and the pet was your only companion, coming to terms with their loss can be even harder. And if you were unable to afford expensive veterinary treatment to prolong your pet’s life, you may even feel a profound sense of guilt.

Whatever the circumstances of your loss, remember that grief is personal to you, so you shouldn’t be ashamed about how you feel, or believe that it’s somehow not appropriate to grieve for an animal friend. While experiencing loss is an inevitable part of owning a pet, there are healthy ways to cope with the pain, come to terms with your grief, and when the time is right, perhaps even open your heart to another animal companion.

Losing a pet, for any reason, is something that happens to every pet owner eventually. Whether your pet is stolen, dies, or must be re-homed – the loss can be overwhelmingly difficult to deal with.

Our pets often become members of the family, companions, confidantes, best friends, and some cases a coworker (working dogs) or ticket to independence (service dogs). For those reasons (and many others), the loss of a pet can trigger agonizing grief along with a whole host of other emotions – anger, guilt, shock, and many other strong emotions.

Grief and Pet Loss:

It’s natural to go through the stages of grief as you would with any loss of somebody you care for. In many cases, the people around you don’t understand the grief you are going through, and may tell you to “get over it.” You may hear things like “it was just a dog/cat/bird” or “you can just get another one.” Our society generally doesn’t recognize the significance of pet loss, nor does it allow for ‘proper’ bereavement.

Different Types of Loss.

Grieving is a highly individual experience. Some people find grief following the loss of a pet comes in stages, where they experience different feelings such as denial, anger, guilt, depression, and eventually acceptance and resolution. Others find that their grief is more cyclical, coming in waves, or a series of highs and lows. The lows are likely to be deeper and longer at the beginning and then gradually become shorter and less intense as time goes by. Still, even years after a loss, a sight, a sound, or a special anniversary can spark memories that trigger a strong sense of grief.Different Kinds of Loss
Death can happen expectedly, after a long-term illness or when age has taken its toll. Equally painful are unexpected deaths, such as vehicle accidents or fatal injuries. When human error or maliciousness are to blame for an animal’s demise, feelings of guilt or anger can complicate an already devastating time. If there is a question of wrongful death, do not rule out legal proceedings. State laws are constantly improving with regard to animal abuse and compensation for the loss of companion animals. Visit your state’s legislative Web site for more information. Perhaps your dog was stolen or your cat was accidentally let out or simply disappeared, leaving you without the ability to say goodbye or the knowledge of his or her whereabouts and safety. Divorce, college, or other kinds of forced separation can also prompt feelings of grief.

The grieving process happens only gradually.

It can’t be forced or hurried—and there is no “normal” timetable for grieving. Some people start to feel better in weeks or months. For others, the grieving process is measured in years. Whatever your grief experience, it’s important to be patient with yourself and allow the process to naturally unfold.

Feeling sad, shocked, or lonely is a normal reaction to the loss of a beloved pet.

Exhibiting these feelings doesn’t mean you are weak or your feelings are somehow misplaced. It just means that you’re mourning the loss of an animal you loved, so you shouldn’t feel ashamed.

Trying to ignore your pain or keep it from surfacing will only make it worse in the long run.

For real healing, it is necessary to face your grief and actively deal with it. By expressing your grief, you’ll likely need less time to heal than if you withhold or “bottle up” your feelings. Write about your feelings and talk about them with others who are sympathetic to your loss.

Some things that can make your grief harder to deal with are: lack of support or understanding, guilt over making the decision to euthanize, and wondering how to discuss it with your children. One of the most important things you can do to get through the difficult time of bereavement is allow yourself to feel it. Holding it in and hiding it is generally not conducive to working through the feelings.

Your journey of grief will not take on a prescribed pattern or look like stages, such as the five stages of grief, as Kubler-Ross, or other patterns of grief. The following tips can help with grief and grieving the loss of your beloved pet.

When Death Is a Decision

If your animal companion’s quality of life has diminished to the point where therapy or medicine is no longer able to help, euthanasia is the only humane choice. Discuss this option thoroughly with your veterinarian. Once you have resolved to end your friend’s suffering, insist on being with him or her during the procedure. Ask about sedative options in order to make your companion’s passing as stress-free as possible. As devastating as it may seem, euthanasia is never a mistake. Delaying, in the hope that one more day might make a difference, may actually mean just one more day of distress. Your friend may feel your pain, too, and try to hold on for your sake. Dealing with these emotions, and especially the guilt afterwards, is a journey unto itself.

Acknowledge the reality of the death

Acknowledging the full reality of your loss may take weeks or months, but will be done in a time that is right for you. Be kind to yourself as you prepare for the “new normal” of a life without your beloved pet. Just as it took time to build the relationship with your pet, it will take time to get used to him or her not being there. Once you become accustomed to the idea that your pet has died, you can move forward. Just because your pet is now gone does not mean that you don’t still love him or her as much as you’ve always done.

Move toward the pain of the loss

Experiencing these emotional thoughts and feelings about the death of a pet is a difficult, but important, need. A healthier grief journey may come from taking your time to work through your feelings rather than trying to push them away or ignore it. Those who bury their feelings and pain of the loss of their much-loved pet find it coming out in very different ways: self-medicating with alcohol, irrational bouts of anger, and difficulty concentrating on daily tasks. It is far more healthy to feel your feelings rather than stuffing them down deep inside.

Continue your relationship through memories

Just because your pet has died does not mean that he or she never existed. Your memories allow your pets to live on in you. Embracing these memories, both happy and sad, can be a very slow and, at times, painful process that occurs in small steps. For example, take some time to look at past photos, write a tribute to your pet, or write your pet a letter recalling your time together. Most people can understand the loss of a beloved pet and it may prove beneficial to reach out to others. Plant a memorial garden. Find a special way for you to visit the memories of your pet.

Adjust your self-identity

Part of your self-identity might come from being a pet owner. Others may also think of you in relation to your pet. You may be “the guy who always walked the big black dog around the neighborhood” or “the friend whose cat always jumped on laps.” Adjusting to this change is a central need of mourning. Now you’re in a new reality without your beloved pet. It may feel scary and awful, but over time, you’ll be able to see yourself as the same person who loved that pet, only without the pet. Adjusting to a loss is always complicated and fraught with sadness, but in time, you will be able to look back on cherished memories of your pet.

Search for meaning

When a pet dies, it’s natural to question the meaning and purpose of pets in your life. Coming to terms with these questions is another need you must meet during your grief journey. Know that it is the asking, not the finding of concrete answers, that is important. Many people feel silly or stupid for being so upset about losing their loved pet, like it’s not that serious, but that couldn’t be farther from the truth. This was someone you shared your life with, your home; someone you were responsible for. The emptiness of your life may feel overwhelming, which is why you should try to search for your new normal, place to belong, and practice self-care.

Receive support from others

Don’t hesitate to ask for help dealing with your heartache. Solace is to be found in a number of places. Support groups are springing up everywhere, some sponsored by professionals, and can give you the opportunity to share your feelings with people who understand your pain. There are help lines that you can call and many books for adults and children that deal with losing an animal companion. Some veterinary schools are increasing their efforts to help alleviate animal caretakers’ grief and have social workers on hand for counseling. The Internet is a wonderful resource for helping you find groups, individual grief counselors, and even chatrooms. Sympathetic family and friends can be a great source of comfort, too. They probably have known your nonhuman companion for as long as you have and can share fond memories.

You need the love and support of others because you never “get over” grief. Talking with other pet owners who have experienced the death of a pet can be one important way to meet this need. Try reaching out to others who’ve been where you are so that you can share your sad times and happy times with each other. Support will remind you that you are grieving a very real loss and help you through that grief.

Coping With Pet Loss:

The experience of loss is different for everyone and can present unique challenges to each person in each situation, but some of the following tips may help you come to terms with the loss of your fur-baby.

The deafening silence – the silence in your home after the death of a pet may seem excruciatingly loud. While your animal companion occupies physical space in your life and your home, many times their presence is felt more with your senses. When that pet is no longer there, the lack of their presence – the silence – becomes piercing. It becomes the reality of the “presence of the absence.” Merely being aware of this stark reality will assist in preparing you for the flood of emotions.

The special bond with your pet—the relationship shared with your pet is a special and unique bond, a tie that some might find difficult to understand. There will be well-meaning friends and family members who will think that you should not mourn for your pet or who will tell you that you should not be grieving as hard as you are because “it’s just a cat” or “just a dog.”  Your grief is normal and the relationship you shared with your special friend needs to be mourned.

Grief can’t be ranked—sometimes our heads get in the way of our heart’s desire to mourn by trying to justify the depth of our emotion. Some people will then want to “rank” their grief, pitting their grief emotions with others who may be “worse.” While this is normal, your grief is your grief and deserves the care and attention of anyone who is experiencing a loss.

Questions of spirituality—during this time in your grief journey, you may find yourself questioning your beliefs regarding pets and the after-life. Many people around you will also have their own opinions. It will be important during this time for you to find the answers right for you and your individual and personal beliefs.

Don’t let anyone tell you how to feel, and don’t tell yourself how to feel either. Your grief is your own, and no one else can tell you when it’s time to “move on” or “get over it.” Let yourself feel whatever you feel without embarrassment or judgment. It’s okay to be angry, to cry or not to cry. It’s also okay to laugh, to find moments of joy, and to let go when you’re ready.

Reach out to others who have lost pets. Check out online message boards, pet loss hotlines, and pet loss support groups—see the Resources section below for details. If your own friends and family members are not sympathetic about pet loss, find someone who is. Often, another person who has also experienced the loss of a beloved pet may better understand what you’re going through.

Rituals can help healing. A funeral can help you and your family members openly express your feelings. Ignore people who think it’s inappropriate to hold a funeral for a pet, and do what feels right for you.

Create a legacy. Preparing a memorial, planting a tree in memory of your pet, compiling a photo album or scrapbook, or otherwise sharing the memories you enjoyed with your pet, can create a legacy to celebrate the life of your animal companion. Remembering the fun and love you shared with your pet can help you to eventually move on.

Look after yourself. The stress of losing a pet can quickly deplete your energy and emotional reserves. Looking after your physical and emotional needs will help you get through this difficult time. Spend time face to face with people who care about you, eat a healthy diet, get plenty of sleep, and exercise regularly to release endorphins and help boost your mood.

If you have other pets, try to maintain your normal routine. Surviving pets can also experience loss when a pet dies, or they may become distressed by your sorrow. Maintaining their daily routines, or even increasing exercise and play times, will not only benefit the surviving pets but can also help to elevate your mood and outlook, too.

Seek professional help if you need it. If your grief is persistent and interferes with your ability to function, your doctor or a mental health professional can evaluate you for depression.

When Others Devalue Your Loss:

One aspect that can make grieving for the loss of a pet so difficult is that pet loss is not appreciated by everyone. Some friends and family may say, “What’s the big deal? It’s just a pet!” Some people assume that pet loss shouldn’t hurt as much as human loss, or that it is somehow inappropriate to grieve for an animal. They may not understand because they don’t have a pet of their own or are unable to appreciate the companionship and love that a pet can provide.

• Don’t argue with others about whether your grief is appropriate or not.
• Accept the fact that the best support for your grief may come from outside your usual circle of friends and family members.
• Seek out others who have lost pets; those who can appreciate the magnitude of your loss, and may be able to suggest ways of getting through the grieving process.

How Do I Tell My Children?

Young children aren’t developmentally ready to understand death in the same way adults do. As their understanding deepens over time, the lens through which they view death changes too. From ages 3 to 5, children tend to view death as temporary and reversible. They may believe you can bring a pet back to life by taking it to the doctor for a shot. Magical thinking also may prompt your 4-year-old to believe he somehow caused the pet’s death when he wished for a playful puppy to replace an elderly dog with bad breath and health problems.

From ages 6 to 8, children usually know death is irreversible but believe it only happens to others. They understand the concept but may not be able to accept that a death is happening to them. From ages 9 to 11, children come to understand that death is inevitable, even for them. However, children in these age ranges may still feel somewhat responsible for the pet’s death, thinking their beloved pet may not have died if only they’d taken her for more dog walks or kept the water bowl full.

You are the best judge of how to discuss the loss with your little ones. Honesty is important, and you should encourage your children to talk out their feelings with you. This may be the first time a child has dealt with death in any way, and an opportunity for you to help them understand how to grieve, as well as clear up any misconceptions they may have about death and dying.

One of the most difficult parts about losing a pet may be breaking the bad news to kids. Try to do so one-on-one in a place where they feel safe and comfortable and not easily distracted.

As you would with any tough issue, try to gauge how much information kids need to hear based on their age, maturity level, and life experience.

If your pet is very old or has a long illness, consider talking to kids before the death happens. If you have to euthanize your pet, you may want to explain that:

• the veterinarians have done everything that they can
• your pet would never get better
• this is the kindest way to take the pet’s pain away
• the pet will die peacefully, without feeling hurt or scared

Again, a child’s age, maturity level, and questions will help determine whether to offer a clear and simple explanation for what’s going to happen. If so, it’s OK to use words like “death” and “dying” or to say something like “The veterinarian will give our pet a shot that first puts it to sleep and then stops the heart from beating.” Many kids want a chance to say goodbye beforehand, and some may be old enough or emotionally mature enough to be there to comfort the pet during the process.

If you do have to euthanize your pet, be careful about saying the animal went “to sleep” or “got put to sleep.” Young kids tend to take things literally, so this can conjure up scary ideas about sleep or surgery and anesthesia.

If the pet’s death is more sudden, calmly explain what has happened. Be brief, and let your child’s questions guide how much information you provide.

Sticking to the Truth

Avoid trying to gloss over the event with a lie. Telling a child that “Buster ran away” or “Max went on a trip” is not a good idea. It probably won’t alleviate the sadness about losing the pet, and if the truth does come out, your child will probably be angry that you lied.

If asked what happens to the pet after it dies, draw on your own understanding of death, including, if relevant, the viewpoint of your faith. And since none of us knows fully, an honest “I don’t know” certainly can be an appropriate answer — it’s OK to tell kids that death is a mystery.

Helping Your Child Cope

Like anyone dealing with a loss, kids usually feel a variety of emotions besides sadness after the death of a pet. They might experience loneliness, anger if the pet was euthanized, frustration that the pet couldn’t get better, or guilt about times that they were mean to or didn’t care for the pet as promised.

Help kids understand that it’s natural to feel all of those emotions, that it’s OK to not want to talk about them at first, and that you’re there when they are ready to talk.

Don’t feel compelled to hide your own sadness about losing a pet. Showing how you feel and talking about it openly sets an example for kids. You show that it’s OK to feel sad when you lose a loved one, to talk about your feelings, and to cry when you feel sad. And it’s comforting to kids to know that they’re not alone in feeling sad. Share stories about the pets you had — and lost — when you were young and how difficult it was to say goodbye.

Looking Ahead

After the shock of the news fades, it’s important to help your child heal and move on.

It can help kids to find special ways to remember a pet. You might have a ceremony to bury your pet or just share memories of fun times you had together. Write a prayer together or offer thoughts on what the pet meant to each family member. Share stories of your pet’s funny moments. Offer lots of loving hugs. You could do a project too, like making a scrapbook.

Keep in mind that grieving over the loss of a pet, particularly for a child, is similar to grieving over a person. For kids, losing a pet who offered love and companionship can be much harder than losing a distant relative. You might have to explain that to friends, family members, or others who don’t own pets or don’t understand that.

Perhaps most important, talk about your pet, often and with love. Let your child know that while the pain will go away, the happy memories of the pet will always remain. When the time is right, you might consider adopting a new pet — not as a replacement, but as a way to welcome another animal friend into your family.

Euthanasia: The Difficult Choice

While some pets die of old age in the comfort of their own home, many others become seriously ill, get injured in some way or experience a significantly diminished quality of life as they grow very old. In these situations, it may be necessary for you to consider having your pet euthanized in order to spare it from pain and suffering. Here are some suggestions for dealing with this difficult decision, as well as some information about the euthanasia procedure itself.

Knowing when it’s time

Talk to your veterinarian. He or she is the best-qualified person to help guide you through this difficult process. In some cases, your veterinarian may be able to tell you definitively that it is time to euthanize your pet, but in other cases, you may ultimately need to make the decision based on your observances of your pet’s behavior and attitude. Here are some signs that may indicate your pet is suffering or no longer enjoying a good quality of life:

• He is experiencing chronic pain that cannot be controlled with medication (your veterinarian can help you determine if your pet is in pain).
• He has frequent vomiting or diarrhea that is causing dehydration and/or significant weight loss.
• He has stopped eating or will only eat if you force feed him.
• He is incontinent to the degree that he frequently soils himself.
• He has lost interest in all or most of his favorite activities, such as going for walks, playing with toys or other pets, eating treats or soliciting attention and petting from family members.
• He cannot stand on his own or falls down when trying to walk.
• He has chronic labored breathing or coughing.

Saying goodbye

Once you have made this very difficult decision, you will also need to decide how and where you and your family will say the final goodbye.

• Before the procedure is scheduled to take place, make sure that all members of your family have time with the pet to say a private goodbye.
• If you have children, make sure that you explain the decision to them and prepare them for the loss of the pet in advance. This may be your child’s first experience with death, and it is very important for you to help her or him through the grieving process. Books that address the subject, such as When a Pet Dies by Fred Rogers or Remembering My Pet by Machama Liss-Levinson and Molly Phinney Baskette, may be very beneficial in helping your child to deal with this loss.
• It is an individual decision whether or not you and your family want to be present during the euthanasia procedure. For some pet owners, the emotion may be too overwhelming, but for many, it is a comfort to be with their pet during the final moments. It may be inappropriate for young children to witness the procedure since they are not yet able to understand death and may also not understand that they need to remain still and quiet.
• Some veterinarians will come to your house, which allows both the pet and the family to share their last moments together in the comfort of their own home.

What Happens During Euthanasia?

Making the decision to say goodbye to a beloved pet is stressful, and your anxiety can often be exacerbated if you do not know what to expect during the euthanasia procedure.

• Your veterinarian will generally explain the procedure to you before he or she begins. Don’t hesitate to ask your veterinarian for further explanation or clarification if needed.
• Small to medium-size pets are usually placed on a table for the procedure, but larger dogs may be more easily handled on the floor. Regardless of the location, make sure that your pet has a comfortable blanket or bed to lie on.
• In most cases, a trained veterinary technician will hold your pet for the procedure. The veterinary technician has the skill needed to properly hold your pet so that the process goes quickly and smoothly. If you plan to be present during the entire procedure, it is important that you allow enough space for the veterinarian and technician to work. Your veterinarian will probably show you where to stand so that your pet can see you and hear your voice.
• Your veterinarian will give your pet an overdose of an anesthetic drug called sodium pentobarbital, which quickly causes unconsciousness and then gently stops the heartbeat. Your veterinarian will draw the correct dose of the drug into a syringe and then inject it into a vein. In dogs, the front leg is most commonly used. In cats, either the front or rear leg may be used. The injection itself is not painful to your pet.
• Often, veterinarians will place an intravenous (IV) catheter in the pet’s vein before giving the injection. The catheter will reduce the risk that the vein will rupture as the drug is injected. If the vein ruptures, then some of the drug may leak out into the leg, and it will not work as quickly.
• Your veterinarian may give your pet an injection of anesthetic or sedative before the injection of sodium pentobarbitol. This is most often done in pets that are not likely to hold still for the IV injection. An anesthetic or sedative injection is usually given in the rear leg muscle and will take effect in about five to 10 minutes. Your pet will become very drowsy or unconscious, allowing the veterinarian to more easily perform the IV injection.
• Once the IV injection of sodium pentobarbitol is given, your pet will become completely unconscious within a few seconds, and death will occur within a few minutes or less.
• Your veterinarian will use a stethoscope to confirm that your pet’s heart has stopped.
• Your pet may experience some muscle twitching and intermittent breathing for several minutes after death has occurred. Your pet may also release his bladder or bowels. These events are normal and should not be cause for alarm.
• After your veterinarian has confirmed that your pet has passed, he or she will usually ask if you would like to have a few final minutes alone with your pet.

The choice to stay for the euthanasia or not is a personal one. Some vets will make a home visit to ease the transition, others prefer not to have the owner present at all. You’ll want to discuss your desires and concerns with your vet, and if they are unable or unwilling to accommodate you, then perhaps you should ask for a referral.

What’s Next?

After your pet’s death, you will need to decide how to handle the remains. It may seem easiest to leave your pet with a clinic for disposal (a fee may apply – check with them), but there are several other options available to you.

Your veterinarian can offer you a variety of options for your pet’s final resting place.

• Cremation is the most popular choice, and you can choose whether or not you would like to have your pet’s ashes returned to you. Most cremation services offer a choice of urns and personalized memorials.
• Burial is another option. You may want to bury your pet in your own yard, but before doing so, be sure to check your local ordinances for any restrictions. There are also many pet cemeteries throughout the United States. To locate a pet cemetery near you, check with the International Association of Pet Cemeteries.

Home burial is a popular choice, but you’ll need to have the land, and make sure it’s legal in your area.

Cremation is generally less expensive than a cemetery, and offers up more options as to what you do with the remains. You can choose to keep the ashes with you, scatter them somewhere special, or bury them. Your vet, a pet store, or local shelter is likely to have more information about the options available in your area. It might be a good idea to have a plan in place ahead of time, rather than trying to muddle through in the midst of your grief.

Saying Goodbye

A burial service can provide closure. There are hundreds of pet cemeteries around the world as well as several companies that manufacture coffins, urns, and grave markers for companion animals. If you decide on a home burial, however, you must first check with city and county ordinances to determine the legality of interment. Your veterinarian can also dispose of the body but you may want to ask about the clinic’s policy. Space or legal limitations may necessitate developing your own method of remembrance. Your veterinarian can recommend an animal crematory center, enabling you to keep the remains in an urn for a private memorial at your companion’s favorite park or beach.

When Should I Get Another Pet?

You may be tempted to rush right out and get another pet just like the one you lost. However, it might be better to mourn your old pet and wait until you’re more emotionally ready. You’ll also need to be careful of expecting the new pet to be the exact same as the older pet; this can lead to disappointment and frustration.

There are many wonderful reasons to once again share your life with a companion animal, but the decision of when to do so is a very personal one. It may be tempting to rush out and fill the void left by your pet’s death by immediately getting another pet. In most cases, it’s best to mourn the old pet first, and wait until you’re emotionally ready to open your heart and your home to a new animal. You may want to start by volunteering at a shelter or rescue group. Spending time caring for pets in need is not only great for the animals, but can help you decide if you’re ready to own a new pet.

Some retired seniors living alone may find it hardest to adjust to life without a pet. If taking care of an animal provided you with a sense of purpose and self-worth as well as companionship, you may want to consider getting another pet at an earlier stage. Of course, seniors also need to consider their own health and life expectancy when deciding on a new pet. Again, volunteering to help pets in need can be a good way to decide if you’re ready to become a pet owner again.

Children may feel it’s disloyal to love a new pet, especially if what they really want is the old pet back. In most cases, it is better to get a pet that is different from your old one, to avoid making comparisons, but you will know what you and your family can handle.

If you live alone, you may want to find a new pet sooner, to help stave off loneliness and give you a sense of purpose and companionship.

You’ll also need to consider the needs of any other pets you have.

Additional Pet Loss Resources:

Pet Loss Support Page – This page is a little cluttered, but has extensive resources, including many international ones, as well as several articles and many links to other helpful pages.

Association for Pet Loss and Bereavement – Professionally trained volunteers in pet bereavement counseling, and many resources, including a pet memorial

Support Line Pet Bereavement – Article on dealing with pet loss with links and information specific to the UK.

Delta Society: The Human-Animal Health Connection – Offers up articles, information, and links that may be very useful (and quite a bit of information about pets in general and how they can benefit us).

Pet Loss Memorial Pages:

Rainbow Bridge – Well known Rainbow Bridge poem. Also has resources about animal health and pet loss grief.

Pet Loss Hotlines:

US Pet Loss Hotlines:

C.A.R.E. (Companion Animal Related Emotions) Pet Loss Helpline – (877) 394-CARE (2273) We are here to accept calls from 1 to 6 pm on Tuesdays and Thursdays. You may call at any time and leave a message, and your call will be returned as soon as possible, usually within 24 hours.

Washington State University Pet Loss Support – 1-(866) 266-8635 Phone and/or email message can be left for staff 24 hours a day. Phones are normally staffed during the semester Monday-Thursday from 7 PM-9 PM and Saturday 1PM-3 PM PST. While school is not in session and during holidays – abbreviated hours checking phone and email messages Monday-Thursday and Saturday once daily.

ASPCA National Pet Loss Hotline- 1-877-GRIEF-10

Iams Pet Loss Support Hotline 1-888-332-7738 M-F 9am-5pm

Canadian Pet Loss Hotlines:

Ontario Veterinary College Pet Loss Support Hotline – 519-824-4120 x53694 Tuesday – Thursday 6:00 pm -9:00 pm ET An answering service is available outside regular hotline hours.

Greater Victoria Area: Pacific Animal Therapy Society Pet Loss Support Line 1-250-389-8047 Daily 8:00 am – 9:00 pm Pacific Time

Edmonton: 780-707-3007, Pet Therapy Society; leave message if no response

UK Pet Loss Hotlines:

Pet Bereavement Support Service- 0800 096 6606 Daily 8.30am – 8.30pm

Animal Samaritans Pet Bereavement Service: 020 8303 1859

Australian Pet Loss Hotlines:

Pet Rest Grief Line – 03 9596 7799 from 12pm – 3pm 7 days a week

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