Special To The Herald
Ilyene Barsky does more than cringe when she hears of tragedies such as the deaths of Andrea Yates' five children, ages 6 months to 7 years, all drowned by their mother.
The actions of the Houston woman, who allegedly had been battling severe postpartum depression, bring back chilling memories for Barsky, who had her own bout with the mood disorder when her son was born in 1980.
At the time, she had no idea what was wrong with her.
``I had terrible, disturbing thoughts, which I wouldn't discuss with anyone because they were so scary,'' says Barsky, who remembers being wracked by sleeplessness and withdrawing from friends.
``I kept this hidden for nine months. I was ashamed and embarrassed because nobody told me this could happen.''
Finally, Barsky sought help for the insomnia. Her physician recognized depression and prescribed antidepressants. Four years later, she learned about PPD for the first time, and recognized her own symptoms.
``I've been lecturing ever since, just to get the word out,'' says Barsky, who founded the Center for Postpartum Adjustment in Coral Springs and conducts weekly support sessions for women struggling with the isolation of motherhood that can weigh too heavily, the hopelessness of not knowing how to escape the misery of PPD.
It's estimated that 10 percent to 20 percent of new moms will have PPD, a condition quite different from the baby blues that affect about 80 percent of new mothers and typically pass in about two weeks, experts say. Of those afflicted with PPD, a much smaller number -- .1 percent to .3 percent -- will develop postpartum psychosis, characterized by a fear of harming the baby, and only 1 percent of those actually turn homicidal or suicidal.
Despite the low incidence of such cases, their devastating impact is felt far and wide as they shine a spotlight on a condition that remains largely underdiagnosed and untreated.
Yates, the Texas mother who killed her children June 20, had ceased taking a strong anti-psychotic medication just a few days before. Her husband and family were aware of her history of mental illness, which included a prior suicide attempt.
KILLED CHILD, SELF
Closer to home, Alanna DePasquale of Dania Beach drowned her 7-month-old daughter, Kylie, then killed herself June 10 in what also appears to be a psychosis-driven incident. Her husband said she would not take any medications because she feared they might hurt the baby she was breast-feeding. In both instances, the women seemingly suffered privately -- a pattern that is not uncommon, according to experts.
``Many times, it's not the woman herself that comes seeking help,'' says Paul Gluck, an assistant clinical professor in the obstetrics and gynecology department at the University of Miami and an OB/GYN at Baptist Hospital.
``Family members may notice there's a new baby in the house and this person is sad, can't take care of the baby, maybe is pushing the baby aside and not caring for the baby. They know she's not behaving normally.''
A depressed person may sleep a lot, or not enough, exhibit changes in eating habits and a loss of enthusiasm, a sense of hopelessness or lost self-esteem. Thoughts of death or suicide are a red flag that a person needs help untangling a twisted mental condition. Other symptoms include panic or anxiety attacks, a fear of being alone or compulsive behavior.
``Family and friends need to realize that the person isn't just weak and that they can't just snap out of it,'' says Gluck. ``It's a medical condition that needs to be diagnosed with professional help, a real chemical imbalance. Friends need to be sensitive and supportive.''
Barsky agrees that emotional support can make the difference between a difficult time and full-blown PPD.
``A new mom needs strong emotional support during this time, someone who takes this seriously and will roll up their sleeves and help,'' says Barsky. ``One of the highest predictors of PPD is the stability of the marriage or the relationship. If the partner is non-supportive or unavailable, it can increase the likelihood of postpartum depression.''
Antidepressant medications such as Elavil and Norpramin, or selective serotonin reuptake inhibitors Zoloft, Prozac and Paxil, are often prescribed to help women recover from PPD. Doctors must consider the severity of the condition, and whether the mother is breast feeding in selecting the appropriate medication. Some antidepressants can pass into breast milk, but many doctors feel that the slight risk is outweighed by the benefit of improving the mother's mental health. Women may choose to switch to formula use.
Barsky also advises that women increase their intake of Vitamin B6 and calcium, and spend at least 20 minutes per day outside in the fresh air and sunshine.
``It's hard but you just have to force yourself,'' she says. ``Just put the baby in a carriage and get out -- it will stimulate your endorphins and give you a sense of well-being, and chances are you'll meet other mothers and you can start networking to decrease that sense of isolation.''
MANY FACTORS
Fluctuating hormones have been identified as playing a role in the development of PPD, but many other factors contribute to the condition. The physical stress of pregnancy, delivery and nursing, plus the emotional pressures of new and demanding responsibilities combined with isolation, hormonal imbalances and a personal or family history of depression all come together to create the problem.
``We expect new moms to be deliriously happy,'' says Barsky. ``We don't look at all the losses of becoming a new mother: loss of identity, she's just moved up the generational ladder, she's lost her job, her income, her career status, her recreational activities, her one-on-one relationship with her husband, and her figure.''
And the crying new baby who is her 24/7 companion and responsibility may not fit the picture she had in mind during pregnancy. Combined with fatigue and isolation -- all very common elements of the first few months of motherhood -- a woman can become overwhelmed. She may feel guilty about negative feelings that are quite normal. That's why support groups can be valuable.
``There are few things as significant as family and friends in the home and the community,'' says Diana Gonzalez, a medical social worker who facilitates the Baby's First Year group at South Miami Hospital, a free program for new moms and their babies.
`YOU FEEL ACCEPTED'
Elizabeth Cefalo, who attends Baby's First Year sessions twice monthly with her 10-month-old daughter Hannah, agrees.
``Every time I had a question, there was already somebody in the room who either went through the same thing or something similar. You feel accepted -- your opinions and how you feel are very important.''
Cefalo says although she has known other women who struggled with varying levels of PPD, she wasn't affected by it.
``It's hard to balance Mommy, wife, and yourself. In the first few months, I couldn't clean the house, couldn't have dinner ready and do all those things, and when I didn't get any sleep, the world was a very ugly place,'' she says. ``I had to slow down and ask for help -- which was very hard for me.''
But she did it and soon reinstated her workout program and ballet dancing, her main outlet for stress, Cefalo says.
Although postpartum mood disorders have been attributed to the sudden decrease of hormone levels in a woman's bloodstream immediately following birth, recent research questions that premise.
Scientists at the University of Bristol in England have found that depression is present as much or more frequently among women in the third trimester of pregnancy (13.5 percent) than after the birth (9.1 percent). Further studies show that the effects of a depressed mother on an infant can be long-lasting.
``One of the biggest risks is that it will affect the mother-infant bond,'' says Catalina Jacobs-Fernandez, a psychologist at South Miami Hospital. ``If a mother is depressed, she's not going to interact as well with the baby or have the same quality of interactions. That's going to lead to difficulty in learning, and often to behavior problems later in school. If the bonding isn't there -- if the depression isn't treated in the beginning -- there's going to be long-reaching effects throughout life.''
Ilyene Barsky shares her knowledge with her children, now 17 and 21, so they'll be aware should similar problems crop up in their own lives.
``The family is the cornerstone of society,'' Barsky says. ``If mom is not functioning well, everybody in the family is going to be affected.''
Women who have experienced PPD are at a greater risk of developing the condition with subsequent pregnancies, developing premenstrual syndrome and having a more difficult menopause.
``They really should get help,'' says Jacobs-Fernandez. ``It's best for them and for their baby. The best kind of treatment is the combination of medication and therapy. It's not for the rest of their lives, just a few months until the symptoms pass.''