Postnatal post-traumatic stress disorder (PTSD) is being found to be an important mental health issue among new mothers. Usually presenting within a month of childbirth, it occasionally takes up to a year to manifest.
It is preceded by a perception of trauma during labor and delivery, which presents a threat to the life or health of either the mother or the baby, coupled with a feeling of helplessness and resulting extreme fear.
In some cases the symptoms of PTSD fluctuate in severity, but in others the features remain constant and troubling. It may be a source of impaired functioning at home, in society and at work, but women are often afraid to seek help. However, PTSD can be treated even years after the occurrence of the original trauma.
Therefore anyone who is struggling to overcome memories and fears connected with a traumatic experience should be encouraged to face their fears and negative feelings, so that they will receive the right assistance to come to terms with it.
At the first appointment, the patient’s healthcare provider will spend time determining the symptoms so as to confirm the diagnosis and decide on the appropriate treatment. If the symptoms of PTSD have lasted more than 4 weeks or are causing severe disturbance, psychiatric evaluation and help are advised to ensure that remission is brought about as fast as possible.
The health specialists who are equipped to manage PTSD include psychologists, psychiatrists, or a community psychiatric nurse.
The main avenues of treatment for PTSD are watchful waiting, psychotherapy and medication.
This mode of treatment is chosen in patients with mild symptoms, especially if they are of recent onset (less than 4 weeks old). The patient is supported for depressive symptoms if present, and plans are made to relieve stressors, if any. The symptoms are watched by close monitoring to observe their course. If they worsen, other therapies are adopted. The woman should attend a follow-up session within a month of the first.
The rationale for this approach is based on the finding that two of every three people who have undergone trauma usually recover without specific treatment.
Once the healthcare provider determines that the patient requires treatment, psychotherapy is advised. This may take various forms, such as cognitive behavioral therapy (CBT), with or without medication. Severe forms of PTSD may require both medication and psychotherapy.
Psychotherapy is also called talk therapy, and is effective in dealing with disorders of the emotions leading to mental health issues. The doctor is trained to listen to the patient so as to understand the true problems, which can then be handled with various tools.
For example, CBT recognizes that one’s behavior springs from one’s thoughts, so that changing the thought pattern will change the behavior as well. Behavioral exercises are coupled with first identifying and recording the counterproductive thought which leads to self-destructive behavior.
The benefit of the sessions lies in the fact that the woman can be helped to deal more effectively with her emotions while recollecting the painful experience in the presence of a therapist. This gives a safe outlet and helps her confront the trauma, while the therapist can identify unhelpful or self-destructive thoughts about the past experience, and guide her to change such ways of thinking.
Avoidance and numbing behavior will be gradually phased out by behavioral exercises which are aimed at facing the fear. CBT may take several months of treatment.
Eye movement desensitization and reprocessing (EMDR) is another somewhat newer technique which helps women recall the trauma with greater emotional detachment, finding ways to deal with it as a result.
Sharing your experiences and treatment results with a group of people who have PTSD is often very helpful in overcoming feelings of isolation, providing emotional and relational support, and helping the woman find and give understanding. People in the group learn from each other and manage their condition better as a result.
Severe PTSD may require antidepressants. Indications for their use include:
- A patient’s unwillingness to start psychotherapy
- Current threat of trauma as when domestic violence is present
- Failure of psychotherapy
- Co-existing severe mental disorders such as major depression which unfits you for psychotherapy alone
- Reducing depression or anxiety in older people
At least a year of medication is indicated, followed by graduated withdrawal. Patients should be aware of possible side effects and contact their healthcare providers as required.
Reviewed by Afsaneh Khetrapal, BSc (Hons)