The COVID-19 pandemic has had many of us in social isolation and practicing social distancing when in public for weeks now. For a fortunate few, this has been a welcome reprieve from an otherwise hectically paced life. For the majority, it has meant being cut off from friends, family, community, and routine supports such as gyms, recreation centres, and social gatherings. We have become a people who are afraid to even greet one another in person. It’s because of these shifts that some of us, particularly those who have struggled with depression before, may be asking the question, “How can I prevent depression during COVID-19?”
How Can I Tell If I’m Depressed During COVID-19?
Anxiety about the risks of catching the Coronavirus are at an all-time high as are concerns about the future of jobs, financial security, and the availability of needed supplies, the education of children, and so on.
When ongoing anxiety is combined with a lack of social and community support, the result can be despair and even full-on depression. Depression is defined by features such as:
- A feeling of purposelessness or hopelessness about life
- Feelings of intense sadness often combined with heightened irritability
- Failing to attend to one’s personal hygiene
- A loss of interest in activities previously enjoyed
- Changes in appetite
- Failure to adhere to previous routines
- Sleep disturbances
- Loss of motivation
Some of the features indicated above are currently forced upon us by the pandemic. For example, simple aspects of hygiene such as going for a haircut are not currently available. And, even if we can find the motivation, many of the activities we would do are structured and rely on facilities such as a gym or a recreation centre which are currently closed.
The Effects of Social Distancing on Depression
Perhaps most alarming out of all of the effects of the pandemic is the imperative that we practice social distancing (or maybe more aptly, physical distancing). While this is entirely necessary at the present time, it can serve to greatly contribute to the development of depression. It is primal in human beings to gather with a friend, a family member, or community supports when experiencing stress. As it happens, we are incurably pack animals – maybe like orcas or wolves. Rare is the person who wants to be alone for extended periods of time while anxious. Rather, we naturally gravitate toward one another and, furthermore, we need social connection to remain emotionally and psychologically healthy. The need for social distancing has forced us to behave in a manner that is counterintuitive to our being healthy in the world.
Ways to Prevent Depression During COVID-19
What all of this means is that we will need to be very deliberate and stubborn in our efforts to fend off depression. I have a few suggestions for us all to consider, as I try to answer the question, “How can I prevent depression during COVID-19?” Here they are:
- Contacting with friends or supports by phone or video. Don’t be shy about admitting that you’re in a funk and just need to talk.
- Go for walks outside alone or with others (6 feet apart of course…)
- Do a bit of what you enjoy – whether it’s a hobby, listening to your favourite music, etc
- Pay close attention to your nutrition and don’t let it slide into bad habits
- Exercise – whether it’s a run outside, a workout following a TV or YouTube instructor, throwing the ball for your dog, riding a bicycle, etc. 20 minutes of exercise daily is ideal to fight depression
- Reach out for professional support if needed. Yes, we’re open for business and can safely meet with you if you feel that a counsellor is needed to support you for a time.
- Stick to as much routine as possible. Get up at a decent hour, get showered and dressed even if you aren’t going out. And then do that 20 minutes of exercise mentioned above
We don’t currently know how long the pandemic will last and that uncertainty can be very upsetting. Preventing the anxiety and the upset from becoming depressed in life is one of the few factors that we can actually control with some decided effort.
If you’re resonating with anything I’ve written, know that I’m rooting for you. We’ve all been there, and we’re all in this together. If you’re asking yourself how you can prevent depression during COVID-19, I’d love to help you out. Give us a shout at the office, and set up an appointment. Don’t go through this alone, we all need some help sometimes and I’d love to be there for you through this.
“I love that it gets dark at 3 pm, that it’s pouring rain constantly, and that I haven’t seen the sun in 4 months!” said no one ever. Although some people may prefer the cold winter weather, there are a lot of us who are counting down the hours until patio season starts up again (okay, maybe that’s just me). So, until then, we are binge-watching TV, sleeping in, indulging in comfort foods, and pretty much avoiding the outdoors unless we absolutely have to go outside. The different seasons and the weather impact what we do and how we feel, which is why many of us prefer indoor activities during this time of year and for the next few months to come. However, on a rare day that the sunlight does shine through or when summer finally rolls around, we are quick to get outside and enjoy the sun. We may notice that our mood improves when the sun comes out and it can be a bit easier to get things done. Other times, we notice that when it’s dark and rainy, it’s a little harder to get out of bed, be alert, or even feel happy.
If you’re relating to this post right now, you’re not alone! Approximately, 17% of Canadians are also feeling pretty low during the winter months (CMHA, 2013). You can thank Seasonal Affective Disorder (SAD) for these mood changes, which is a form of depression that occurs at certain times of the year, specifically between September/October and April/May. It affects anyone and everyone but is more common amongst women, individuals between 15-55, people who live further up north or farther down south away from the equator, or individuals with a family history of SAD or other types of depression (HealthLinkBC, 2017).
How Do I Know If Seasonal Affective Disorder is affecting me?
You may be experiencing Seasonal Affective Disorder if you identify with these statements:
- I feel sad, moody, or anxious
- I feel tired or slowed down all the time
- I’ve lost of interest in work, friends, or interests
- I’m gaining weight
- I’m craving carbohydrates such as “comfort foods” like bread or pasta
- I’m having trouble concentrating
- I’ve been experiencing changes in my sleep, such as sleeping too much or not enough
(CMHA, 2013; HealthLinkBC, 2017)
Why Do We Struggle With SAD?
But why is SAD even an issue to begin with? It is thought that the lack of sunlight creates a change in the chemicals in our brain, specifically serotonin, which is responsible for regulating our mood. Additionally, because it is darker, it can signal to our brain that it’s time to sleep which can cause an increase of melatonin in our brain, which is responsible for regulating our sleep/wake rhythm. The truth is that we’re not completely sure why it happens, just that it does, and to many people in our community.
What Can I Do About SAD?
It’s great to identify if we have SAD. One of the main ways to help yourself if you’re struggling with SAD is to increase your exposure to the right wavelength of light. This can include:
- Spending more time outside during daylight hours
- Opening the curtains or blinds during the day
- Rearranging the space that you are in to allow more sunlight to enter
- Arranging office/household furniture so you can sit close to a window
- Adding lamps into your space
- Using a SAD Lamp
Counselling can help with the symptoms of Seasonal Affective Disorder by giving us a better understanding of how SAD affects us as individuals and helping us to cope with the effects that come about during this time of year. It can also be useful in helping us to look at our thoughts, feelings, and behaviours and how they influence our mood and can aid us in creating strategies for making changes in these areas. In addition to this, being able to talk to someone who is able to empathize and listen to us can be very beneficial.
If you’re struggling with Seasonal Affective Disorder, you’re not alone and you don’t have to go it alone. Seeing a Registered Clinical Counsellor or one of us counselling interns can be a great help!
If you’re not sure if what you’re struggling with is Seasonal Affective Disorder (SAD), please go to your family doctor who can help you determine if this is what you’re dealing with, and can refer you to a specialist if needed.
In the meantime, we’re here and we’d love to support you until the sun comes back! Feel free to contact us!
Find Help Now. (2013). Retrieved from https://cmha.bc.ca/documents/seasonal-affective-disorder-2
Seasonal Affective Disorder (SAD). (2017, May). Retrieved from https://www.healthlinkbc.ca/health-topics/hw169553
It can be difficult to know what to say or do when someone has experienced a loss. It is a delicate subject to approach since we do not want to say the wrong thing or come off as intruding or prying towards someone who is grieving. We don’t want to add to anyone’s pain, so sometimes we go back and forth between being present and supportive, to taking a step back and giving a person their space to cope. Both of these can be beneficial for the other person, but our uncertainty about how to respond can make us feel unhelpful or that we are adding to their pain. When it comes to offering support, however, being present and available to help or spending time with them can be healing.
What else can we do to be supportive during this difficult time? Here are a few practical ideas of how to help a friend or family member who is grieving:
- Know what “normal” grief is and how to respond – check out my last article for a primer
- Know that there is no one right way to grieve, every response and emotion is valid; people who are grieving may feel relief, guilt, anger, emptiness, sadness, etc. These emotions may be intense or extreme or they may be more mild. Be prepared for any reaction, and know that the reaction isn’t about you, it’s a response to pain.
- There is no timeline or linear process to grief; each grief process is unique. People will cope in whatever way feels right for them and will take as long as they need.
- Expressing support
- Be empathetic by acknowledging the bereaved individual’s feelings (e.g. I can’t imagine how difficult this must be for you). Showing acceptance and support of their emotions, whether it’s anger, sadness, or otherwise, can provide a safe space for the person to experience their emotions openly.
- Give them space to tell their story. The person may want to discuss the details of their loss repeatedly or in detail as a way to come to terms with what has happened.
- Reach out to the person who is grieving whether it be through a phone call or an in-person visit. Remember them as time goes on and check in. Many times, people respond immediately and then support fades quickly.
- Avoid saying things like: “Everything happens for a reason”, “They’re in a better place”, “At least…”, “It’s time to move on”, “I know how you feel”, “You can always have another child/get another job/get remarried”, “Time heals all wounds.” Avoid finding a silver lining to the loss or trying to fix what’s happened.
- Instead, say things like: “I’m here for you.”, “I don’t know what to say, but I care.”, “I’ll call you/visit in a few days.”, “What can I do?”, “I can’t imagine what you must be going through.”
- Saying nothing and just listen. It’s okay to listen or just be present with the other person. Sometimes there’s nothing at all that we can And certainly, whatever we say is unlikely to make the situation better.
- Providing practical support can be very helpful, such as offering to:
- Help with arrangements related to the loss, such as funeral arrangements, packing, finding a new place to live, etc.
- Complete household chores or run errands
- Cook or drop off meals in non-reusable containers so they don’t have to worry about washing your dishes and getting them back to you
- Watch their children or pets if needed, giving them time for themselves
- Help with insurance or other paperwork
- Answer or make phones calls or for them
- Take them out for a meal or a movie
- Watch for signs of depressed feelings or complicated grief
- We’ll take as long as we need to cope with our loss, but we do need to eventually come to terms with what has happened. Over time, we’ll adjust to a new normal and be able to move forward. However, sometimes we don’t move on and get stuck, which is called complicated grief which involves:
- Being unable to move on from the loss
- Being unable to carry out daily routines
- Isolating ourselves
- Having feelings of intense loneliness, numbness, or sorrow
- Wishing to be dead with the loved one who has passed
Depression can also occur and is often a part of complicated grief. The challenge with depression and complicated grief is they can be hard to tease apart, and often co-exist. Both can come in waves, or be constant companions.
If you’re noticing a complexity in the grief of a loved one, or signs of depression, then it’s best to encourage your loved one to seek out mental health support such as counselling. This can provide a space for emotions and thoughts related to the loss to be processed and allow for healing to occur. It can also provide an invaluable resource for depression and trauma screening by experienced professionals who can direct care most appropriately.
A loss isn’t something that can be fixed or repaired; it is something that has to be lived with. The pain cannot be taken away, so instead, we can help others by sitting with them in their pain. It is okay not to know what to say or how to help; if we can show up, listen, and be present, then that’s enough, and is valuable!
Complications of Grief. (2017). Retrieved from https://www.healthlinkbc.ca/health-topics/aa129291
Grief and Loss Resources. (2017). Retrieved from https://livingthroughloss.ca/
Helping Someone Who’s Grieving. (2018). Retrieved from https://www.helpguide.org/articles/grief/helping-someone-who-is-grieving.htm
Neurofeedback is one of the most amazing technologies at our disposal for so many reasons. It’s an invaluable tool for overall resilience, cognitive flexibility, mental health management, sleep enhancement, and so much more. One of the most common questions I get, however, is how on earth does it work? I’m going to do my best to explain it here for you!
Dynamic Neurofeedback Training
The type of neurofeedback training that we use here at Alongside You is called dynamic neurofeedback. What this means is that our neurofeedback system constantly monitors the brain using electroencephalography (EEG) and provides feedback to train your brain. To put this into perspective, our system monitors the brain 256 times per second. That’s a lot of feedback!
The feedback happens through video and audio sources. During neurofeedback training, you’ll be watching a computer screen that displays a variety of moving images and listening to an audio soundtrack. The neurofeedback system monitors your brain activity through EEG, and when it senses that your brain activity on the various wavelengths is outside of the optimal range for your brain, it interrupts the video and audio signals briefly. Because this interruption is tied to your specific brain activity, your brain knows to connect the dots. This allows your brain to know what it is doing at that point in time, and adjust accordingly.
I Still Don’t Get How It Works Andrew!
Let me explain a little bit more then! One of our misconceptions is that because our brain is constantly working, it must know what it’s doing at all times. This is unfortunately not the case. It’s like when I grew around 6 inches in one year, I kept walking into door frames because I didn’t realize where my shoulders were in 3-D space! What our brain is able to do, however, is adjust itself for optimal health if it has the information it needs. Neurofeedback training is what helps provide the necessary information for the brain to change itself.
Imagine you’re driving. Anyone who has driven for any length of time knows that the mind wanders sometimes. Every once in a while, we’ll wander too far to the right and our right tires will go over the shoulder, and we’ll feel a rub strip or gravel under the tires, and hear a noise that signals to us that we are over the shoulder. What happens next is automatic – we naturally move over to the left a little bit. We generally don’t even need to think about it, we just do it. This is analogous to what happens with our brain during neurofeedback training. The interruptions in the audio and video signal to the brain where it is on the wavelengths. The brain uses this information and adjusts itself accordingly. Over time, this training helps the brain stay within the optimal range on the various wavelengths on an ongoing basis.
How Long Does Neurofeedback Training Take?
This is the million-dollar question! It’s also an understandable one. We all want to know how long something is going to take. It’s really no different than wanting to know how long counselling is going to take. Unfortunately, the answer may not be any more gratifying than the answer to how long counselling is going to take: it depends.
Here’s the truth – it depends because every brain is different. It’s also challenging to predict because dynamic neurofeedback training is not a specific treatment for a specific symptom, it is a whole-brain training aimed at helping the entire brain function better. Because of this, we can’t claim that neurofeedback will cure your anxiety, depression, or otherwise. What we can say, however, is that by helping your brain to function better, symptoms that exist because your brain is not functioning at its best are likely to improve. What I can say, is that this has definitely been my experience in working with clients with neurofeedback. Symptoms of concern do improve, our ability to manage any remaining symptoms gets better, and we become more flexible and resilient, but it takes time.
It may be helpful to think of neurofeedback training as gym training for your brain. When we go to the gym, we don’t see much improvement after one workout. We see improvement over a series of workouts, and over a consistent effort to train. How fast each of us builds muscle, and get in shape depends on a whole lot of variables, so in the same way, we can’t predict how long it’s going to take for you to build the muscles you want and get in the shape you’re looking for. What we do know, however, is that if you train consistently over time, you’ll build muscle, and you’ll get in better shape.
How Do You Know It Works?
This is a great question. Monitoring brain changes can be challenging, but here’s how we do it. Before you start, we use a variety of tracking tools to track the symptoms you have concerns about, and over the course of the sessions, we repeat these tracking tools to look at improvements. In addition, we check in with you each session to see how things are going and what you’re noticing. The true indication of whether it’s helping is the answer to a very simple question: “How do you feel now versus how you felt before we started?” Sometimes it’s hard to notice the shifts, and this is where we can also help you monitor by asking the right questions to pick up on shifts.
I have noticed significant positive results in my clients who have done neurofeedback training. In fact, it’s uncanny how positive it has been. I hope this article has helped explain a bit more about neurofeedback, how it works, and how it might be helpful. If you have any more questions, give us a call and we’d be happy to answer them!
Grief is a normal emotional process that happens when adjusting to a loss or change. It happens not only when someone has died, but also after things like a job loss, the ending of a relationship, or while anticipating a future loss. Grief is a complex process that has no concrete roadmap, but there are some common factors that influence the process we go through. Some of these factors are:
- Our relationship with the individual who is gone
- The circumstances surrounding the loss
- Our current coping mechanisms and how past emotional distress has been handled
- The availability of support networks while we grieve
(Living Through Loss, 2017)
No matter what we are grieving, it is difficult, painful, and exhausting.
Part of the difficulty in grief, as I alluded to above, is that the roadmap isn’t clear. What we do know, however, is that there’s no right or wrong way to grieve. It is okay to feel relief, emptiness, or nothing at all when coping with a loss. It’s also okay to cry, feel physically exhausted, be angry, or struggle with feelings of guilt. Grief is a process that is unique to each person and so our bodies and our minds will respond as best they can in whatever way they feel is best for us to move on; in other words, they do the best they can at the time, with what they have to work with.
Sometimes the timeline of grief can be a challenge. Often, we expect ourselves, or even others expect us to move through the grieving process more quickly than we’re able to. It’s important to know that it’s okay to take as long or as little time as we need to move forward. Given the popularity of the five stages of grief (denial, anger, bargaining, depression, and acceptance), many people believe that they need to go through these five stages linearly to move forward (Living Through Loss, 2017). That may be the case for some people, but it is not for everyone. As mentioned above, people experience a wide range of emotions and experience grief in different ways so their grieving process may not always be forward moving. Sometimes we get stuck, sometimes we go backwards, or sometimes we’re all over the place and have a mix of good days and bad days, which sometimes ends up looking like a mess.
How do we manage while all of this is happening? With how intense and exhausting grief can be, it is vital that we take care of ourselves. Often, we’re so overwhelmed we can’t even think of how to take care of ourselves. Here are some suggestions for ways you can practice self-care while going through the grieving process:
- Avoid drugs and alcohol since they may make you feel worse
- Avoid isolating yourself and find support from a friend or counsellor
- Get lots of rest. Grieving is exhausting, so you will likely be more tired than usual
- Drink lots of water and try to eat the best you can, and try to avoid sugar and caffeine
- Exercise, even if it’s only going for a walk around the neighbourhood
- Give yourself time and permission to mourn as often as needed
- Do things that make you feel good such as journaling, art, listening to music, reading
- Be kind to yourself. You’re doing the best you can
(Living Through Loss, 2017)
After some time, we will adjust to our losses. It’s hard work and takes time, but eventually, we can come to terms with what has happened, grieve and mourn our loss, and move forward. However, some people find themselves stuck. This experience has been described as something called Complicated Grief. Some of the signs of complicated grief are:
- Being unable to move on
- Being unable to carry out everyday routines
- Isolating yourself
- Feeling intense loneliness or numbness
- Feeling extreme sorrow, pain, or depression
- Feeling that life has no purpose
- Ruminating or experiencing intrusive thoughts about your loss
- Wishing you died with your loved one
If you notice that you or someone you care about are experiencing any of these symptoms, then may be time to seek out professional help such as counselling. Therapy can give you a space to talk about your loss and help you to work through your thoughts, feelings, and memories relating to your experience. Counselling can also help to identify and work through any potential trauma relating to the loss and helping you to adjust to this change.
I hope this article has been helpful if you’re experiencing grief and loss. We’ve all been there, and some of us are there right now with you. If you could use some help as you walk through this journey of grief, we would love to talk to you. Please give us a call or contact us anytime, we’re here.
Complications of Grief. (2017). Retrieved from https://www.healthlinkbc.ca/health-topics/aa129291
Grief and Loss Resources. (2017). Retrieved from https://livingthroughloss.ca/
Over the past two decades, we have seen a steady rise in media attention covering Postpartum Depression (PPD). This is partly because the psychiatric community officially recognized PPD as a distinct condition in the mid-90s [i] and partly because of celebrities who have started to talk about their experiences with postpartum depression. And yes, you read that correctly, although there are abundant records of women talking about their experiences with maternal mental illness from the early 1800s to the present, it only started being recognized as a distinct mental illness in the 1990s[ii]. As you might imagine, the result is that the science, the literature and the media reporting are all a bit behind. Luckily, with organizations such as Postpartum Support International (PSI), the science is finally starting to catch up and hopefully, that means the media and our social perceptions of maternal mental health will too.
What is Postpartum Depression?
Postpartum depression is often used as an umbrella term for all maternal mental health conditions, but in reality, there are a number of maternal mental health conditions that are distinct and vary in terms of severity, duration and characterization. All of these conditions tend to get jumbled up together in the media which is confusing for those who have PPD, as well as their loved ones. So, let’s break it down.
The technical term for postpartum depression is a Major Depressive Episode with Peripartum Onset. What that mouthful of jargon basically means is that PPD can be understood as a depressive episode that lasts a minimum of 2 weeks and is characterized by depressed mood, insomnia or hypersomnia, fatigue, feeling worthless, low interest in pleasurable activities and having thoughts of suicide[iii]. If you read my last blog post about the Baby Blues, you might note here that PPD is very different from the Baby Blues. Baby Blues are a normal part of giving birth where most mothers experience a drop in the mood right after giving birth for a short period of time. PPD not only last longer but is more severe. About 15% of new mothers experience PPD as opposed to 85% of mothers who get the Baby Blues[iv][v]. And while this distinction is important, keep in mind that whether you have the Baby Blues or PPD, you can absolutely get treatment, you don’t have to wait and see if it’s severe enough. Every person’s experience is different, and you deserve help. Do yourself a favour and check in with your doctor, midwife and/or therapist to see how they can support you to feel like yourself again.
Men experience PPD too. A growing body of research has shown that roughly 5% of new fathers experience PPD which comes as no surprise because mothers and fathers both endure the many new stressors like lack of sleep, way more responsibilities and demands put of their plate, and feelings of failure and inadequacy often associated with bringing a baby home[vi].
I won’t go too far into the causes of PPD here but if you ever want to talk about them, my door Alongside You is always open.
I’ve spoken to a lot of mothers and fathers who were very confused about the way their PPD presented itself. Interestingly, PPD might look different from what we might think of as a typical episode of depression. A lot of people with PPD have reported either anger or anxiety as their primary symptoms[vii]. Some experience periods of elevated energy and racing thoughts where they’re unable to sleep and can’t stop cleaning. Many also report panic attacks[viii]. While these responses may feel scary at the time, they are normal and can be helped with a number of different therapies that I will get into at the end of this article.
Overcoming Stigmas and Getting Help
Experts agree that PPD is underdiagnosed, primarily because those who endure it often feel too ashamed to seek help. There’s a common misconception that PPD is associated with infanticide which is simply not true. Those over-reported cases of infanticide are not cases of PPD, they are cases of severe psychosis with peripartum onset. Unlike depression, psychosis is characterized by delusions and hallucinations[ix]. And even if a parent does show signs of psychosis with peripartum onset, it is incredibly rare that these delusions will lead to infanticide[x]. I can’t stress enough how rare that is.
New parents are often under a lot of stress and experience intrusive thoughts. When a person’s brain is in an anxious state, it’s common for their mind to go to the worst possible thing they could do (as if you weren’t stressed enough already…). This happens to all of us. Sometimes when I’m driving up the Sea to Sky highway, my brain imagines veering my car off the cliff. Of course, I will never do that, but my brain plays some pretty wild tricks sometimes, just like yours might when you’re under a lot of stress and your baby is still crying.
The main danger with PPD is that the stigmas that result from those sensationalized media stories keep many new parents from reaching out for help. As a result, suicide (not infanticide) is the greatest risk associated with PPD.
What can Help Postpartum Depression
As I mentioned at the start of this blog, science is catching up and we now have many treatments to choose from for PPD. Some find antidepressants helpful, like one woman said, “the me I was used to re-appeared after medication.” Other treatments include infant sleep interventions, massage therapy and relaxation, increasing Omega-3 intake (fish, nuts, seeds, healthy oils), spiritual practices, yoga, bright light therapy and, of course, counselling (individual and couples counselling are both helpful). For most new parents, a combination of any of these above methods works best.
I’ll leave you with a simple and accurate quote from a mother I recently spoke with who had PPD – “Let people help, they want to.”
We’d love to help, if you’ll let us. Give us a call at the office, or contact us through our contact page and we’ll be happy to talk to you about how we might be of help!
Some books that have been helpful to others:
- Motherhood May Cause Drowsiness: Mom Stories from the Trenches: A Second Edition Monkey Star Press Anthology (What Is a Mother to Do? Adventures in Motherhood and Mayhem) – by: Lisa Nolan, et al.
- When Postpartum Packs a Punch: Fighting Back and Finding Joy – by: Kristina Cowan
- Tokens of Affection: Reclaiming Your Marriage After Postpartum Depression 1st Edition -by: Karen Kleiman, Amy Wenzel
- The Birth Partner: Everything you Need to Know to Help a Woman through Childbirth – by: Penny Simkin
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.) VA: American Psychiatric Association
 Segre, L.S., & Davis, W.N. (2013). Postpartum Depression and Perinatal Mood Disorders in the DSM. Postpartum Support International. Retrieved from www.postpartum.net.
 American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). VA: American Psychiatric Association
 Shapiro, G.D., Fraser, W.D., & Seguin, J.R. (2012). Emerging risk factors for postpartum depression: Serotonin transporter genotype and Omega-3 fatty acid status. CanJPsychiatry, 57(11), 704-712.
 Khajehei, M., Doherty, M., & Tilley, M. (2012). Assessment of Postnatal Depression Among Australian Lesbian Mothers During the First Year after Childbirth: A Pilot Study. International Journal of Childbirth Education, 27(4), 49-54
 Breese McCoy, S.J. (2012). Postpartum depression in men. In M. G.Rojas Castillo (Ed.) Perinatal Depression (p. 173-176.) Rijeka: InTech. Available from: : http://www.intechopen.com/books/perinatal-depression/postpartum-depression-in-men-
 APA (2013)
 APA (2013)
 Postpartum Support International (2018). Postpartum Psychosis. Retrieved from http://www.postpartum.net/learn-more/postpartum-psychosis/
 APA (2013)
 Shapiro, et al. (2013)
[i] American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.) VA: American Psychiatric Association
[ii] Segre, L.S., & Davis, W.N. (2013). Postpartum Depression and Perinatal Mood Disorders in the DSM. Postpartum Support International. Retrieved from www.postpartum.net.
[iii] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). VA: American Psychiatric Association
[iv] Shapiro, G.D., Fraser, W.D., & Seguin, J.R. (2012). Emerging risk factors for postpartum depression: Serotonin transporter genotype and Omega-3 fatty acid status. CanJPsychiatry, 57(11), 704-712.
[v] Khajehei, M., Doherty, M., & Tilley, M. (2012). Assessment of Postnatal Depression Among Australian Lesbian Mothers During the First Year after Childbirth: A Pilot Study. International Journal of Childbirth Education, 27(4), 49-54
[vi] Breese McCoy, S.J. (2012). Postpartum depression in men. In M. G.Rojas Castillo (Ed.) Perinatal Depression (p. 173-176.) Rijeka: InTech. Available from: http://www.intechopen.com/books/perinatal-depression/postpartum-depression-in-men-
[vii] APA (2013)
[viii] APA (2013)
[ix] Postpartum Support International (2018). Postpartum Psychosis. Retrieved from http://www.postpartum.net/learn-more/postpartum-psychosis/
[x] APA (2013)