Until recently postpartum depression has been controversial in the medical community and poorly understood by the general public. Historically women experiencing this debilitating and dangerous condition were subjected to guilt and shame of being “bad” mothers and not being able to “just snap out of it” shortly after childbirth. Fortunately there has been a lot more publicity and awareness of this illness in the last twenty years partly due to many more women entering the medical profession and several prominent celebrities sharing their struggles with motherhood with the general public. As a result, we now have more knowledge about this condition and evidence-based practices that are effective in recognizing, diagnosing and overcoming it. If only we could get women in the community, regardless of their cultural background or socioeconomic status, to actually seek and get help.

Shame and guilt are the major obstacles to getting help for postpartum depression. The primary message that needs to get out there is: “Untreated depression can cause significant harm to the baby. For the sake of your child, you have to ask for help!” And another important message is: “Postpartum depression is no one’s fault.”

What is Postpartum Depression? What are the symptoms?

Postpartum Depression is a very common and serious mood disorder that typically does not resolve without treatment. According to some estimates up to 15% of mothers experience symptoms of Postpartum Depression within the first month after delivery. This disorder is characterized by the mother feeling sad, hopeless, empty or overwhelmed, and crying more often than usual and for no apparent reason. The mother might worry a lot or feel overly anxious. She might be feeling moody, irritable, restless, oversleeping or unable to sleep when the her baby is asleep. She may be having trouble concentrating, remembering details, or making decisions. She may be experiencing anger, rage, and loss of interest in pleasurable activities. She may be suffering from physical aches and pains, eating too little or too much, and withdrawing from or avoiding friends and family. She is typically having trouble bonding or forming an emotional attachment with her baby and persistently doubting her ability to care for her baby. She might be having scary thoughts about harming herself or her baby, even though it is something she would never actually do.

Even though every mother experiences anxiety, worry, self-doubt and preoccupation with her new baby, Postpartum Depression is different from regular “baby blues” because of the extreme nature, duration, frequency and severity of the symptoms. “Baby blues” are experienced by about 80% of mothers with mild symptoms of worrying a lot and being understandably very tired. The symptoms last one or two weeks and resolve on their own. Postpartum Depression can go on and get worse for many months.

Postpartum psychosis is rare, affecting only about 0.1% of births, but has severe and serious symptoms that require immediate hospitalization. Symptoms show up within a week of birth and might present as hallucinations, delusions, or paranoia. This condition is very dangerous because the mother is experiencing a break with reality, which causes high risk of danger to herself and the baby. This is a treatable condition but it is considered an emergency.

What causes Postpartum Depression?

Postpartum Depression does not have a single cause. It is a result of numerous physical and emotional factors, which are not well understood. However, we know that our mental state is heavily influenced by hormonal balance in our bodies and our brains. After birth, some of the mother’s hormone levels drop a thousand times in a matter of hours, affecting their brain’s ability to emotionally self-regulate. Many women experience abnormal thyroid function in the postpartum period, which also regulates our moods, and it is often undetected. On top of the painful process of recovery after often traumatic birth experience, followed by sleep deprivation and extreme exhaustion, this often leads to extreme symptoms of a full-blown mood disorder.

What are the risk factors of Postpartum Depression?

Even though the mechanism of Postpartum Depression is not well understood, there are several known factors that put the mother at high risk for developing Postpartum Depression. These factors are previous history of Postpartum Depression or any other type of depression, including Bipolar Disorder, family history of mental illness, experiencing a stressful life event, traumatic birth or medical complications during childbirth for either the mother or the child, substance abuse, difficulty with breastfeeding, and environmental factors such as lack of support from family. The woman’s feelings about pregnancy (wanted, unwanted, complications, etc.) can also play a role.

The brain regulates our body. When the brain is biochemically disregulated it will create other imbalances in the body. There many anxiety and depressive disorders that are co-morbid (co-occurring) with Postpartum Disorder.

Surprisingly panic attacks have protective hormonal effects. They often go away during pregnancy but might come back with a vengeance after birth during postpartum period.

When to seek help?

It is important to be aware of your own risk factors and bring it up to your doctor very early, even before conception or very early in pregnancy, so that you can collaboratively come up with a plan to reduce the risk and minimize the symptoms.

What help is out there?

Research shows that a combination of medication and psychotherapy works best. Medication can be prescribed by primary care physician or a psychiatrist. In severe cases of the disorder antidepressants are absolutely necessary, but they take a while to be effective. Cognitive Behavioral Therapy is a therapeutic approach that builds on the interaction of feelings, thoughts and behaviors and has been proven to help with Postpartum Depression, especially when working with a therapist that has training and experience with this disorder.

It is critical for the mother to take good care of herself in the postpartum period by engaging in physical activity, going for long walks with the baby and socializing with other new moms. Getting adequate rest, eating healthy foods, not using any drugs or alcohol, making time for yourself, and accepting help from a friend to make a meal or watch the baby while the mother takes a nap are all great ways to starting and maintaining recovery from Postpartum Depression.

What happens if it goes untreated?

Maternal sensitivity is a mother’s attunement to the baby, her ability to perceive her child’s signals accurately and to respond to them promptly and adequately. Studies of mother–infant interaction provide evidence that mothers who are more sensitive are more likely to have a child with a secure infant–mother attachment experience. Attachment security, in turn, is widely recognized to be a protective factor fostering life-long, healthy socio-emotional and psychological development. Unfortunately, mother’s physical presence is not enough to create attunement and secure attachment. The mother needs to be continuously emotionally present and connecting with the baby in order for the child to thrive. This does not happen if the mother is severely and clinically depressed, such as in the case of the mother suffering from Postpartum Depression. The risk is less than optimal brain development for the child and lower social-emotional functioning that will affect the child for the rest of their life.

What are the barriers to care?

The stigma of any mental illness and especially of postpartum depression is still huge, despite publications as popular as People magazine routinely writing about postpartum experiences of Gwyneth Paltrow and Hayden Panettiere after the birth of their babies. Yet, somehow women still get the message that asking for help is a sign of weakness and if they just try hard enough everything will be “just fine.” False societal expectations are based on unrealistic perceptions of having a new baby being a beautiful care-free time in a young mother’s life. Most of these perceptions are based on advertisements and commercials of baby products that show gorgeous polished well-rested moms in freshly ironed white shirts, perfect make-up and professionally done hair, playing with their cherubic babies in a crystal clean room or socializing with other moms in a picturesque park. These advertisements do a great disservice to young moms, who think these are the expectations they need to live up to.

In addition to the negative stigma, women suffering from Postpartum depression experience feelings of guilt, shame, and hopelessness that are typical for any depressive disorder. This leads to isolation and lack of support, and makes it even less likely that the woman will seek help. Lack of alternate child care and financial obstacles prevent many people from going to see a doctor or a therapist.

How can we support the new moms?

The best way to support the new mom is to remind her and reassure her that:
– Postpartum Depression is not her fault.
– Postpartum Depression is treatable.
– It is OK to ask for help.
– The best way to take care of the baby is to take care of yourself first.

Specific practical ways the father can help:
– Plan to take time off work for at least the first few weeks so that you can help with taking care of the baby while the mom rests
– Consider taking paternity leave, even if it is unpaid (budget and save ahead of time), especially if your wife is high-risk for PPD
– Hire a helper if at all possible or enlist friends and family to help
– Offer lots of emotional support
– Give your wife a break when you get home

– Send her out of the house and let her have time by herself
– Tell her she is doing a wonderful job and her critical mother and mother-in-law is wrong

Most importantly, always encourage the new mom who is struggling with extreme moods to seek help from a professional. Reach out to a counselor, therapist, or a psychiatrist experienced in treating postpartum mood disorders. Getting professional help early is critical for the well-being of the mother, the baby, and the whole family.

Resources:

Postpartum Support International:
http://www.postpartum.net/
Postpartum Education for Parents (PEP):
http://www.sbpep.org/
805-564-3888 Warmline is a free 24-hour service that provides confidential one-on-one support from trained volunteers, parents just like you. From basic infant care to breast or bottle feeding issues to postpartum adjustment, the Warmline can be a great source of information and support.