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“I don’t know what’s wrong with me. I’m supposed to feel a surge of maternal instinct, right? I’m supposed to love my baby. Why am I so overwhelmed and uninterested?”
I’m just getting to know Michelle. She had her first baby 3 weeks ago and has been sad and irritable ever since. Her pediatrician was worried about her at the well-baby visit this week and sent her to me. She’d had a tough pregnancy (morning sickness that wouldn’t quit for what felt to her like forever), made tougher by the financial stress that came from her husband being out of work for several months. The doctor is worried that she and her baby aren’t getting off to a good start.
Sadly, moms like Michelle often feel alone and guilty. Not feeling what they think they are supposed to feel, they are embarrassed to admit to themselves and others that things aren’t going well. Just when they need help the most, many don’t reach out. Some start to resent their babies and begrudge them time and attention. They force themselves to do what needs to be done but don’t provide their newborns with the nurturing they need.
Still others give up on nursing, or holding their babies when bottle feeding, depriving themselves and their babies with the closeness that comes with the quiet feeding times. Propping a bottle is the best they can do. Overtired, irritable, and sinking into depression, life after birth isn’t at all what they expected.
As hormones shift and settle, it’s absolutely normal to feel what is commonly known as the baby blues in the weeks following birth. One of my clients described the first couple of weeks after her first child was born as PMS times ten. Others feel more emotionally fragile than usual and maybe a little weepy. Still others are surprised that they are on an emotional roller coaster, feeling great one minute and set off into tears by something that normally wouldn’t bother them the next. It’s all because the endorphins from delivery are leaving the new mother’s system and the body is resetting itself.
Different women react differently but normal baby blues are usually accompanied by moments of joy and wonder and happiness about the baby and motherhood. The emotions settle down after a couple of weeks and the routines and rhythms of new parenting get established.
But when those up and downs last more than a few weeks, and especially if they get worse, it may indicate that the new mom is developing postpartum depression (PPD). This happens to between 11 and 18 percent of new mothers, according to a 2010 survey by the Centers for Disease Control (CDC). Surprisingly, it can last anywhere from a couple of months to a couple of years.
Symptoms of Postpartum Depression
Postpartum depression looks like any major depression. Things that once gave the mother pleasure are no longer fun or interesting. She has trouble concentrating and making decisions. There are disturbances in sleep, appetite, and sexual interest. In some cases, there are thoughts of suicide. Many report feeling disconnected from their baby and some worry that they will hurt their baby. Feelings of hopelessness, helplessness and worthlessness immobilize them. Many feel guilty that they can’t love their child, which makes them feel even more inadequate.
In some cases, women develop psychotic delusions, thinking their baby is possessed or has special and frightening powers. Sadly, in some cases, the psychosis includes command hallucinations to kill the child.
Who Develops Postpartum Depression?
There are a number of issues that contribute to a woman’s risk of developing PPD:
- A prior diagnosis of major depression. Up to 30 percent of women who have had an episode of major depression also develop PPD.
- Having a relative who has ever had major depression or PDD seems to be a contributing factor.
- Lack of education about what to realistically expect of herself or the baby. Teen mothers who idealized what it would mean to have a baby to love with little appreciation for the work involved are especially vulnerable.
- Lack of an adequate support system. Unable to turn to someone for practical help or emotional support, a vulnerable new mom can become easily overwhelmed.
- A pregnancy or birth that had complications, especially if mother and baby had to be separated after the birth in order for one or the other to recover. This can get in the way of normal mother-child bonding.
- Being under unusual stress already. New mothers who are also dealing with financial stress, a shaky relationship with the baby’s dad, family problems, or isolation are more vulnerable.
- Multiple births. The demands of multiple babies are overwhelming even with substantial support.
- Having a miscarriage or stillbirth. The normal grieving of loss is made worse by the shifting hormones.
What to Do
In cases of the normal “baby blues,” often all a new mom needs is reassurance and some more practical help. Engaging the dad to be more helpful, joining a support group for new parents, or finding other sources of support so the mom can get some rest and develop more confidence in her mothering instincts and skills can put things back on track. As with any other stressful or demanding situation, new parenthood goes better when the parents are eating right, getting enough sleep, and getting some exercise. Friends and family can help by bringing some dinners, offering to take over with the baby for an hour or so so that the parents can get a nap, or by babysitting siblings to give the parents time to focus on the infant without feeling guilty or pulled in multiple directions.
Postpartum depression, however, is a serious condition that requires more than naps and caring attention. If the problem has persisted beyond a few weeks and has been unresponsive to support and help, the mother should first be evaluated for a medical condition. Sometimes a vitamin deficiency or another undiagnosed problem is a contributing factor.
If she is medically okay, those who care about her and her baby need to encourage her to get some counseling, both for the emotional support counseling offers and for some practical advice. Cognitive-behavioral treatment seems to be especially helpful. Since women who have experienced postpartum depression are vulnerable to having another episode of depression in their lives, it is wise to establish a relationship with a mental health counselor to make it easier to seek help if it is needed in the future. If the mom has had thoughts of suicide or infanticide, the therapist can help the family learn how to protect them both. If the birthing center or hospital offers a PPD support group, the new mom and dad should be encouraged to try it. Finally, sometimes psychotropic medications are indicated to alleviate the depression.
The baby blues are uncomfortable. Postpartum depression is serious. In either case, a new mom deserves to get practical help from family and friends. When that alone doesn’t help a new mom adjust, it’s time to seek out professional help as well.
It's Not Just "Baby Blues": My Life With Postpartum Depression
According to the National Alliance on Mental Illness, approximately 18.5% of adults in the United States experience mental illness every year. That's a significant portion of our population—one in five people—yet the stigma and misunderstanding that surround mental health remain. That's why in honor of Mental Health Awareness Month, we put the call out to our readers to share their own experiences with mental illness: their victories, their struggles, and what it's really like to negotiate a society that makes misguided assumptions about who you are based on an arbitrary definition of the word "normal." Our series My Life With highlights the raw, unfiltered stories of women who deal with anxiety, bipolar disorder, postpartum depression, and more, all in their own words. Below, Micaela Oer shares an intimate look inside her experience with postpartum depression.
I began my undergrad as a music major, but after taking an intro to psychology course, I switched my major to psychology. I was obsessed. I was a young woman on a journey to get to know herself better, and to me, this was a great way to do that. I remember early on being very fascinated by attachment theory and the different styles that children displayed. It made me think about myself and how I was as a child with my mother. (I had a rather difficult upbringing.) Even though I did not have plans on ever having children, I still kept that knowledge in the back of my mind, just in case.
Magnitude of postpartum depression unheard of – reproductive psychiatrist
Being a mother brings joy and a sense of fulfilment, but it's also a psychological and physiological challenge. We discuss this with Dr. Jeffrey Newport, professor of psychiatry, behavioral sciences and women&rsquos health.
Sophie Shevardnadze:Dr. Jeffrey Newport, Professor of Psychiatry, Behavioural Sciences and Women&rsquos Health. So great to have you with us, Dr. Newport, so many questions to ask you, I&rsquove just had a baby two and a half months ago. So my questions are actually coming from here, not theories. Alright. So I already know that postpartum depression happens when the body of a pregnant woman is overfilled with hormones and once the baby's out, they don't get back to normal levels very quickly and this translates into psychological torture for the new mom like it was, for me. I didn't have it for too long, it was maybe two and a half weeks. But it was just crazy because it was just such a weird feeling holding this baby that I've longed for for such a long time and then crying at the same time as if life was over. So if postpartum depression is pure and simple biochemistry, &ndash is it really just biochemistry? Even the happiest of women can fall prey to it? What is it really?
Jeffrey Newport: So actually, that's a bit of a misconception. Women, men, actually everyone is most vulnerable to depression at times in their life when they're under stress. And stress can come from tremendous changes internally inside our bodies or externally from the events that go on around us. And having a child introducing a child to a family, when a new mother is going through that process, yeah, there's certainly tremendous cause for great joy, but because it's an event that causes so many different changes, it's stressful at many levels. So there are women whose vulnerability to depression in the postpartum period appears to rise primarily, if not solely, from the hormonal changes that happen immediately following delivery, because what's happened during the course of the nine months of gestation is that estrogen, progesterone, allopregnanolone and a variety of other hormone levels have gradually risen to astronomical levels by the time of delivery. And then once the baby's delivered in the space of just a day or two, those things plummet. But what we've learned is that not all women are susceptible to depression or anxiety or other problems, when those hormone levels change, even drastically like that. So there's a subset of women for whom, absolutely, that appears to be to be the cause. But I would argue, from my experience, and the research that we've done, that even more often, the precipitant or the trigger to postpartum depression is a product of all of the external changes that go on that also produce stress. And one of the key things exploring that is this mode of therapy designed for women during the postpartum period called interpersonal therapy, which has identified role conflicts and role transitions that very often come up in the course of beginning a family and having a baby so that prior to the arrival of the baby women have a variety of roles in their lives as employees and having careers, as being sisters and daughters, being spouses, and partners and so forth, and they found a balance for all of those roles. And now you introduce a baby and you have this new role. And balancing that with all of these other changes can lead to a variety of sources of stress, particularly when the social support network is not readily available. I know in many parts of the world that becomes an issue.
SS:So I see your point, but once again, I want to give you my example because my pregnancy, I think, was a dream pregnancy in a way that it was during the pandemic. So I had a chance to be in a beautiful house, my parents next to me, getting a lot of help, with a beautiful backyard, having walks every day, eating by the hours, sleeping really well. So in terms of how stressful my pregnancy was, it really wasn't stressful and I still got a postpartum for two and a half, maybe three weeks. Are there women who are more prone to postpartum than others?
JN: Absolutely. And that's the research I was alluding to earlier. There's been research that inquired about this or explores this after the fact where you take women with histories of postpartum depression, and then those who have had babies without developing postpartum depression. And you put them through an experimental protocol, where you adjust their hormone levels in a similar manner, you do that chemically with medications. What you find is, again, there are many women for whom those hormone shifts don't appear to affect them in that way. But there's a subset of women who are vulnerable to when those things when those hormone levels shift so abruptly, and particularly when certain of those hormones not just change but fall dramatically. Absolutely, that's the case for some women.
SS:You know, can postpartum depression be averted somehow? Is there some preventive therapy like, you know, taking particular vitamins, doing yoga during pregnancy, which I actually did, eating hormonal supplements right after? Is there anything to prevent that? Or it's out of our control?
JN: No, absolutely, there are preventive measures that can be taken. And again, when you look at the broader picture of all the different things that can come to bear. So for example, in terms of, you know, medicinal approaches that you can use, we know that contributors to postpartum depression include an array of things such as thyroid dysfunction, which can happen in the postpartum period, as well as anaemia, those sorts of things. So monitoring those things very closely in light pregnancy, and then rechecking those, you know, following delivery can be an early clue that someone may be susceptible. And then, of course, you know, preparing yourself for all of the social transitions, that come up during the course of having a baby. So ensuring that you have proper social support, realistic expectations, those sorts of things, and counselling can come to play. In terms of the contribution that these rapidly changing levels of estrogens and other hormones play, there's not really a preventative measure you can take other than being aware of that possibility and when it does arise then being able to very quickly make use of the treatments that can reverse that process so that there's not a delay in access to care.
SS:Okay, what about treating it once you have it? I mean, when you're breastfeeding, taking antidepressants is not an option. So what can you actually do to ease that state?
JN: So I would actually disagree with your statement that taking antidepressants is not an option when you're breastfeeding. When you're pregnant or breastfeeding, for that matter, and you have a health condition (right now we're talking about depression, we can be talking about anything from high blood pressure to epilepsy, to a variety of other health conditions), when you're making decisions about how to treat those health conditions, what you're weighing is the risk of leaving it untreated to both mother and baby, a baby within the womb or a newborn baby, and then you're weighing that against the risk of exposing the baby to a medication. And so one of the things that is very often, there's been this focus on depression as postpartum depression what we've learned over the course of the last 20 years is that postpartum depression is actually a bit of a misnomer in that many women experience depression during pregnancy. And when that's the case, then you have to take a look at what's the risk for mom and baby of the depression left untreated versus the medicine. And I will certainly acknowledge there is no medication, certainly no antidepressant, but no medication that is completely risk-free, if taken during pregnancy or during breastfeeding. But if you take stock first of the illness and what dangers it poses &ndash and so we know that, for example, in pregnancy, depression left untreated triples to quadruples rates of preterm birth, birth weight, hypertension during pregnancy, ICU admissions for newborns are higher if the mothers are depressed during pregnancy, and so forth. And we know that postpartum depression interferes with mother-infant bonding that can lead to problematic developmental outcomes for children, contributing to childhood depression and anxiety. And so we get faced with these difficult situations where if we don't treat, then the baby is at risk. And it may be that non-medication treatment such as yoga, exercise, psychotherapy, and that's always the first line of treatment, but sometimes those are ineffective. And then we find ourselves in these situations from time to time, where, even though the medication may carry some risk to the baby, starting the medication, taking the medication while pregnant, or while breastfeeding may actually be safer for the baby because it provides some protective benefit against the illness. And we face the same sort of thing with a variety of other illnesses. So this is not unique to depression. The same thing comes into play, for example, I mentioned epilepsy earlier. You know, anti-seizure medicines are quite risky to take during pregnancy and breastfeeding. And yet, we know that because having seizures when you're pregnant, or when you're holding a newborn baby is so dangerous, we routinely recommend that women with epilepsy continue their medication. And so to a lesser extent, but still, sometimes we find ourselves in positions where medication has to be recommended.
SS:I feel like postpartum [depression] is sort of downplayed as something that, you know, you get, it's normal, and you'll just get over it, it will go away. But you know, I've heard some cases, maybe 10 or 15% of women actually get clinical depression after that if not treated.
JN: That&rsquos correct.
SS:I know some extreme cases where a woman, you know, went as far as commit suicide during the postpartum. So would you recommend treating it to all the women or just those who feel like they're in need?
JN: So there is a continuum, there is a mood disturbance after delivery, called postpartum blues, or sometimes it's called baby blues, which is experienced by over half of women, you know, sadness, being very emotional. But by definition, baby blues, postpartum blues only lasts three days, and then it will resolve. Beyond that, then, you know, when you're looking at something that's going to last weeks, then you're in a position where now this is not a normal thing. This is an illness. And now sometimes, you know, the illness of depression, because it is episodic, will spontaneously resolve, which, you know, fortunately, that was your experience, it didn&rsquot last. But there are other occasions where that postpartum episode or depression, I mean, I've been referred women who were more than a year past, you know, their baby was more than a year old, and that postpartum depression had never gone away. And it can set up for some long term chronic problems. And so because of that, yes, for those normal mood disturbances &ndash just the support and encouragement. When it begins to unmask itself as an illness that has the potential at least to be long-lasting than then intervening with treatment is important. And that doesn't necessarily mean the treatment has to be medication. You know, the first line of treatment, like I said, is one that does not entail medication exposure to a baby, which would be a form of psychotherapy, so meeting with a trained therapist. And there are a variety of psychotherapies that have been adapted for use in women during the postpartum period: I mentioned interpersonal therapy earlier, certain forms of cognitive behavioural therapy and the like. And then the biological treatments, the medication treatments then are that last line of defence when other things are not bringing that depression into resolution.
SS:You know, I've often heard from like, older generations that fancy words like postpartum depression is something that we made up in our new reality, a new world and back then when, you know, in the 60s or 50s, and 40s, or even 70s, people didn't even know such thing as postpartum, it didn't exist, that they just gave birth and got on with it. Is there any truth to that? It? Or did it just become a thing because we have a name for it? Or they had it too, but they didn't acknowledge it? And if they did have it, then could we get some pointers from them maybe?
JN: So it's funny that you bring that question up, because in a chapter that I've written for a textbook several times, I point out that when we look through the ancient literature, we actually find the first mention of postpartum depression in ancient Greece by Hippocrates. And so the founder of modern medicine, although we call it modern medicine it is very ancient. So we see that mentioned, you know, millennia ago. And then, with more publications, The Marcé Society is one of the leading worldwide groups of healthcare providers who work with women during the postpartum period for postpartum depression and anxiety and it's named after a gentleman who studied and wrote about postpartum mental illness back in the 1800s. So no, this is by no means a new issue. Yeah, it is one that you hear more about, because the magnitude of it, in terms of the frequency, and the numbers of women who experience that, is something that has been studied more carefully. And you mentioned the numbers, as many as 10 to 15% of women will experience a clinical depression during the postpartum period. If you go back several decades ago, we knew that postpartum depression existed, we had no idea that that was the magnitude of how often it&rsquos heard.
SS:Is it easier to maybe deal with postpartum or baby blues when you're older and wiser like me, for instance? I&rsquom 42. And in general, do you feel like there is an age limit to when a woman should give birth to a baby? Because times have shifted, you know, like, giving birth to a baby at 40 is really nothing anymore, everyone does that. Even 45, sometimes 47. 20-30 years ago that would be unheard of. So is there in your professional medical opinion, a time limit, after which a woman shouldn't give birth to a baby, because she can't cope psychologically?
JN: So there's certainly no time limit with regard to contributing to depression where at a certain age, you should not be having children. I think it's what's most important, though, is to educate people about the things that they may face, so that they can make the best-informed decision as to whether or not to proceed with a pregnancy, but recognising that even when people are educated, there are times where the way that they respond emotionally to being a new mother is not at all what they anticipated. So, for example, you know, if we use the example of women who are a bit older and established in their lives and established in their careers, what I have seen through the years is typically women who are having their first child and have already established a career, you know, will face a choice as to &lsquowhat am I going to do with my career when I have a child?&rsquo And some will opt to continue their career unabated and hire other folks, or have extended family members help provide care for the child. Some go the other way and say, you know, &lsquowhen my child's young, I want to put my career on hold temporarily and be the primary caregiver for my child&rsquo. And then all points in between. But the thing that I've noticed is there are times where those plans are in place and yet, once they have the baby, they find that what they had planned is not what they want. So I've seen those who had planned to put their career on hold and were just bored and miserable, they love their baby but missed all of that activity, and decided &lsquono, I need to shift back in another direction and have my career remain more active.&rsquo And I've seen the opposite, those whose plan was to have the baby, &lsquotake my maternity leave, and then return to work&rsquo and were miserable with that plan and changed. And so I think educating women as to what are the issues and decisions that they're going to face once they have their baby, and to make a decision as to what their plans are but to prepare them for the possibility that once they have their child that their opinion and approach to that may change. And it's not for me to dictate to them what works best for them and their family.
SS:Alright, so another huge topic is the hardcoded biological fear for your kid. I never knew that before I've had him. And then all of a sudden this little being comes to life and it is constant. I mean, in the middle of the night, right now I'm talking to you, he is with a wonderful nanny and my mother at the same time, I know he'll be fine. But I'm parallelly thinking, &lsquoWhat is he doing? Is he okay? Is he sneezing? Is he burping?&rsquo This fear, the sort of alertness inside you, it's exhausting. What do you do with it? I mean, I theoretically understand that it's probably not good for the baby either because they say that mother's fears always transmit to the kids, they're transferred on to the kids. So I'm not sure how to deal with that. &lsquoCause it&rsquos just there, it's in me, I can&rsquot help it.
JN: Yeah. So there's anxiety that is symptomatic of a problem, of an anxiety disorder when the anxiety is disproportionate to the actual threat or circumstances that are what's going on. But, you know, anxiety can also be existential, it can also be part of the normal course of human experience. My point being, there are times where it's appropriate to be anxious and it's appropriate to be cautious. And so I don't think it's wise for us to &ndash our quest to be to eliminate all anxiety, because that can then leave us making ill-informed decisions and so forth. And, you know, what I've observed in terms of that existential parental anxiety, it never goes away. And my children are now in their 30s and late 20s and, you know, the frequency at which I worry about them is not the same as when they were just a few days or a few weeks old, but it never goes away. And so, it's about finding that balance. One of the things about anxiety that separates it from depression is anxiety is always oriented towards the future. One can be depressed about things from the past or present, or future but anxiety is always about the future. Even if it's a past event, the anxiety is focused on what are the implications of that going to be going forward. And there's nothing that generates more anxiety than uncertainty, and not knowing. And so even more so than for depression, one of the keys to managing anxiety is education, is learning what to anticipate in going forward. I think that's a big part of why susceptibility to severe postpartum anxiety is less often seen in those who are having their second or third or fourth child than the first child because everything is so new, there is so much uncertainty. And that's where things like postpartum peer support groups can be very, very helpful. So that you're talking with other individuals who are going through that and experiencing that, and you're benefiting from their experience. And, you know, the more that you learn about what to expect and alternatives for how to manage these things, and it doesn't have to be with a formal peer support group, but just from your peers, be it family members or friends, and you share information and you learn from that and you benefit from that. That really helps alleviate, you know, a lot of that existential anxiety and then by extension protects you from that expected real-life anxiety from morphing into an anxiety disorder.
SS:Professor Newport, thanks a lot for this wonderful insight. You've actually really helped me a lot, this wonderful chat, and I hope we get to do this again because this is a never-ending topic for me, especially now that I've had a baby. So thanks a lot. Thanks for all the wonderful work you're doing and good luck with all your future endeavours.
JN: Thank you so much. I'm grateful for the opportunity to speak with you.
Postpartum depression may last 3 years after childbirth
A new “miracle” drug that addresses one of the most common pregnancy complications — postpartum depression — is one step closer to being on the shelves, new research released Wednesday shows.
Scientists from Northwell Health’s Feinstein Institutes for Medical Research just wrapped up a clinical trial examining the new drug Zuranolone and found more than half of participants saw a full remission of their clinical depression at the end of the trial period.
The neuroactive steroid pill also worked much quicker than typical antidepressants given to women suffering from the condition — trial participants showed “immediate and sustained results” after just three days of taking the drug, Northwell Health said.
“Postpartum depression affects one in eight women and currently there is only one FDA approved medication for those women,” Dr. Kristina Deligiannidis, the New York-based principal investigator on the trial, told The Post in a statement.
Scientists from Northwell Health’s Feinstein Institutes for Medical Research just wrapped up a clinical trial examining Zuranolone. Feinstein Institutes
“Far too long women suffering from PPD feel ashamed or unsure of how to get the help they need. Through further clinical trials, and potential approval of this drug, these women will have help literally at their fingertips.”
Like other mental health issues that only impact women, postpartum depression — a condition as old as childbirth — has long been understudied and under researched and often goes undiagnosed despite the devastating effects it can have on both mother and child.
Women suffering from postpartum depression have difficulty bonding with their children or caring for them and are often overcome with feelings of hopelessness, anxiety and crushing beliefs about their perceived ineptitude to be a mother.
Kristina Deligiannidis, MD, led the Phase 3 clinical trial looking at the safety and efficacy of a potential pill medication for postpartum depression. Feinstein Institute/Northwell He
In serious cases, postpartum depression can lead to suicide and in the most extreme cases, women suffering from the condition have felt impelled to hurt or kill their baby.
Without intervention, PPD can persist for years.
When Tonya Fulwider was a young mom in 1998, she didn’t realize she had postpartum depression until her daughter was six-months-old.
“Every step felt like walking through concrete,” Fulwider, 47, recalled.
“People talk about the blues, feeling blue. That is way too bright. Depression is colorless, it’s black, there’s nothing there, there is no hope there and when you have a beautiful new baby, it was just awful.”
Fulwider, who has since devoted her life to helping women with PPD after starting the non-profit POEM, said she was never asked how she was doing by her pediatrician or her OB-GYN. When she finally told her primary care doctor, he “threw me a script” and sent her on her way.
“The reality of mom’s mental health being so vital is because she is generally the source of all nurturing, she is generally the one who is providing not only the diaper changes and the feeding but the sing song, the hugs, the warm embrace and babies need that too,” Fulwider said.
“And if she’s depressed… it’s just torture, it’s fighting, you’re fighting to do everything you have to do and that’s just not fair to mom.”
The Feinstein Institutes’ Zuranolone trial, part of the drug’s crucial Phase 3 study, examined 151 randomized patients at 33 centers across the US in a double-blinded, placebo-controlled test.
The Feinstein Institutes for Medical Research at Northwell Health found more than half of participants saw a full remission of their clinical depression at the end of the trial period. Fein Institutes
By day 15 of taking the drug, 45 percent of women were in remission, versus 23 percent in the placebo group, and by day 45, 53 percent were in full remission, compared with 30 percent who received the placebo.
Fulwider said she was grateful a new drug could soon be on the market because women who suffer from PPD need all the options they can get.
“While we can talk all day about mental health is health and that is 100 percent true, it’s much harder, it’s a much more complicated process and it’s even more complicated to get the right kind of care, particularly for moms,” Fulwider explained.
“We tell moms to white knuckle through this and we’ve got to flip that script.”
The neuroactive steroid pill also worked much quicker than typical antidepressants given to women suffering from the condition. Fein Institutes
Postpartum Anxiety Causes and Risk Factors
Postpartum anxiety often results from a variety of triggers, experts say. For starters, "there&aposs a huge hormonal shift𠅎strogen and progesterone levels increase 10- to 100-fold during pregnancy, then fall to essentially zero within 24 hours of delivery," explains Elizabeth Fitelson, M.D., director of the Women&aposs Program at the Columbia University Department of Psychiatry.
In the days that follow, you&aposre dealing with sleep deprivation, changes to your relationship, and new schedules and responsibilities, including around-the-clock care of a newborn. Add to that society&aposs expectation that this should be one of the happiest times in your life, and it&aposs no wonder so many mothers start to come unglued.
While any new mom can develop postpartum anxiety, there are some factors that might increase your risk. These include:
- A personal or family history of anxiety
- Previous experience with depression
- Certain symptoms of PMS (such as feeling weepy or agitated)
- Eating disorders
What&aposs more, women who have had a miscarriage or stillbirth are more susceptible to postpartum anxiety and depression with a subsequent healthy delivery, according to a study by the University of Rochester in New York, because they&aposre so worried something else might go wrong.
Personality may also come into play: "Moms with postpartum anxiety often describe themselves as Type A, sensitive, or easily worried," says Sherry Duson, a family therapist in Houston who specializes in treating those with pregnancy and postpartum mood and anxiety issues.
Many people expect that pregnancy and afterwards will be one of the happiest times in their lives. However, what society does not discuss are the natural up and downs that come along with being pregnant as well as all the psychological, physical, and social changes that occur after giving birth.
In fact, many women find themselves questioning if they are suffering from the baby blues or postpartum depression. 15 to 20% of women experience significant depression or anxiety that is beyond the baby blues. Below explains the general differences between the two.
This is in reference to typical feelings most new mothers experience. Symptoms may include, but are not limited to: feeling exhausted, having anxiety, feeling nervous, worries about motherhood, and feeling overwhelmed of this new responsibility.
Perinatal Mood and Anxiety Disorders
The term “Perinatal” is used to describe the time all throughout pregnancy as well as up to a year after childbirth. The term “Postpartum Depression” is used most frequently, yet the wording “Perinatal Mood and Anxiety Disorders” better reflects the spectrum of disorders that can affect mothers during pregnancy and after childbirth. Below are definitions of these disorders.
“Postpartum” refers to after childbirth. Symptoms for all postpartum disorders can appear days or months after childbirth. Symptoms specific to postpartum depression may include, but are not limited to: feelings of irritability, lack of interest in the baby, continual crying, and sadness.
Symptoms may include, but are not limited to: constantly worrying, feeling as if something bad is going to happen to the baby, and racing thoughts.
Postpartum Panic Disorder
This disorder is a form of anxiety. Symptoms may include, but are not limited to: reoccurring panic attacks and having multiple fears.
Postpartum Obsessive-Compulsive Disorder
Symptoms may include, but are not limited to: obsessions which are intrusive, repetitive thoughts related to the baby, compulsions (which are things the mother may do over and over again in attempt to reduce obsessions), and hypervigilance in protecting the infant.
Postpartum Post-Traumatic Stress Disorder
This is caused by a real or perceived trauma that occurred during delivery or after childbirth. Symptoms may include, but are not limited to: flashbacks, nightmares, panic attacks, and hypervigilance.
This is a rare disorder when compared to the prevalence of postpartum depression and postpartum anxiety. Women who are at significant risk for postpartum psychosis have a personal or family history of bipolar disorder or a past psychotic episode. Symptoms may include, but are not limited to: delusions or strange beliefs, hallucinations, hyperactivity, paranoia, and rapid mood swings. There is a 5% risk of infanticide or suicide that is associated with postpartum psychosis, thus it is imperative that immediate treatment is obtained.
For a more detailed explanation on the spectrum of perinatal mood and anxiety disorders, view the Postpartum Support International (PSI) website at: http://www.postpartum.net/Get-the-Facts.aspx
When dealing with perinatal mood and anxiety disorders, significant others need support too. A partner may feel unsure of how to respond to their loved one who is struggling, and they often can feel overwhelmed. A therapist that specializes in these disorders can provide significant others with education and tools to learn how to be more supportive and understanding, in addition to dealing with their own anxiety concerning the new baby.
A new mother may have difficulty recognizing if she is indeed suffering from anxiety or depression due to being tired, overwhelmed, and adjusting to being a mother. New mothers may also not want to reach out for help as some are afraid of being seen as not being able to handle motherhood. It is always best to reach out for help if one is unsure if they are struggling or not. After all, new mothers who do not meet the criteria for a perinatal mood and anxiety disorder also need and are entitled to proper support.
It is important to note that if a woman does not receive appropriate intervention, maternal depression and anxiety can have long-term implications for mother, baby, and the entire family. These disorders do not go away without treatment. However, perinatal mood and anxiety disorders are 100% treatable. As PSI’s saying goes, “You are not alone. You are not to blame. With help, you will be well.”
Dr. Melissa Geraghty at or 630.637.9300 x313 has specialty certification in the treatment of perinatal mood disorders.
Postpartum depression/ Perinatal depression
Postpartum depression (PPD) is depression that occurs to a mother after a childbirth. PPD is defined as an episode of non-psychotic depression with onset within 1 year of childbirth. PPD can happen any time after childbirth. It often starts within 1 to 3 weeks after a childbirth and may last for weeks or months at a time.
The word "postpartum" means "after birth," so "postpartum depression" is talking only about depression after the baby is born. For many women, this term is correct: they start feeling depression sometime within the first year after they have the baby. But some women start to feel depression while they're still pregnant and the term "perinatal depression" is used to describe this situation. The word "perinatal" describes the time during pregnancy or just after birth. Researchers believe that depression is one of the most common problems women experience during and after pregnancy. Perinatal depression affects as many as one in seven women.
This type of depression does not only affect mothers. Sometimes new fathers also experience postpartum or prenatal depression.
Feelings of postpartum depression are more intense and last longer than those of &ldquobaby blues&rdquo. It is a term used to describe the worry, sadness, and tiredness many women experience after having a baby. &ldquoBaby blues&rdquo symptoms typically resolve on their own within a few days.
Mothers with postpartum depression experience feelings of extreme sadness, anxiety, and exhaustion that may make it difficult for them to complete daily care activities for themselves or for others.
Postpartum depression is a common complication of childbearing and as such represents a considerable public health problem affecting women and their families and make it an important medical condition to diagnose, treat and prevent.
The patterns of symptoms in women with postpartum depression are similar to those in women who have depression unrelated to childbirth, apart from the fact that the content may focus on the delivery or baby.
Some of the more common symptoms a woman may experience include:
- Feeling sad, hopeless, empty, or overwhelmed
- Crying more often than usual or for no apparent reason
- Worrying or feeling overly anxious
- Feeling moody, irritable, or restless
- Oversleeping, or being unable to sleep even when her baby is asleep
- Having trouble concentrating, remembering details, and making decisions
- Experiencing anger or rage
- Losing interest in activities that are usually enjoyable
- Suffering from physical aches and pains, including frequent headaches, stomach problems, and muscle pain
- Eating too little or too much
- Withdrawing from or avoiding friends and family
- Having trouble bonding or forming an emotional attachment with her baby
- Persistently doubting her ability to care for her baby
- Thinking about harming herself or her baby.
Postpartum depression is different from the baby blues-
- The &ldquobaby blues&rdquo is a term used to describe the feelings of worry, unhappiness, and fatigue that many women experience after having a baby. Babies require a lot of care, so it&rsquos normal for mothers to be worried about, or tired from, providing that care. Baby blues, which affects up to 80 percent of mothers, includes feelings that are somewhat mild, last a week or two, and go away on their own.
- With postpartum depression, feelings of sadness and anxiety can be extreme and might interfere with a woman&rsquos ability to care for herself or her family. Because of the severity of the symptoms, postpartum depression usually requires treatment. The condition may begin shortly before or any time after childbirth, but commonly begins between a week and a month after delivery.
Postpartum depression probably is caused by a combination of factors. These factors include the following:
- Changes in hormone levels just after childbirth: levels of estrogen and progesterone decrease just after child birth and these changes may trigger depression in the same way as smaller changes in hormone levels before menstrual periods trigger mood swings and tension.
- History of depression: Women who have had depression at any time-before, during, or after pregnancy, or who currently are being treated for depression have an increased risk of developing postpartum depression.
- Emotional factors: If the pregnancy is not planned or is not wanted, this can affect the way a woman feels about her pregnancy and her unborn baby. Even when a pregnancy is planned, it can take a long time to adjust for having a new baby. Parents of babies who are sick or who need to stay in the hospital may feel sad, angry, or guilty. These emotions can affect a woman&rsquos self-esteem and how she deals with stress.
- Fatigue: Many women feel very tired after giving birth. It can take weeks for a woman to regain her normal strength and energy. For women who have had their babies by cesarean section, it may take a longer time.
- Lifestyle factors: Lack of support from family members and stressful life events, such as a recent death of a loved one, a family illness, or moving to a new city, can greatly increase the risk of postpartum depression.
Other risk factors may be-
- Family history of depression
- A difficult pregnancy or birth experience
- Giving birth to twins or other multiples
- Experiencing problems in your relationship with your partner
- Experiencing financial problems
- Being a teen mother
- Preterm (before 37 weeks) labor and delivery.
- Pregnancy with birth complications.
- Smoking, drinking alcohol, and use of harmful drugs
- Negative thoughts and feelings about being a mother, these include
- Having doubts that you can be a good mother
- Putting pressure on yourself to be a perfect mother
- Feeling that you&rsquore no longer the person you were before you had your baby
- Feeling that you&rsquore less attractive after having your baby
- Having no free time for yourself
- Feeling tired and moody because you aren&rsquot sleeping well or getting enough sleep
A health care provider can diagnose a woman with postpartum depression. Because symptoms of this condition are broad and may vary between women, a health care provider can help a woman figure out whether the symptoms she is feeling are due to postpartum depression or something else. A woman who experiences any of these symptoms should see a health care provider right away.
Your doctor will usually talk with you about your feelings, thoughts and mental health to distinguish between a short-term case of postpartum baby blues and a more severe form of depression. Don't be embarrassed, share your symptoms with your doctor so that a useful treatment plan can be created for you.
As part of your evaluation, doctor may:
- Do a depression screening that may include having to fill out a questionnaire.
- Advice blood tests to determine thyroid functions, and
- other tests, to rule out other causes for symptoms.
Many options are there for managing PPD during pregnancy or after birth. Some women may participate in counseling (talk therapy) and others may need medication. There is no single treatment that works for everyone.
Woman with PPD may have one-on-one therapy with just she and the therapist (a counselor, therapist, psychologist, psychiatrist, or social worker) or group therapy where she meets with a therapist and other people with problems similar to her.
Another option is family or couple&rsquos therapy, in which she and her family members or her partner may work with a therapist. Sometimes, therapy is needed for only a few weeks, but it may be needed for a few months or longer.
Counseling can be done with two ways:
- Cognitive behavioral therapy (CBT), which helps people recognize and change their negative thoughts and behaviors.
- Interpersonal therapy (IPT), which helps people understand and work through problematic personal relationships.
Support groups: These are groups of people who meet together or go online to share their feelings and experiences about certain topics. Counselor can suggest the support group to help.
Medicine: PPD often is treated with medicine. Several medications can treat depression effectively and are safe for pregnant women and for breastfeeding mothers and their babies.
- Antidepressants. These are medicines used to treat many kinds of depression, including PPD. Some medicines are not safe to take during breastfeeding. Talk to your health care provider to find out about these medicines to decide which one is right for you.
- Estrogen. This hormone plays an important role in menstrual cycle and pregnancy. During childbirth, the amount of estrogen in the body drops quickly.
In addition to treatment following things can be advised to new mothers to manage PPD:
Stay healthy and fit:
- Do something active every day. Go for a walk or get back to the gym.
- Eat healthy foods. These include fruits, vegetables, whole-grain breads and lean meats. Try to eat fewer sweets and salty snacks.
- Get as much rest as you can. Try to sleep when your baby sleeps.
- Don&rsquot drink alcohol. Alcohol is a depressant, and also can interact with the medicine given for PPD. You can pass alcohol to your baby through your breast milk.
Ask for and accept help:
- Be with others: Keep in touch with people who care about you and share your feelings.
- Make time for yourself: Do something for you, like getting out of the house, if a family member or your partner can look after the baby.
- Be realistic: You don't have to do everything. You don't have to have the "perfect" home. Just do what you can and leave the rest.
- Ask for help: Don't be afraid to ask for help from family and friends, whether it's caring for the baby or doing household chores.
- Rest when the baby rests: Sleep is just as important for you as it is for the baby. Sleep when the baby sleeps, during naps and at night.
- Reduce your stress:
- Do the things that used to make you feel good about yourself before you got pregnant.
- Do not make any major changes in your life right after having your baby.
Family members and friends may be the first to recognize symptoms of postpartum depression in a new mother. They can encourage her to talk with a health care provider, offer emotional support, and assist with daily tasks such as caring for the baby or the home.
Without treatment, postpartum depression can last for months or years. In addition to affecting the mother&rsquos health, it can interfere with her ability to connect with and care for her baby and may cause the baby to have problems with sleeping, eating, and behavior as he or she grows.
Certain kinds of counseling can prevent perinatal/postpartum depression (PPD) in women at increased risk of depression. Counseling by a counselor or therapist helps the woman to solve problems and cope with things in her everyday life.
Counseling can be recommended for women with one or more of these risk factors:
- Current signs and symptoms of depression
- A history of depression or other mental health condition
- Being pregnant as a teenager or being a single mom
- Having stressful life circumstances, like low income
- Being a victim of intimate partner violence (IPV)
Two types of counseling can be recommended to prevent PPD for women at increased risk:
- Cognitive behavioral therapy (CBT), which helps people recognize and change their negative thoughts and behaviors.
- Interpersonal therapy (IPT), which helps people understand and work through problematic personal relationships.
Support groups: These are groups of people who meet together or go online to share their feelings and experiences about certain topics. Counselor can suggest the support group to help.
Optimal postpartum care provides an opportunity to promote the overall health and well-being of women. Timely recognition of maternal distress, both physical and psychological, during the course of pregnancy and in the postpartum period should be important concerns for her family members and health care professionals.
New support group aims to prevent postpartum depression and stress
Becoming a new mother can be exciting, but it is also one of the most stressful and vulnerable times in the lives of many women. It is estimated that as many as 85% of new moms experience some form of postpartum depressive symptoms, and a large number go on to experience clinical levels of depressive symptoms.
Starting February 21, 2020, the Clinical Psychology Center in the Arizona State University Department of Psychology will launch a new support group for expectant mothers. This group will be open to members of the community, and ASU staff, students and alumni.
The goal of the support group is to prevent postpartum depression and stress following birth.
Postpartum depression is often confused with “baby blues,” which are normal mood swings that happen during the week or two after the baby is born. Baby blues can include anxiety, irritability or trouble sleeping, but postpartum depression is more severe and can last up to a year after the birth and include symptoms like withdrawing from family, excessive crying or feelings of worthlessness or shame.
“The arrival of a new baby is filled with a lot of new stressors. Even though it is an exciting time, there are a lot of changes that come with pregnancy. There are body changes, emotional changes and life transitions,” said Sarah Curci, a clinical psychology graduate student who will run the group.
The support group will provide a way for expectant mothers to think about the transitions that accompany a new baby and to learn coping strategies. The ASU Clinical Psychology Center has three goals for the group: teach better stress-management tools, increase attachment with the expected baby and leverage existing support networks in the participants’ lives. This program has been
A New Mom’s Guide to Baby Blues and Postpartum Depression
I've just given birth and now, my emotions are all over the place?! - Here's everything you need to know about baby blues and postpartum depression, including where and how to get help.
Being a new mom can be overwhelming, especially in the first few days or even months. You are adjusting to life with a newborn, probably dealing with lack of sleep and body pain (from just giving birth and even breast pain if you’re nursing), and coping with the idea that you are now responsible for another person’s life.
And what about the wave of emotions and mood swings brought about by hormone changes? These emotions, also sometimes referred to as “baby blues” can forcefully hit new moms around four or five days after giving birth.
Do I have baby blues?
You might have baby blues if you are:
- Weepy, or cries even for no reason
- Mood Changes
- Poor Concentration
How long will this last?
You might get episodes of the baby blues for a few minutes or even hours each day, but don’t worry, the symptoms should lessen and disappear within 14 days or 2 weeks after you have given birth.
How do I deal with baby blues?
Aside from taking care of yourself, other ways you can deal with baby blues are to:
- Talk to someone you trust about what you are feeling. You can open up to your partner, your own mom, or even friends – whether they themselves are moms or not.
- Eat well. A new baby is not an excuse to eat unhealthily, plus, too many simple carbohydrates might make the mood swings more evident.
- Now is the time to take out that journal and write. Journalling or writing your thoughts and feelings could give you an outlet to just let it all out.
- Give yourself a few minutes of break each day. Don’t keep yourself confined to your room with all the diaper changes and milk. Go outside and just enjoy a few minutes of fresh air.
- Don’t be afraid to ask people for help – whether its help with your meals, getting into a routine with a new baby, diaper changes, cleaning your home, or even anything that can relieve you of any pressure you might be feeling as a new mom.
- Give yourself time – it is quite understandable for moms to want to be perfect, but perfection cannot be attained in just a few days. Give yourself time to heal from the birth and adjust to your new job as a mom.
Nothing’s working for me so far, what can I do?
If you think nothing’s working for you and the symptoms are stronger than ever, then perhaps you’re dealing with postpartum depression or PPD.
Baby blues is a less severe form of postpartum depression. Their symptoms are similar, but whereas baby blues’ symptoms can be relieved by a bit of comfort and time, postpartum depression’s symptoms, on the other hand, can be a bit more unmanageable and cannot be cured as easily. For example, baby blues can make you feel irritable, but it goes away after a little “me” time. On the other hand, with postpartum depression, irritability can easily lead to anger and even thoughts of harming yourself or even your baby – and it doesn’t go away as easily.
Another consideration is that baby blues can last a few weeks after you have given birth, while postpartum depression can last a few weeks or even months.
If you think you have postpartum depression and the aforementioned tips do not seem to work, here are a few things you can do:
1. Visit your OB or family doctor and seek help. Don’t be afraid to admit to yourself and to others that you need help in handling and overcoming this phase in your life. A healthcare professional can fully assess your situation and refer you to a course of treatment as necessary.
2. Don’t isolate yourself. If you wish to talk to other mommies who have gone through PPD or join mommy support and counseling groups, then here are a few options:
a. Better Steps Psychology: Located in Pasig, Better Steps is a team of psychologists experienced in counseling and psychotherapy for families and students. Call them at (02) 216 1586 or visit their website at http://bettersteps.org/
b. Center for Family Ministries (CEFAM): CEFAM has offices in both Quezon City and Makati, and offers counseling, talks, and workshops on marriage and parenting. Call them at (02) 426 4285 or (02) 894 5932, or visit their website at http://www.cefam.ph/mainpage.aspx
c. Christ’s Commission Fellowship (CCF): CCF offers counseling services for single parents and couples. Call them at (02) 635 3410 or visit their website at http://www.ccf.org.ph/
d. Love Institute: Love Institute offers talks, programs, and counseling on marriage, parenting, and relationships. Call them at (02) 436-4143 or visit their website at https://theloveinstitute.com/
e. Anxiety and Depression Support Philippines (ADSP): ADSP is a mental health community support group. Visit their Facebook page at https://www.facebook.com/ADSPpage/
Always remember, and quoting Dumbledore – help will always be given to those who ask for it. So don’t be afraid to reach out if you’re feeling anxious, helpless, or dejected. At the same time, if you think your loved one is dealing with postpartum depression, provide them with the necessary understanding and support, and seek help for them.
INCORPORATING POSTPARTUM DEPRESSION CONTENT INTO THE LAMAZE CURRICULUM
According to Humenick (2002), it is during the prenatal period that couples are most receptive to the changes that are happening in their lives, and they are willing to take in and absorb a great deal of information on their pregnancy and beyond. Even though educators try to maintain a sense of “normalcy” in childbirth and do not want to instill fear in couples, approaching the possible challenges couples may face in the postpartum period may prevent serious consequences that can happen from delayed diagnosis and treatment.
Stress Importance of Advance Planning Prior to Birth
The topic of PPD can be added to the last class in the series when the discussion mostly focuses on preparation for labor, the hospital, bringing the newborn home, and what to expect in the postpartum period. Couples can be encouraged to do some after-birth planning such as interviewing pediatricians, preparing their hospital bag, and stocking up on all the necessities and paraphernalia that they will need for their arrival home from the hospital with their newborn. This is also a good time to discuss breastfeeding.
The last class may also be reserved for discussions on how couples can prepare their home in order to make life as easy as possible. Most new couples are unaware of the magnitude of bringing a newborn home. Educators can suggest that the couples prepare meals in advance or obtain takeout menus from local restaurants. Most of all, they can be encouraged to arrange in advance for domestic help during the postpartum period. Many new mothers are unaware of how tired, sore, and overwhelmed they will be during the postpartum period. There is also always the possibility of having an unplanned caesarean section, which can further immobilize the mother in the first few days after birth. By making advance arrangements—with her mother, mother-in-law, or even hired help such as a doula—the new mother can anticipate the ability to get the rest that she needs. According to Simkin (2001), a new mother's most important tasks in the early postpartum period are to initiate a good feeding relationship with her newborn, to get enough rest, and to eat properly in order to give both partners an opportunity to get to know their newborn.
Stressing the importance of planning in advance for help during the postpartum period may prevent the fatigue, sleep deprivation, and/or social isolation that can sometimes create vulnerability in postpartum women and, in turn, may make them more likely to develop PPD. According to Sichel and Driscoll (1999), women may have various psychological or psychosocial issues or stressful life events that occur over time. The weight of these life events can disrupt the balance of the brain biochemistry, resulting in a sort of 𠇎motional earthquake” (Sichel & Driscoll, p. 99).
Introduce Possibility of Developing Postpartum Depression
Studies have shown that many physiological, biological, and psychosocial factors may contribute to the etiology of PPD. Some of the physiological factors include fatigue, pain, thyroid abnormalities, weakened immune system, and elevated cholesterol (Kendall-Tackett, 2005). Some of the psychosocial factors include alterations in self-esteem, expectations of motherhood, a sense of loss, prior psychiatric diagnosis, family history of psychiatric illness, history of abuse or violence, parenting difficulties, stressful life events, socioeconomic status, social support, and cultural rituals (Kendall-Tackett, 2005).
Again, the final childbirth education or Lamaze class, which typically focuses on the postpartum period, is an appropriate time to introduce the possibility of developing PPD. A brief discussion of normal postpartum adjustment issues and postpartum blues can be presented, followed by a discussion of more severe emotional reactions such as PPD. Because the spectrum of symptoms can vary, it is important to review the five categories of postpartum mood disorders, as described by Bennett and Indman, (2003). Sometimes, a postpartum woman will feel a variety of symptoms and not be aware that she is experiencing PPD because she is having more anxiety than depression. Providing a list of warning signs ( Table 1 ) will help couples understand what to look for and when to know to seek help. It is important to emphasize that early detection and treatment is the fastest way to recovery. It is also important to explain to the couples how to differentiate between normal postpartum adjustment, postpartum blues ( Table 2 ), or a postpartum mood disorder.
Warning Signs of Postpartum Mood Disorders (Onset May Occur at 4 Weeks up to 1 Year)