Postpartum depression (PPD) can be treated and the earlier you intervene, the easier your recovery will be. PPD can also be experienced by fathers, and adoptive mothers. Not every women with risk factors will experience postpartum depression, however if you have risk factors you would benefit from attending a consultation with me to develop a plan for support during pregnancy and postpartum.
Postpartum depression is NOT the baby blues. Baby blues is considered a normal part of postpartum adjustment, requiring no medical or psychological intervention. Postpartum depression is an umbrella term that refers to various mood or anxiety disorders which can follow childbirth. PPD can present in a number of ways depending on the predominating set of symptoms. PPD is typically an agitated depression, with symptoms of both depression and anxiety. When depressive symptoms dominate, we refer to it as postpartum depression. When anxiety is the compelling symptom, we refer to it as a postpartum anxiety disorder. Postpartum anxiety disorders include postpartum panic, postpartum obsessive-compulsive disorder and postpartum posttraumatic stress disorder.
Some experts are now comfortable using the term postpartum distress to encompass both symptoms of depression and anxiety.
Postpartum depression is the most common complication following childbirth, characterized by frequent crying, mood swings, irritability, extreme fatigue, difficulty concentrating, sleep problems, loss of sexual interest, anxiety, appetite changes, negative scary thoughts, feelings of inadequacy, hopelessness and despair. In addition, thoughts of suicide and feelings of anger, shame and guilt are often present.
Postpartum psychosis is a severe medical condition that is often misdiagnosed as postpartum depression. Psychosis occurs in 1 or 2 out of 1,000 postpartum women and is often associated with bipolar illness. The most common symptoms are severe agitation, delusional or bizarre thinking, hallucinations, insomnia, confusion, and a feeling of being out of touch with reality. Although this is a rare condition, it is always an emergency and requires immediate medical attention.
Baby blues are considered a normal part of postpartum adjustment (up to 85% of new mothers!) The blues are related to the hormonal shifts following delivery. They are self-limiting and require no treatment. Symptoms generally appear within three to four days after delivery and remit spontaneously within 2-3 weeks. The blues do not interfere with your day-to-day functioning. If emotional vulnerability lasts beyond 2-3 weeks postpartum, it is not the blues.
Postpartum Stress Syndrome is another term for an adjustment disorder. You may notice yourself struggling to get through the day with constant feelings of distress which do not resolve with reassurance or self-help measures. You may be overwhelmed by feelings of self-doubt and feel pressure to be the perfect mother who is in control at all times. Most of the time, women with postpartum stress syndrome feel like they are imposters, or like they are going through the motions without anyone noticing how bad they are really feeling. Postpartum stress syndrome can lead to depression if symptoms linger without supportive attention to them. Resource: (This Isn't What I Expected by Kleiman and Raskin)
Postpartum depression is characterized by a depressed mood most of the day nearly every day. It can present with symptoms similar to baby blues, but symptoms of depression are more disruptive and last beyond the first two weeks after delivery. Onset is usually within the first three months postpartum, but symptoms can emerge any time during the first postpartum year.
Symptoms of postpartum depression can be difficult to distinguish from "normal" postpartum conditions associated with being a new mother because most new mothers are tired, overwhelmed and anxious. The determining factor is how much distress the feelings cause you and how much they interfere with your ability to function during the day.
Postpartum depression can range from mild to severe. Even mild depression requires treatment. If left untreated, postpartum depression can have serious adverse effects on you and your relationship with significant others, and on your baby's emotional and psychologic development. Your baby deserves a healthy mom.
Postpartum Anxiety is the presence of excessive worry during the postpartum period. While anxiety is normal during the postpartum period too much worry can make you feel tense and irritable more of the time, than not.
Postpartum OCD is an anxiety disorder characterized by obsessive, intrusive thoughts, images or urges which may or may not be accompanied by compulsive behaviors. These unwanted thoughts appear "out of nowhere" and are extremely distressing. You might be worried that if you tell anyone about the thoughts you are having, something terrible will happen, like someone will take your baby away. While it is understandable that you would worry about these thoughts because they feel so bad, these thoughts are a common manifestation of acute anxiety and are not associated with any negative outcomes. Most new parents experience unwanted negative thoughts about their infants, even women who do not have OCD. The anxiety you feel about these thoughts tells us that they are anxiety-driven and this is a symptom that is very treatable.
Postpartum PTSD is an anxiety disorder that can follow an experience involving a threatened, perceived or actual serious injury or death to you or your baby. Witnessing an event involving death and reacting with horror or feelings of helplessness contribute to the definition of trauma. Examples of trauma which can lead to PTSD after childbirth are: history of previous sexual trauma, birth trauma related to medical complications or injury, birth loss or NICU experience, or any unexpected outcome.
Postpartum panic is when the anxiety manifests as distinct periods of intense fear. These periods are often marked by subsequent fear and avoidance of another attack.
Bipolar disorder during the postpartum period is characterized by periods of extreme highs (mania) and lows (depression).
Bipolar I is primarily distinguished by the presence of manic episodes, while Bipolar II is characterized by hypomanic episodes. Although postpartum hypomania may not be associated with major impairment in functioning, it is not uncommon for it to be linked with a subsequent, significant depression.
If you have a history or family history of bipolar disorder you are at an increased risk of experiencing an episode during pregnancy and postpartum. You are also at risk for postpartum psychosis so please inform your healthcare providers so you can be carefully monitored.
Postpartum psychosis is the least common, but most serious, postpartum mood disorder. It affects one to two per thousand deliveries and typically appears within the first month after delivery. The presence of psychotic symptoms necessitates aggressive medical treatment and most likely, hospitalization. Psychosis is strongly associated with bipolar disorder; therefore, if you have a personal or family history of bipolar disorder you should be carefully assessed.
If you are worried about the thoughts you are having, that's a good sign. Of course you're worried. It's a terrible burden to feel so attached and loving toward your baby and have such scary thoughts at the same time. Having these thoughts probably make you feel enormously guilty. (You might think, "A good mother wouldn't be thinking such awful things.")
But good mothers DO think bad thoughts when they are struggling with depression and anxiety. If these thoughts do not feel consistent with who you are, if they seem totally out of character for you, or if you know they are irrational and make no sense, it shows that the thoughts are obsessive symptoms of acute anxiety.
Remember that these thoughts are NOT about who you are. They are symptoms. Your brain is playing a trick on you. The more you focus on them, the more you are telling your brain to believe them and the more you empower these thoughts. Try your best to distract yourself. Tell yourself that it's okay you're having these thoughts, nothing bad is happening and that you won't always feel this way. Keep your brain busy with other things. As silly as it may sound, it works. Focus on brain tasks, such as puzzles or other games that make you concentrate. Get up and out, take a walk, listen to upbeat music, dance, fool your brain into doing something else. It's hard, but it can help.
Scary thoughts can be so disturbing that it's hard to tell anyone how you are feeling or what you are thinking. Believe it or not, you might actually feel better if you tell someone you trust that you are having these thoughts. No one is going to take your baby away. No one is going to think you're a bad mother. Tell someone you trust that you don't feel good and that you know these thoughts are symptoms of depression. Let them reassure you that you will be okay when you get the treatment you need. Let them remind you that you are loved and safe.
The good news is that these thoughts are symptoms that are treatable and respond well to both medication and supportive therapy. This is why it's so important to ask for help. Talk to your partner. Talk to your doctor. Don't let your fear get in the way of you getting the help you need. Reach out to someone who understands. You deserve some relief. Do what you need to do to feel better.
Women and families who struggle with anxiety and depression after the birth of the baby can feel out of control and helpless. We know that feeling vulnerable can make it difficult to ask for help. But we also know that reaching out for support can empower a family by providing information, understanding and tools for intervention.
Psychotherapy for postpartum depression is a well established treatment, but for a number of women, it can be hard to attend weekly sessions. Additionally, some women hesitate to take medications while nursing or at all because of the side effects or because they would rather not be on medication for many personal reasons. When considering other treatments, families should remember that the evidence continues to support the efficacy of psychotherapy and/or antidepressant drug therapy for the treatment of postpartum depression. The use of alternative treatments however is becoming increasingly popular due to the fact that they are readily accessible and generally well-tolerated. Again, we caution families not to rely on alternative therapies as the sole course of treatment for anything other than a mild depression. Alternative approaches are best used as adjuncts to methods such as therapy and/or medications in which effectiveness has been well documented.
Omega-3 polyunsaturated fatty acids have been shown to offer health benefits to pregnant and nursing mothers.
Light therapy, often used for seasonal affective disorder, is another intervention that may be preferred by women who are interested in non-medical treatments.
Massage therapy, acupuncture, and relaxation techniques are wonderful ways to improve mood.
Exercise has been shown to reduce mild to moderate depression and anxiety.
Hypnotherapy, a longtime useful tool for childbirth preparation, can be an effective intervention for an agitated postpartum depression.
Support groups can decrease the isolation and stigma that depressed mothers often feel and can provide an important outlet for self-expression and unconditional support.
It can be exhausting to keep up appearances when you are feeling depleted and depressed. When you have a baby to take care of on top of that, life can feel unmanageable and out of control. Some women who experience depression or anxiety after childbirth may believe this is just what being a mother must feel like. They may think something is wrong, but not know exactly what. Or they may think that postpartum depression is something that happens to other women.
Postpartum depression and anxiety is much more common than you might think and can occur anytime during the first postpartum year. One out of every 7 women who gives birth experiences symptoms of a clinical depression that requires treatment. While there is no single cause for postpartum depression, it likely results from a combination of biological (your brain and body), genetic (your family history), psychological (your personality and make-up) and environmental (external stressors) factors in your life.
In addition, while pregnancy has traditionally been thought of as a time of emotional wellbeing, recent studies indicate that 10% to 15% of women experience clinically significant depressive symptoms during pregnancy.
Many women make the mistake of waiting too long in the hopes that things will get better on their own. Postponing treatment can lead to harder-to-treat symptoms and a lingering illness. Postpartum depression and anxiety is very treatable. If you are worried about the way you are feeling, tell someone. Talk to your partner. Talk to your healthcare provider. Do not let feelings of shame or embarrassment get in your way. Do what you need to do to help yourself heal so you can feel like yourself again.
This educational material is provided by Postpartum Stress Centre in Philadelphia, PA, www.postpartumstress.com