Having a baby, for many women, is one of the biggest joys of their lives. When that highly anticipated bundle of joy finally arrives, families are completed, people become parents, and everyone's as happy as pie. In theory, that's what happens, but for the one in seven women who suffers from postpartum depression, new-mom bliss is overshadowed by a tough mental-health struggle.
Postpartum depression, or the onset of moderate to severe depressive symptoms that set in a few weeks to a year after giving birth, affects about 14 percent of women. According to non-profit organization Postpartum Progress, the number might be closer to 20 percent. The statistics on postpartum depression may not reveal the full extent of the disorder, since most studies rely on self-reporting, and many women may be too afraid or ashamed to admit that they're suffering.
Recently, actress Hayden Panettiere spoke about her own experiences with postpartum depression, calling it "one of the most debilitating, scary, guilty feelings that you can ever feel." We're here to break the stigma, so that more women can be open about their experiences, shake off the guilt, and get the help that's essential for both mom and baby to start living a healthy and happy life.
Postpartum depression is now often referred to as perinatal mood and anxiety disorders, or postpartum mood disorders (PPMD). "There are four subtypes: depression, anxiety with or without depression, panic attacks, and OCD," Susan Benjamin Feingold, Psy.D., a licensed clinical psychologist who works with many women going through infertility treatments and author of Happy Endings, New Beginnings: Navigating Postpartum Disorders, tells SELF. Referring to it more broadly better encompasses what these illnesses include, and makes it less confusing for women who are highly anxious but not necessarily depressed, and don't realize they're experiencing a subtype of postpartum depression.
It's important to distinguish between the blues and an actual postpartum mood disorder, says Helen L. Coons, Ph.D., president and clinical director of Women's Mental Health Associates in Denver, Colorado. "Baby blues are very common, and typically start within the first six weeks postpartum," she explains. Anywhere from 50 to 85 percent of moms experience the baby blues, a completely normal phenomenon following childbirth that lasts anywhere from a few hours to two weeks. Experts assume this is caused by the big change in hormones that happen postpartum, mixed with the huge change in routine and lack of sleep a new mom usually experiences. A case of the baby blues typically manifests as weepiness, or crying without knowing why you're crying, and will usually clear up on its own, whereas postpartum depression and other mood disorders need to be treated.
Symptoms can start to show within a few weeks of childbirth, but sometimes it can take up to a year, Coons says. Most commonly, it occurs within three months of delivery, according to the National Institutes of Health.
A prior history of a mood disorder before pregnancy, a past history of a mood disorder throughout pregnancy, or a past history of postpartum depression all make a woman more likely to experience postpartum depression. Yet for half of women diagnosed with postpartum depression, it's the first depressive episode they've ever experienced, according to the American Psychological Association.
Other factors that up the risk for women, according to Coons: a history of one or more pregnancy losses, a complicated pregnancy for medical reasons, health problems with themselves or the fetus, a sick baby or a premature baby in the NICU, being socially isolated and lacking a support system postpartum. "Women with other medical conditions themselves, or women who abuse alcohol or other drugs," are also at a higher risk, simply because they are at a higher risk for depression and anxiety in general.
Hormonal sensitivity is another factor that can trigger a mood disorder. "Some women are just hormonally sensitive—if they're having symptoms of mood changes or depression or anxiety or irritability during PMS, that tells us they’re more hormonally sensitive," Feingold explains. This means you'll probably be more vulnerable to the hormonal rollercoaster that occurs during and after pregnancy. Levels of hormones like progesterone and estrogen go up through pregnancy, then there's a severe drop a few days after birth. "For some women who are sensitive, it sort of sets off a cascade of effects and mood symptoms."
And any parent will tell you that getting a solid night's sleep is pretty impossible, thanks to feedings every two hours.
That’s why shuteye is the first thing doctors focus on for treating postpartum depression. “If we can get them to a five- or six-hour block of sleep plus a nap, they’re going to feel a lot better in one to three week’s time,” Coons says. Intervention and backup are key here, since slipping away for six solid hours and a nap is pretty much a postpartum pipe dream. It might mean having someone else bottle-feed the baby sometimes so she can rest at night. Doctors also recommend sleeping whenever the baby sleeps. Some women may need medication in order to get onto a stable sleep schedule.
Regular symptoms of depression include sadness, difficulty concentrating, trouble sleeping, loss of pleasure, and even thoughts of hurting oneself. Postpartum, some additional red flags can signal either depression, anxiety, or another mood disorder related to childbirth: experiencing anxiety about being left alone with the newborn, anxiety about not being a good mom, thoughts the woman is going to drop the baby, thoughts about hurting the baby, irritability, and not being able to sleep when the baby sleeps. "Lots of women are giving the baby good care but are kind of indifferent or flat," Coons adds as another sign of a postpartum mood disorder. "I will ask patients, 'When you’re putting those cute little onesies on or socks, do you brighten up?' and if they shake their head no, that’s a red flag."
Plenty of new parents are anxious about caring for a new human, and not all women bond with their babies immediately when they are born, but when these behaviors interfere with the mom's ability to care for her baby or complete other daily tasks, or are paired with classic symptoms of depression, there's cause for concern. Not all women have all of these symptoms and many women have different symptoms, Coons adds. Some women may also have one mood disorder, or a blurring of two or more.
Women suffering from postpartum depression may assume that everyone else is basking in the new-baby glow except them. "They feel ashamed, and think other people think they’re not a good mother," says Feingold. The reality is, many other women who are suffering are hiding it. "Sometimes postpartum women are going through depression, but don’t all look like they haven’t washed their hair or showered," Feingold says. "Many of them look perfect. There’s this mask they put on, and people would never believe that they’re going through a hard time." This not only makes it difficult for other sufferers to see they're not alone, but it also hinders women from getting help.
"Other people sometimes stigmatize it, and think, 'That doesn’t happen to well adjusted women, that happens to mentally ill women,'" Feingold says, when the reality is that all women are susceptible.
In the most severe cases of postpartum mood disorders, women can experience postpartum psychosis. It's very rare, affecting 1 to 2 women in every 1,000, but very dangerous. "When someone is psychotic, they're not necessarily able to make healthy decisions for themselves or someone else, much less take care of an infant," Coons says. "She may be paranoid, may go for days without sleep, and have not just thoughts of hurting oneself or the baby but plans to carry it out," she adds. Other signs include psychotic symptoms like delusions, unrealistic beliefs (like thinking the baby is the devil), and hallucinations, says Feingold. "It’s a clinical emergency," she says, "and [the mother will] need to get to the hospital and be medicated."
Therapy sessions with a clinical psychologist are a key part of treatment to help women understand what they're experiencing and that it's not their fault. Feingold explains that with her patients, she focuses on these general principles of recovery: finding ways to heal (interventions), building hope and inspiration, spirituality (anything from meditation and yoga to attending church), and establishing one's narrative (by journaling or being more open with loved ones). Some women will need antidepressants or anti-anxiety medications to recover fully, but not all. In those cases, it may be necessary to stop breastfeeding.
Once mom is cleared for exercise, some doctors might also get her up and doing some aerobic activity to help balance mood. Ultimately, treatment requires mobilizing the support system. "We often educate the family that getting over this isn’t just willpower," Coons says. "It really takes a village to support mom, baby, and family after the delivery."
After a patient experiences postpartum depression, Feingold says she monitors them closely in subsequent pregnancies. "It can be very helpful to be under preventive care to meet with them during their pregnancy—even if they don’t have symptoms—to set up a postpartum plan and kind of work on that," she says, so that next time around, they can be better prepared to notice symptoms right away and jump right into treatment before the symptoms begin to negatively impact your life.
It can feel unbearable to have anything other than happy thoughts about your new baby, but postpartum depression is totally normal and it’s not a reflection of you or your abilities as a mom. If you seek treatment, and enlist the help of those who love you, it will get better. Asking for help is not a sign of weakness. It's a sign you're mortal—a totally badass mortal, at that, for bringing a new person into this world.
