Postpartum Depression, PPD - New Mothers and Clinical Depression

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Postpartum Depression

You've just given birth to a delightful baby, and everyone is ecstatic. Everyone, that is, except you. If this is supposed to be the happiest time of your life, why do you feel so low?

You're not alone. Some degree of emotional vulnerability is natural and expected after childbirth, and many women have conflicting or troublesome feelings at this time. At least 60 to 80 percent of new mothers experience the baby blues, a mild form of depression that begins a few days to a week after delivery and generally lasts no longer than two weeks. If you have the blues, you may be weepy, anxious, and unable to sleep. You may also be irritable and moody.

Listen to our radio show on Postpartum Depression

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Are you suffering from the "baby blues?" For many women, the time after their child is born is a time of great despair and helplessness. Our guest suffered from severe postpartum depression. Suzanne told us what it was like and how she overcame it. Other callers shared their experiences with post-partum depression and postpartum psychosis. Dr. Kris outlined the symptoms and had helpful suggestions for overcoming self-defeating thoughts and reduced self-esteem as well as medical and therapy treatment options.

Moms often find themselves feeling better after getting some rest and help with the baby. You can find out more in our article Battling the Baby Blues. But if your blues — or those of someone you love — have lasted more than two weeks, read on.

Could I be suffering from postpartum depression?

If your mood doesn't lift after two weeks, you may have postpartum depression (PPD). Ten to 20 percent of new mothers develop a full-blown clinical depression, which can last from two weeks to as long as a year.

Symptoms of Postpartum Depression include:

insomnia
weepiness or sadness that persists all day
diminished interest in almost all activities
difficulty concentrating
change in appetite
anxiety
moodiness and irritability
excessive guilt
panic attacks (symptoms include heart racing, dizziness, confusion, feelings of impending doom)
suicidal thoughts

For Help

Postpartum Stress Center
(610) 525-7527

Depression After Delivery (D.A.D.)
(800) 944-4773

Postpartum Support International
(805) 967-7636

Depression Awareness, Recognition, and Treatment Program
National Institute of Mental Health
(800) 421-4211

Your doctor can best determine whether you have PPD, but you may spot some clues yourself. Experts say that if you can't sleep when the baby sleeps, no matter how hard you try or how tired you are, you may have postpartum depression. A small number of women believe they cannot adequately care for their baby.

Others report having intrusive thoughts about harming their babies. One Queens, New York, mother remembers falling asleep in a rocker one evening while holding her newborn son, and later waking up convinced she had dropped him on his head. No amount of reassurance from her husband that she hadn't hurt the baby would change her mind.

Postpartum Psychosis

A few new mothers experience postpartum psychosis, an extremely rare illness that requires immediate medical intervention and is characterized by hallucinations, bizarre thinking, delusions, and often suicidal impulses.

Women with postpartum psychosis might not realize they’re having problems and may be unable or unwilling to seek treatment. It’s critically important to seek medical help if you suspect that you or someone you know may have this problem. Depression and confusion can be very frightening to experience or to observe in a friend. It’s important to know that waiting and hoping for improvement aren’t enough and that medical treatment can be very helpful. The goals of treatment are to keep mother and baby safe and to preserve the mother’s sense of competence as a parent while she recovers.

It's important to know the difference between normal emotional changes after birth and a need for further support. It's not just what you are feeling that indicates something may be amiss, but the frequency, intensity, and duration of your feelings. In other words, many new mothers feel sad and anxious periodically during the first few months after childbirth. But if you are crying all day long for several days in a row and having panic attacks, you should contact your doctor.

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Postpartum depression can strike any woman, either immediately after the birth of her baby or many months later. Unfortunately, the medical community has a long history of misunderstanding and misdiagnosing PPD. Sometimes healthcare providers don't take new mothers' concerns seriously, brushing them off as hormonal shifts and adjustment to motherhood. Our society also makes it difficult to admit to having negative feelings about motherhood or the baby. When mothers do express feelings such as ambivalence, fear, or rage, they can frighten themselves and those close to them.

What causes depression after childbirth?

Experts have yet to come up with a precise explanation, but they agree that it is caused by a combination of hormonal, biochemical, environmental, psychological, and genetic factors. The precipitous drop in hormone levels immediately after childbirth may be partly to blame. Also, the emotional high of giving birth disappears quickly, to be replaced by the many new responsibilities that come with parenthood. Taking care of a newborn, while emotionally gratifying, can also be taxing and frustrating, especially for a first-time mom. It's normal to feel overwhelmed.

The sleepless nights that plague new parents only aggravate your already vulnerable condition. Writer Anne Lamott describes the postpartum experience in her memoir Operating Instructions. "I'm crazy tired," she writes. "I feel as stressed out by exhaustion as someone who spent time in Vietnam."

Am I at risk for PPD?

Some women are more likely than others to get PPD. You're more at risk for PPD if:

you or anyone in your family has a history of depression or other mental problems, or you were prone to bouts of intense anxiety while you were pregnant
your pregnancy was not planned
your spouse or partner is unsupportive
you're having marital difficulties
you're having financial problems
you've recently gone through a separation or divorce
you went through a serious life change such as a big move or loss of a job at or around the time you had the baby
you suffer from severe premenstrual syndrome
you had obstetric complications
you were subject to early childhood trauma, have a history of abuse, or a dysfunctional family

Remember, though, that these risk factors don't actually cause PPD. Many women with a number of these risk factors never get depressed. Others with just one or even no risk factors end up with a full-blown major depression.

What can I do to cope?

Above all else, be good to yourself. Make sure your own basic needs are met: Try to sleep and eat well, and try not to feel guilty about the way you feel. Just because you have PPD doesn't mean you're a bad mother or don't love your child.

"It isn't your fault that you feel this way," says Karen Kleiman, a Pennsylvania therapist and co-author of This Isn't What I Expected: Overcoming Postpartum Depression. "We live in a society that doesn't tolerate women who don't feel good about being a mother. Because of this, women feel enormously guilty when they have negative feelings about motherhood."

Here are some other ways to cope with depression:

* Get help. Part of being a good mother is knowing when to ask for help — so don't be afraid to ask for it during this difficult time. Help can come in many forms, from friends who cook meals and do the vacuuming to therapy. If you're concerned about the way you're feeling, talk to your doctor. And if you think you might hurt yourself or your baby, or if you feel incapable of responsibly caring for your newborn, seek professional help immediately.

* Share your feelings with others. Find someone you trust and let that person know how you feel. Call a friend. Look for a new mothers group for support. Reach out to other moms — you may be surprised at how many women are experiencing similar feelings. It's also important to talk to your partner if you have one and make sure he knows how you're feeling and what you're worried about.

* Take care of yourself. Sometimes taking care of your physical self can help you feel better. Have your partner watch the baby so you can take a relaxing shower before he leaves for work, and put on makeup if you usually wear it. Although your maternity clothes may still fit, pack them away. Go on a shopping trip just for yourself and buy something new for your postpartum wardrobe. Wear a favorite outfit on especially difficult days to give yourself a boost.

* Sleep when the baby sleeps. It's age-old advice, but it works. The rigors of caring for a newborn, coupled with exhaustion and sleepless nights, will almost certainly bring on the blues. To fight fatigue and depression, you must get your rest. Have a relative or friend over during the day, even if only for an hour, and sleep. If no one is available, consider hiring a doula, or a sitter experienced with newborns.

* Venture outdoors. Put your baby in a stroller and take a walk around the block, or meet a friend at a cafe nearby. The fresh air, sunshine, and company will do you and your baby a world of good. If even a brief excursion is too much for you right now, then just go outside, take a deep breath, and sit in the sunshine for a few minutes. It will help.

* Simplify your life. Your baby's arrival is a good reason to take it easy. Resist the temptation to do the laundry while your baby sleeps, and let the chores wait. Have food delivered, or ask your partner to get takeout on the way home. If you find that the phone rings at inopportune moments (for example, when you're trying to get the baby to sleep, or when you're finally sitting down for a much-needed break), hook up the answering machine and return calls only when it's convenient. Ask a friend to help, and set aside time — even half an hour — for you and your partner to be alone without the baby. If you're on maternity leave, banish all thoughts of work that awaits you at the office. Don't worry — you'll get back on track soon enough. Achieving perfection shouldn't be on your agenda.

My doctor has prescribed antidepressant medication. Is it safe to take while breastfeeding?

It's an individual choice. Although some studies show certain antidepressants are compatible with breastfeeding, you should carefully consider all alternatives before you make a decision. (For more details, check out the BabyCenter chart on the interaction of drugs and breast milk.) Some doctors say it's okay for breastfeeding women to continue nursing, but others are more cautious. Much depends on the severity of your depression; if you're seriously depressed and no amount of rest, sleep, or emotional support is making a difference, you may decide to forgo breastfeeding. Ultimately, it's up to you, your partner, your doctor, and your baby's doctor.

How long does postpartum depression last?

It's hard to say. Some women feel better within a few weeks, but others feel depressed or "not themselves" for many months. Women who have more severe symptoms of depression or who have had depression in the past may take longer to get well. Just remember that help is available and that you can get better.

My partner has PPD. How can I make life easier for her?

The postpartum period is hard on fathers, too. After all, you're also busy tending to your baby's needs, so make sure you get a lot of rest. In the meantime, offer your partner help whenever she needs it, and try not to judge her. It can be difficult to adjust to a partner with PPD, especially if you expected life after the baby's birth to be a joyous time for your family. But remember — your support is vital to her recovery.

Talk to your wife's obstetrician, midwife, or therapist to better understand what she's experiencing. "You cannot fix this," says Kleiman. "You just have to be there for her." What's important is that she seek proper treatment. PPD is very treatable.