Having a baby takes a huge toll on a woman’s body. The physical changes are expected but a lot of women are surprised especially after delivery when their hormones drop and start to revert back to where they were before they got pregnant. It is very common for new mothers to experience ‘baby blues’ which is not the same as Postpartum Depression (PPD). Some may experience a more serious condition called Postpartum Psychosis. Psychosis affects how the brain processes information and can cause a woman to lose touch with reality. It is a symptom and is not an illness; women who develop Postpartum Psychosis most likely will require treatment through a mental health professional.
PPD is one of the most common medical conditions related to pregnancy and after birth. It is a combination of changes that are physical, behavioral and emotional. PPD is considered a form of major depression that often begins about a month after delivery; however, it occasionally starts to manifest during late-stage pregnancy. It can be difficult to recognize and the degree a woman experiences it can greatly vary. Most woman are aware that after giving birth it is common to feel exhausted, sad, tired and moody because of all the stress your body has been through which causes chemical changes. These common ‘effects’ are normal but the signs of PPD are somewhat different and more profound than the type of depression that may have been experienced previously from other life events or situations. It goes deeper than just ‘having the blues’ and that may be concerning to the new mother or to those around her. Being diagnosed with PPD is not based on the length of time between having the baby and when the symptoms start but on the severity of the depression being experienced. Although men do not experience hormonal changes fathers can also experience a degree of PPD during the first year after their child is born.
Signs of PPD are: persistent feelings of sadness, anxiety, feeling empty, irritability, difficulty in emotionally attaching or bonding to the baby, doubting one’s ability to care for the baby, guilt, worthlessness, hopelessness, helplessness, loss of interest or pleasure in things that are normally enjoyed, abnormal loss of energy, severe fatigue, difficulty concentrating, difficulty remembering, difficulty making decisions, difficulty sleeping (over-sleeping or awakening), changes in appetite resulting in weight changes, thoughts of suicide or self-harm, thoughts of harming the baby, feeling restless, fidgety or difficulty sitting still, lower libido, crying all the time without a known reason, unusual or unexplained aches, pains, headaches, cramps or stomach problems without a known cause or that do not improve with treatment.
Untreated PPD can become very dangerous for a mother and child and professional help should be obtained if persistent symptoms continue for more than two weeks. It is important to remember that if a new mother experiences PPD it happens for many reasons and can be different for each person. It is very important to be aware that having previously experienced depression or there is a family history of depression a woman may be more likely to develop PPD. Treatment includes psychotherapy or counseling using evidence-based approaches that includes cognitive behavioral therapy and interpersonal therapy, prescribed medication (antidepressants), life-style changes (exercise, diet, sleep schedule), and when PPD is severe, electroconvulsive therapy. Consequences of untreated PPD can not only be detrimental to the mother but the child can experience higher levels of risk in developmental delays, impaired cognitive skills, emotional stability, inability to handle life stress, developing depression and anxiety as they grow to adulthood. PPD also increases the risk of suicide.
Most people are familiar with Postpartum Depression but Perinatal Depression is not as commonly known. Perinatal Depression begins during pregnancy and can lead to Postpartum Depression. Perinatal depression is a real illness. It is not brought on by anything that a woman did or did not do nor does it have a single cause. It may come from a combination of things such as life stress, past trauma, changes in hormones, mental illness such as bipolar disorder or a history of depression.
In addition to developing PPD, it is not uncommon for new mothers to develop other related mental health concerns after giving birth such as Postpartum Anxiety (PPA) which includes experiencing panic attacks along with feelings of anxiety. This includes changes in eating, sleeping, racing thoughts that are difficult to control, persistent worrying, impending sense of doom, difficulty focusing or sitting still, dizziness, hot flashes and nausea. New mothers can also experience Postpartum Obsessive-Compulsive Disorder (PPOCD) which is part of the Postpartum mood disorders group which can include being overly concerned about keeping the baby safe, repetitive actions to relieve anxiety and fears such as counting things, listing things checking and re-checking actions such as cleaning, feeding or taking care of the baby. Postpartum Post-Traumatic Stress Disorder (PPTSD) can also be experienced which can occur when a woman who experienced real or perceived trauma during childbirth or immediately after birth such as an unplanned C-section, emergency prolapsed cord, NICU, lack of support, communication and feeling powerless. Symptoms can include nightmares, flashbacks, anxiety, panic attacks, feeling detached from reality, hypervigilance, easily startled, irritability, avoidance of reminders and re-experiencing past traumatic events. The most severe form of PPD is Postpartum Psychosis (PPP) which is extremely rare. The onset is sudden and severe within two to three weeks after birth. Symptoms of PPP are bizarre behavior, suicidal thoughts, hallucinations or delusions, thoughts of hurting the child, rapid mood swings and hyperactivity. PPP is a medical emergency and should be immediately treated.
It is important that spouses, partners, family members and friends who may notice subtle changes at first should discuss their concerns with the new mother. Treatment is necessary for recovery; it is difficult to move past PPD without assistance. Support groups can be helpful both on-line or in person. It is important to remember there should be no shame in any part of childbirth and experiencing PPD is part of that process.
Here are some books that may be helpful:
The Fourth Trimester: A Postpartum Guide to Healing Your Body, Balancing Your Emotions and Restoring Your Vitality by Kimberly Ann Johnson.
This Isn’t What I Expected: Overcoming Postpartum Depression by Karen Kleiman and Valerie Raskin
The Postpartum Husband: Practical Solutions For Living With Postpartum Depression by Karen Kleiman
Good Moms Have Scary Thoughts: A Healing Guide to the Secret Fears of New Mothers by Karen Kleiman
Dropping The Baby and Other Scary Thoughts: Breaking the Cycle of Unwanted Thoughts in Motherhood by Karen Kleiman, Amy Wenzel, Hilary Waller and Abby Adler Mandel
Beyond The Blues: Understanding and Treating Prenatal and PostPartum Depression & Anxiety by Shoshana S. Bennett and Pec Indman
The Pregnancy and Postpartum Anxiety Workbook: Practical Skills to Help You Overcome Anxiety, Worry, Panic Attacks, Obsessions and Compulsions by Pamela S. Wiegartz
Breathe, Mama, Breathe: 5 Minute Mindfulness for Busy Moms by Shonda Moralis
The Mother -to-Mother Postpartum Depression Support Book by Sandra Poulin