Rachel Cannon doesn’t wait for a pregnant woman to deliver her baby to start looking for signs of postpartum depression. Like most practitioners in her field, the Boston-based OB-GYN and instructor at Boston University begins screening for postpartum depression before a woman is anywhere near the postpartum period. She wants to know if her patients have a history of depression or anxiety. She asks what their support system is like. She makes inroads at every prenatal visit. Cannon isn’t trying to police the thoughts of moms-to-be, and she’s not being judgmental. She is trying to treat postpartum depression before it starts. What’s more, she’s aware that just 14 percent of postpartum depression sufferers actually seek and receive treatment in America, an unfortunate reality that comes down to a multitude of factors—from moms’ fear of judgment and recrimination to societal attitudes that make asking for help a taboo for hundreds of thousands of women every year. For new parents in America, the fight for postpartum depression treatment isn’t just one of awareness. Moms need to feel safe recognizing the symptoms in themselves and to feel secure saying, “hey, I need a little help.” Whether you’re expecting a baby soon or already delivered…if you’re wondering what’s part and parcel of the life changes that come with bringing a new one into the world and when it’s time to put up the white flag, here’s what the doctors say.
Postpartum Depression or Just the Baby Blues?
If you had a dime for everyone who told you that the days after you welcome a child are different, you’d be living it up like Bill Gates by now. But guess what: All those clichés that come at you during pregnancy come at you for a reason. You might as well be Dorothy waking up in Oz after you give birth. Your life has just changed. Your body has been through the wringer. And your new baby has no idea how to do much of anything without you, save for sleeping and sounding out a cry-fueled alarm that they’re hungry, tired, or have a diaper full of yuck. So it stands to reason that you might feel a little down and out in the days after having a baby, and that’s perfectly okay, Cannon says. “Every woman, her life is going to change,” she notes. “Her sleep, her appetite, her libido is going to change, and that’s normal.” And with all that change comes a plummet in mood. The American Pregnancy Association estimates that anywhere from 70 to 80 percent of new moms have these feelings, which usually hit them within a week of birth. You might feel tired. Weepy. Anxious. Unmoored. Usually dubbed the “baby blues,” this period of feeling very un-you doesn’t necessarily mean you have postpartum depression. It could just mean you’re a new mom trying to figure out a whole new life, and those feelings will go away as you adjust to your new routine. So how do you know if you have postpartum depression? It’s when the symptoms of the baby blues stick around that you need to seek an evaluation by your doctor for something more serious.
How to Know if It’s Something More: Diagnosing Postpartum Depression
For 1 in 7 women, the baby blues don’t end, at least not without help. They still feel down and out of sorts well past their baby’s arrival, even as they fall into a routine of diapering and feeding and swaddling. For some, the feeling won’t even show up right after baby’s born. Postpartum depression can begin to rear its ugly head as long as three or even six months after baby’s arrival. But before they can get help, many women face a host of misinformation that they need to wade through. In one BabyCenter poll, 77 percent of women confessed that they thought having postpartum depression meant you were a risk to your child’s safety. It’s a myth perpetuated by alarmist headlines about desperate moms who have hurt their babies. And sadly it does happen. But causing harm to your baby or yourself is just one of the possible symptoms, and it’s one that’s experienced by fewer women than other issues that are still difficult for moms, such as insomnia or anxiety. No matter how minor you may feel your issues are, they are absolutely worth a follow-up with your physician. The truth is, if you’ve gone two weeks with any of the following symptoms of postpartum depression (as outlined by the National Institutes of Health) it’s time to make that call:
- 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 the 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 the baby
- Persistently doubting her ability to care for the baby
Not sure if you fit the bill? Many doctors use the Edinburgh Postnatal Depression Scale as an assessment tool, and the questions are available online. Although the test should not be used to self-diagnose, the 10 questions can help you make sense of what you’re feeling. If you’ve had thoughts of hurting yourself or your baby, it’s particularly important that you don’t wait to make that call, Cannon says. You may be experiencing something called postpartum psychosis. Although it’s much rarer than postpartum depression, postpartum psychosis is the leading cause of maternal death in a baby’s first year. Postpartum psychosis can result in complete psychosis, cognitive impairment, and grossly disorganized behavior. The good news is, as with postpartum depression, there is treatment—but a mom and/or a loved one has to identify the problem and get her help.
The Risks of Postpartum Depression
The postpartum depression symptom list is a long one, and it’s one that many moms say makes them feel inadequate and scared even to broach the topic of postpartum depression with their healthcare providers. For many, it’s something they’ve never felt before. For half of all postpartum depression sufferers, this is the first time they’ve ever experienced these feelings, which can quickly feel like a ding on their brand-new parenting record. But postpartum depression isn’t a mom’s fault. It doesn’t mean she’s failing or that she’s ill equipped to be a parent. It comes down to our own bodies and how they’re affected by pregnancy and motherhood, says Mayra Mendez, PhD, a licensed psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John’s Child and Family Development Center in Santa Monica, California. “Postpartum depression is a condition resulting in emotional dysregulation impacted by hormonal and chemical imbalance associated with pregnancy,” Mendez says. “The condition impairs decision making, interferes with perceptions, [and] may impair relationships and disrupt daily living routines.” In that way, postpartum depression is much like clinical depression. Moms who struggle with postpartum depression show signs that are markedly similar to those of non-parents with depression. But a number of scientists surmise that postpartum depression differs from classic depression in large part because of the hormones that take control of a mom’s body. Although a pre-pregnancy depression diagnosis will increase a mom’s risk of developing depression postpartum, some moms have no history of depression and after treatment never experience symptoms again. If you’re feeling like you need a little help—or a loved one has picked up on the cues—you can start at your OB-GYN’s office. And there’s no need to wait for your six-week postpartum checkup. Call your doctor’s office and explain that you’d like a postpartum depression screening. Regardless of whether you’re feeling postpartum depression symptoms, the experts maintain that risk factors rest largely on genetics and societal factors. Women who have a history of depression are at higher risk than their peers, as are moms who deliver a pre-term baby, moms who lack a support system, and moms who are under other undue stressors during pregnancy or in the postpartum period. Some science even indicates that women who give birth during the winter and spring months are at higher risk than those who have summer and fall babies. Although exact causes have yet to be determined, doctors like Cannon keep a keen eye out for moms who are expressing anxious feelings during pregnancy, as postpartum depression is not singular to the days after a woman gives birth. Symptoms are as likely to crop up during pregnancy or even months after a baby’s arrival.
Help for postpartum depression is on the way.
It’s because of this that postpartum depression treatment may begin well before the postpartum period, especially for women who come into pregnancy with a previous mental health diagnosis. As many as 20 percent of women experience depression during pregnancy, and it’s been linked with adverse obstetric outcomes such as low birth weight and premature birth. That alone could be reason enough to remain on an antidepressant for the nine months of pregnancy, but doctors have also found that a pre-pregnancy depression diagnosis is one of the leading indicators that a mom may suffer from postpartum depression. These days that’s enough to leave the barn door wide open on the topic, with doctors weighing a mom’s well-being against unknown risks to her fetus. Although it was once customary for women to suspend taking antidepressants during pregnancy, an increasing number of doctors advise moms to stay the course if they feel they need the medicine in their system. “Unfortunately, we don’t have a lot of data,” Cannon says of the safety of antidepressants for moms-to-be. But what data they do have indicate that some formulations of medications are safer than others, and your OB-GYN may suggest a change to a specific medicine. The American College of Obstetricians and Gynecologists suggests that “the use of a single medication at a higher dosage is preferred over multiple medications, and those with fewer metabolites, higher protein binding, and fewer interactions with other medications are also preferred.” And while studies continue to present a variety of factors for moms, recent research has shown that fears that antidepressants may hike a child’s autism risk are unfounded, as are fears that it will cause attention deficit disorder. If you’re debating whether to start (or restart) antidepressants during pregnancy, be aware that antidepressants may need to be started at 36 weeks of pregnancy to get adequate blood levels in a woman’s system to ward off uncontrollable emotions once the baby is born. That said, antidepressants aren’t the only tools in a mom’s arsenal if she’s fearing she may develop postpartum depression. Sherry Ross, an OB-GYN at Providence Saint John’s Health Center in Santa Monica, California, suggests adding visits with a therapist to your prenatal plans if you have concerns, as they can not only help you take control of your emotions during pregnancy but also help craft plans for the postpartum period. They’ll also suggest how other important people in your life—from a friend to a sibling to a partner—can provide you support. “It’s important to establish a support team who will help you be successful avoiding the dark days associated with depression,” Ross notes. “The team should include your partner, therapist, and healthcare provider. Women suffering from this type of depression need to acknowledge and be communicative on how they are feeling and use their support team regularly.” If you’ve already given birth when you start to experience issues, you may be in new territory, but it’s never too late to get help. Symptoms for postpartum depression may crop up as long as six months after a woman gives birth, but treatment is out there. “Symptoms associated with postpartum reactivity are usually temporary and responsive to treatment,” Mendez says. That treatment can include cognitive or behavioral therapy with a therapist and/or medication. For moms who are considering breastfeeding, there’s even good news: Studies on moms with postpartum depression found that some antidepressants are safe for breastfeeding. What’s more, research on moms who stopped taking antidepressants versus those who stayed on the meds showed a direct link between staying on selective serotonin reuptake inhibitors (SSRIs) and extended breastfeeding. Regardless of your medical treatment plan, there’s physical support out there too. Postpartum depression support groups exist across the country, and they’re all just a phone call away.