Many of you will have found your way to my website because you are wondering about postpartum depression. What it is, and whether that is what you are experiencing. This page will serve as a source of information about this topic and will hopefully clarify some myths and misconceptions.
Specialists in this field of mental health generally will use the term “perinatal mood and anxiety disorders” (PMADs) to describe the large number of symptoms a person may experience while pregnant or after giving birth (the perinatal period). Depression can be a stand-alone problem or part of a constellation of symptoms. Anxiety in various manifestations is very common, either with or without depressed mood. Unfortunately, many well-meaning healthcare providers are not up to date on the current knowledge regarding PMADs and may inadvertently dismiss a patient’s complaints as “normal” or “the baby blues.”
Which brings me to a very important distinction…
What is the difference between the “Baby Blues” and PMADs?
The so-called Baby Blues are extremely common, affecting as many as 50-80% of postpartum women.* It usually begins within the first couple of days after the birth, and usually resolves on its own within 10-14 days. With the Blues, symptoms can be similar to those of a PMAD however they are transient, that is, they come and go. They do not typically interfere with a new mother’s ability to care for her baby or for herself.* Sometimes it can be tricky to tell if what you are experiencing is the Baby Blues or a PMAD, as the symptoms can overlap. One key thing to understand is that if you are feeling bad and it has been more than two weeks since you gave birth, it is not the Baby Blues. It might not be a full-blown PMAD either, but it is recommended that you seek evaluation from a qualified mental health professional to be sure and to get whatever support you might need.
PMADs are also much more common than many people expect. It is thought that between 10-20% of new mothers experience a perinatal mood or anxiety disorder.* While symptoms can appear right after giving birth, more typically onset is around 4-6 weeks after birth.* Symptoms can range from sadness/weepiness, despair, anger, sleep disturbances not related to baby waking, changes in appetite/weight, excessive worry, rumination/obsessive thinking, panic, agitation, guilt, difficulty concentrating and difficulty concentrating. It is also possible to experience elevated mood, decreased need for sleep, and other symptoms of mania (sometimes for the first time ever). One frequent symptom of PMADs is scary, intrusive thoughts of harm coming to the baby. These are common even in new mothers who do not have a PMAD! However they tend to be more disturbing to a woman who is experiencing perinatal depression, anxiety, or possibly Obsessive Compulsive Disorder. These can be very frightening to the new mother, however it is important that you discuss these with a trained professional if you are experiencing them. And of course, thoughts of harming ones self are always of concern and should be reported to your medical provider or therapist. If not available, you should call 911 or go to your local emergency room.
We do not know for certain why some people will experience a PMAD following the birth of a child and why some do not. There are biological, genetic, environmental, and psychological risk factors that have been identified, such as a history of depression, anxiety, or other psychiatric disorder, maternal age, thyroid problems, difficult pregnancy or delivery, prenatal depression, prior pregnancy or infant loss, instability in the relationship with the other parent, poor social supports, and many others*. The interplay between the biological, psychological, and social factors will be unique for each woman, as will be the factors that protect her against PMADs.
Another important topic of discussion here is Postpartum Psychosis. There is a lot of media sensationalism around PP due to several high-profile tragedies that have been in the news over the years, and PP and PPD have been falsely conflated by the media and by society. This has led to an increase in stigma surrounding both illnesses , and likely has caused some women not to seek treatment for fear that they will be labeled as “crazy,” or worse, have their babies taken away from them. PP and PPD are thought by some to be related on a spectrum of perinatal psychiatric disorders and by others to be completely different disorders. PP is far less common than other PMADs, with the prevalence thought to be in the range of 0.1-0.3% of women who give birth*. It usually surfaces within the first couple of days to the first month postpartum and is associated with delusional thinking, confusion, hallucinations, or thoughts about hurting her baby that do not disturb her. It is considered a medical emergency and immediate attention is needed, such as calling 911 or going to the emergency room. Risk factors include personal or family history of Bipolar disorder or psychosis.*
So what to do? If you do not like the way you are feeling, it is important to speak with a qualified provider. If you live in New Jersey and feel comfortable doing so, feel free to give me a call. If not, speak with your OB, your primary care provider, or even your child’s pediatrician. They can refer you to someone in your area who can help you. Or you can call the Postpartum Support International Warm-line at the link listed below. However you get into treatment, there are options. Psychotherapy, medication, some combination of the two, support groups, and options for different levels of care.
There are so many other important topics to cover in the world of perinatal mental health. For now, here are some resources that I hope you will find helpful regarding perinatal mood and anxiety disorders and their treatment:
Postpartum Support International http://www.postpartum.net the leading organization for information, education, and advocacy for perinatal mental health.
The Postpartum Stress Center http://www.postpartumstress.com founded by Karen Kleiman, LCSW, wonderful resource for information on PMADs.
The MGH Center for Women’s Mental Health https://womensmentalhealth.org/ reproductive psychiatry resource and information center
LactMed https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm database with helpful information for breastfeeding women who are contemplating taking psychiatric or other medications.
InfantRisk https://www.infantrisk.com/ website and hotline at Texas Tech with database of information regarding medication safety in pregnancy and lactation.
National Suicide Prevention Lifeline https://suicidepreventionlifeline.org/ or 800-273-8255
*The links and resources provided on this website are offered solely for educational purposes and as a convenience. They are not intended to in any way substitute for evaluation and/or treatment by a qualified mental health professional.