By Jen Lazuta
Having a baby is supposed to be a time of happiness and joy. But for some women, the weeks and months following the birth of their child is a time of fear, anxiety and sadness. According to the most recent survey by the Centers for Disease Control and Prevention, between 11 and 18 percent of mothers experience such negative feelings, suffering from what medical experts classify as postpartum depression.
“At the most basic level, postpartum depression is caused by changes in brain chemistry after the birth of a child,” said Diana Lynn Barnes, PsyD LMFT, a psychotherapist in the greater Los Angeles area who specializes in women’s reproductive health. “Personal or family history of depression, certain psychological factors, as well as environmental stress are all risk factors that affect a woman’s vulnerability for developing postpartum depression.”
The onset usually occurs within a few months of delivery, but can occur at any time during the first year after the baby is born. Ten percent of women may also experience a mood or anxiety disorder during their pregnancies, said Barnes.
Unlike the “baby blues,” which affects three out of every four women and is considered a normal part of postpartum adjustment, the symptoms of postpartum depression are more intense and prolonged.
“Baby blues is just your body getting used to having a baby, and doesn’t generally require medical intervention,” Barnes said. The symptoms, such as irritability, sleeplessness and emotional sensitivity, usually appear three to four days after giving birth and tend to subside within two to three weeks. “They’re usually mild, and somewhat similar to mood-related symptoms around the menstrual cycle,” she said.
When the symptoms of the baby blues seem to grow worse and continue beyond three weeks, that could signal the onset of postpartum depression, Barnes said. Crying without cause, inability to function during the day or sleep at night, changes in appetite, or feeling disconnected from your baby are all red flags that a new mom may be suffering from something more than the blues.
Barnes said that one indication a woman has postpartum depression is a feeling of indifference towards her baby. “They’ll say they have no idea what to do with the child,” she said, “or that they are just going through the motions of caring for it, without feeling.”
Another hallmark characteristic of postpartum depression is what women describe as a feeling of fogginess, Barnes said. “They’ll often experience disorientation and confusion, and are overwhelmed, unable to perform everyday tasks.”
Shari I. Lusskin, MD, an adjunct associate professor of psychiatry and obstetrics and gynecology at New York University's Mt. Sinai School of Medicine, said that a telltale sign of postpartum depression is having obsessive, illogical or intrusive thoughts about harm coming to the baby.
“These images will be extremely disturbing to the mother, and may be so frightening that she will go to great lengths to avoid doing what she thinks of as inevitable,” she said. “For example, a woman who keeps seeing herself drop the baby reasons that if she holds the baby, she will drop it. And so she just won’t hold the baby. She’ll avoid her child to avoid a tragedy.”
Although it is unlikely a woman will act on these thoughts, it is important to discuss them with your doctor, Lusskin said. In rare cases, it could be an indication of postpartum psychosis, in which a woman experiences a break from reality. The onset usually happens rapidly, and may involve hearing voices, hallucinations, severe paranoia, or thoughts of suicide or homicide.
Although the American Pregnancy Association estimates that postpartum psychosis affects only one or two women out of every one thousand, it is a life-threatening emergency for both mother and baby and requires immediate medical intervention.
It is important to note, however, that contrary to popular belief, postpartum psychosis is not a severe form of postpartum depression. “I want to stress that [postpartum psychosis] is a completely different illness,” said Barnes. “Many women fear that if they have postpartum depression, it will spiral out of control and they will develop psychosis. That’s just not the case.”
Women should know that they don’t have to wait until they give birth to find out if they are at risk for postpartum depression. “You can talk to your doctor about screening before getting pregnant, as well as continue to screen for risk throughout the pregnancy and into the first year,” Barnes said. “There are plans you and your doctor can put in place to reduce your risk.”
Women should also know that postpartum depression is completely treatable, Barnes said. “On occasion, when postpartum depression is mild enough, the symptoms may go away on their own within the year; however, if left untreated, a woman will be at a greater risk for depression in the future.”
Doctors prescribe treatment on an individual basis, depending on factors such as the type, duration and intensity of the symptoms, and a woman’s psychological and biological history, said Lusskin. In general, a combination of psychotherapy and medication, such as anti-depressants, anti-anxiety pills and sleeping aids, is often the most effective way to alleviate the symptoms of postpartum depression. In more severe cases, hospitalization or electroconvulsive therapy may be necessary, Lusskin said.
In addition to medical treatment, it’s important that women suffering from postpartum depression receive help from family and friends. “We live in a culture that romanticizes pregnancy and motherhood,” said Barnes. “We tend to think that good mothers should do everything themselves. But women need a lot of help and a lot of support and a lot of reassurance in order to get better.”
If treatment progresses as it should, women should start to feel better within several weeks, Barnes said.
No matter what treatment route a woman takes, it’s important that she consults a women’s reproductive mental health specialist. “Issues around motherhood are unique and an expert in postpartum depression really understands the full range of symptoms,” said Barnes. “They know what it looks like and they know how to best treat it.”
An important part of any recovery is getting treatment early on. If you are not feeling well, said Lusskin, seek help promptly so that you can get better as soon as possible. She said she tells women: “Complain early; get treated early; get better quicker.”
Published June 26, 2012.
Jen Lazuta recently earned her Master's degree from the Medill School of Journalism and is a Chicago-based freelance writer.