Updated June 8, 2015.
By Jen Lazuta
Having a baby is supposed to be a time of joy — especially in our media-saturated culture, which idealizes the positive aspects of becoming a new mom. But for some, the weeks and months following the birth of a child are dominated less by happy thoughts and more by feelings of fear, anxiety and sadness. Nearly 15% of mothers experience these extreme emotions after birth, a condition otherwise known as postpartum depression or PPD. The official criteria for diagnosis includes onset within four weeks of delivery. However, many experts and organizations — including the American College of Obstetrics and Gynecologists — suggest that PPD symptoms may occur any time within the first year after the baby is born.
At this point, the research suggests that, rather than having one specific cause, PPD is likely the result of several factors combined, which likely include lack of sleep; changing hormone levels, especially the dramatic decrease in the levels of progesterone and estrogen and a lower-than-normal level of thyroid hormone; and stress. At the most basic neurophysiological level, “postpartum depression is caused by changes in brain chemistry after the birth of a child,” says 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.”
“Baby blues is just your body getting used to having a baby, and doesn’t generally require medical intervention,” says Barnes. The symptoms, such as irritability, sleeplessness and emotional sensitivity, usually appear three to four days after giving birth and tend to subside within one to two weeks. “They’re usually mild, and somewhat similar to mood-related symptoms around the menstrual cycle,” she adds.
But while the baby blues, which may affect up to 80% of new moms, is considered a brief but common postpartum adjustment, PPD is more intense and prolonged. Barnes says that one indication a woman has PPD is a feeling of indifference towards her baby. “They’ll say they have no idea what to do with the child,” she notes, “or that they are just going through the motions of caring for it, without feeling.”
Another hallmark of postpartum depression is what many women describe as a feeling of “fogginess,” Barnes says. “They’ll often experience disorientation and confusion and are overwhelmed, unable to perform everyday tasks.”
Other warning signs include a lack of joy; increased sadness and anxiety; inability to sleep; loss of appetite; despondency; overly worried, very fearful thoughts or images concerning the baby; thoughts of suicide; extreme agitation; and difficulty concentrating. To rate yourself on an established screening test, take the Edinburgh Postnatal Depression Scale, then have someone else score it.
If you had the baby blues and your symptoms seem to have grown worse or are continuing beyond the initial three weeks, that could signal the onset of PPD, Barnes says. 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.
A woman with PPD can seem normal at work, but then come home to despair. “Women with postpartum depression are extremely good at pretending that that they feel fine,” says Karen Kleiman, MSW, LCSW, co-author of This Isn’t What I Expected: Overcoming Postpartum Depression, and founder of The Postpartum Stress Center, LLC, which has locations in Pennsylvania and New Jersey.
“There’s so much shame and stigma attached to PPD that women are afraid to talk about how bad they feel,” Kleiman says. Shame can reinforce silence and isolation, which then feeds the PPD.
But women should know that PPD is treatable, Barnes says. An important part of any recovery is getting treatment early on, says Shari I. Lusskin, MD, an adjunct associate professor of psychiatry and obstetrics and gynecology at New York University's Mt. Sinai School of Medicine. If you aren’t feeling right, seek help promptly so that you can get better as soon as possible. She tells women: “Complain early; get treated early; get better quicker.”
Doctors prescribe remedies 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, says Lusskin. In general, a combination of therapy and medication, such as anti-depressants, anti-anxiety pills and sleeping aids, is often the most effective way to alleviate the symptoms of PPD. In addition to medical treatment, it’s important that women suffering from PPD receive help from family and friends.
“We live in a culture that romanticizes pregnancy and motherhood,” says 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.”
As treatment progresses, women should start to feel better within several weeks, Barnes says. “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,” she adds.
No matter what treatment route a woman takes, it’s important that women with PPD work with 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,” says Barnes. “They know what it looks like and they know how to best treat it.”