Is It Baby Blues or Postpartum Depression?

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Whether you’re a woman who’s given birth once, twice, three times or more, you’ve likely experienced an adjustment stage known as baby blues. Upwards of 80 percent of mothers experience this, where hormonal changes, physical recovery from birthing, and lack of sleep from tending to your new baby’s patterns create irritability, mood swings, weariness and frustration. Baby blues generally pass within two weeks as your mind, body and soul refuels. Time is a great healer, and soon your emotional and physical struggles diminish—and then recede altogether.

But for some moms, about 20 percent, this challenging experience doesn’t get better with time. In fact, it continues to linger and worsens, where symptoms become so intense that your find yourself completely overwhelmed. This experience is called Postpartum Depression (PPD) and is a serious mental health concern.

Postpartum Depression is a category of Major Depressive Disorder, which can occur four weeks after birth and up to one year post delivery. Postpartum Depression is sometimes called Postnatal Depression, Postpartum Depression with Anxiety and Maternal Depression. Science tells us that PPD often goes unrecognized because changes in sleep, appetite, attitude and behavior are attributed to normal pregnancy and postpartum changes by family, friends—even health professionals. So, the opportunity to “see” the illness is swayed by these beliefs. Then we have another issue, where many mothers feel shame when they can’t tend to their babies. They often suffer in silence—hoping things will get better. These mothers don’t realize they’re in the midst of a serious, but treatable illness. The combination of misdiagnosis and shame about needing help worsens the trajectory of the PPD and slows recovery. Given these circumstances, research reports that only about 50 percent of women with PPD are recognized and receive treatment.

I was a young psychologist when I had my first child. I was treated previously for depression and new that it was likely that I'd experience Postpartum Depression. I readied myself throughout my pregnancy. Upon delivery, I discovered that I wasn’t really prepared for how PPD immediately took hold. I felt not only overwhelmed by having a baby, my body was crushed by fatigue, and my mind swirled with doubts, guilt and worry. I felt extremely fragile, which was different from my previous depressive experiences.

I immediately began antidepressant therapy and within several weeks, I felt better. And then by about the 3rd month, I was back to my old self. Once I returned to work, I spent some time reflecting on how I was shamed considerably by several friends and family members for not being able to “cope” with my daughter—while others fiercely supported me. It was a most unique experience to view this as both a clinician who treated others with PPD and experiencing it personally.

Symptoms of Postpartum Depression

Postpartum Depression can present in physical, emotional and cognitive ways. Here's a list of some of the symptoms.

Afraid to be left alone with your baby Anxiety, feelings of dread and worry

Difficulty remembering things Feeling disconnected from others

Feeling overwhelmed Frequent crying, about little things

Guilt about not being able to cope Helplessness and hopelessness

Irritability, agitation Looping of unwanted thoughts

Loss of energy, fatigue Loss of interest in self-care

Loss of interest in doing things Not capable of caring for your baby

Not feeling up to doing tasks Panic, shortness of breath

Persistent sadness Poor concentration/indecisiveness

Recurrent thoughts of death/suicide Significant appetite changes

Sleeping difficulties Worried about your future

What Causes Postpartum Depression?

Research reports that there doesn’t appear to be one single cause, but rather a variety of factors that contribute to PPD. The important thing to know is that Postpartum Depression is not a result of being weak, lazy or inadequate as a mother. It is a real illness.

• Biological issues: Studies show several biological factors like intense hormone fluctuations, decreased serotonin levels, decreased insulin, immune system dysregulation, lower levels of oxytocin play a role in the development of PPD.
• Physical issues: Childbirth itself is a major transition. And the changes with your body can cause a great deal of stress and result in depression. If a major health event coincides with childbirth, like a difficult birthing experience or getting a postnatal infection, you'll be more susceptible to PPD.
• Life stressors: Chronic stressful circumstances can heighten the risk for Postpartum Depression. For example, a job change, money problems, a move, relationship difficulties, poor social support systems or a significant loss in your life have been shown to trigger PPD. So too, if your baby is colicky, if you have trouble breast feeding, or your partner is struggling with post baby stress. In addition, if you’ve experienced depression or anxiety before getting pregnant, you have a significantly higher risk for developing PPD.

Treatment

Much has been done over the last few years to study evidenced based methods to help mothers gain recovery. For Postpartum Depression, the treatments of choice include antidepressant medications and psychotherapy. In addition, holistic treatments can bolster traditional treatments, many of which I recommend.

• Medication: Given the biophysical aspects that ground Postpartum Depression, you will likely be given a prescription for an SSRI or SSNI. When taking antidepressant medication, breastfeeding will need to be addressed. It was an easy decision for me to forgo nursing, because my PPD was severe. I remember lactation specialists trying to help me breastfeed, but it was in my best interest for my daughter to be well fed via formula so I could take medication. Furthermore, my husband was able to take over night feedings so I could get the restorative sleep I so desperately needed.
• Psychotherapy: I think it’s crucial to work with a therapist who specializes in Postpartum Depression Related Disorders. While other therapists may understand mood disorders, my recommendation is to work with a trained clinician who knows the evidence based treatments for PPD, has the techniques, and a network of PPD support systems to help you recover.
• Sleep: One of the most important things I tell moms is that they need to create healthy sleeping patterns. Studies show that fractured and interrupted sleep impairs the post-delivery healing process, so setting up a sleeping schedule is extremely important. This is where support from family and friends can work wonders. The more you get restorative sleep, that is, sleep that moves through alpha, beta, delta and theta wave sleep, the more your body and mind heals from PPD. Studies show that Transcranial Magnetic Therapy can help bring about restorative sleep patterns. Listening to Delta-Embedded music can induce sleep too. I recommend downloading Deep Theta Music and suggest you check out composer Steven Halperin.
• Eating: As new moms know, the unpredictable lifestyle that comes with a new baby can make eating nutritional meals tough. When you have Postpartum Depression, it’s important to get healthy food in your day to benefit your mind and body. It’s best to avoid sugar, starches and simple carbohydrates. Instead, stock up on lean protein, foods with Vitamin D, Omega-3 DHA, Vitamin B-12, complex carbohydrates and ancient grains. Indulge in your favorite comfort foods every once in a while, and don't forget to stay hydrated with water. Again, this is where you can call on others to help as you heal from PPD. Ask for family or friends to cook for you, and shop for you, so you can have healthy foods and snacks on hand.
• Sight and Sound: Taking care of a new baby can deplete all your senses. So, make sure you invite natural sunlight into your space. Open the curtains, go for a stroller walk or consider using Bright Light Therapy (BLT) to help offset PPD. It’s recommended to use Bright Light Therapy for 20 to 30 minutes within 10 minutes of when you wake up in the morning. Aromatherapy has been shown to help reduce depressive symptoms in new mothers too. When I was recovering from PPD, I was particularly drawn to essential oils and candles that had a lavender or citrus scents, but choose ones that you find comforting.
• Touch: There are volumes of data showing how interpersonal touch helps reduce depression, lower cortisol and increase the feel-good hormone oxytocin. Holding your baby, your partner or a pet are wonderful ways to get the benefit of touch. If you find yourself feeling disconnected to your baby or your partner, you can look into a more formal kind of touch specifically for moms called Postpartum Massage.
• Exercise: The fatigue of Postpartum Depression and caring for my new baby was far worse than when I experienced depression as a single or married woman. The thought of exercising used to make me laugh, because I could barely get out of bed some days. Instead, I focused on movement. Getting in the shower. Going outside. Short bursts of movement. Slowly, I added more movement to my days, and found that walking with my daughter helped me feel really, really good. On days when I had setbacks, I'd do yoga, simple stretches and poses, as my baby played in her playpen or crawled on her gym mat. I learned that the more I moved, the better I felt. And research supports this too, how exercise significantly reduces stress and depression.
• Education: Read and learn as much as you can about Postpartum Depression. The more educated you become about the biophysical aspects of this illness, the more empowered you’ll feel about your recovery. You can also address stigma and shaming that sometimes comes from others who don’t understand PPD. There are excellent blogs, international websites, and books for you to reference—and a National Postpartum Depression Hotline to reach out to 1-800-PPD-MOMS
• Collaborative Care: In this day and age, getting a team of health professionals to work together regarding your health can feel impossible. Sometimes it takes days to get a message to you doctor or to get a call or email back. Other times you feel like you’re telling the same story over and over to your OBGYN, your primary care physician, your baby’s pediatrician, your psychiatrist, your psychotherapist, and anyone else who is managing your healthcare. This fractured kind of treatment style is not as effective as getting your professionals to talk with each other. Studies tell us that Postpartum Depression improves faster when health professionals work collaboratively. I often take the lead in calling other health team professionals when I work with a mom who has PPD. I check in, go over treatment recommendations, and coordinate care. But you can also ask a family member to be the glue that keeps communication ongoing for your treatment plan. Another way to bolster collaborative care is to attend a Postpartum Depression support group. Being among others who are going through the same experience as you can offer great comfort. It can be a place where you share stories, get advice and learn tips to help you well-being.
• Connect with your partner: For some new moms, it will be easy to talk to your husband or partner about the struggles you’re experiencing, while it may be harder for others. The reason to keep connected to your significant other during your Postpartum Depression has many benefits. First, it strengthens your bond to your partner. Second, it reduces stress and decreases your depressive symptoms. Third, it helps to inoculate your partner from getting Postpartum Depression as well. Studies report that 8% of men can experience Postpartum Paternal Depression and that same sex partners can experience Postpartum Depression.

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Summary

Postpartum Depression affects about 20% of new moms. Early identification, evidence based treatments and holistic supports can minimize the impact of this serious, but treatable mood disorder. I know many moms out there reading this will feel worried their symptoms won’t ever go away, or they may not bond with their babies, or that worse things will loom in the distance. But as a clinician who’s spent over 25 years treating women with PPD, I know that treatment works and recovery comes.

And as a mom, myself, who’s gone through Postpartum Depression, knowing its darkness, its crushing chaos, the numbing detachment and feelings of inadequacy, it will end.

And you will bond with your baby.

And you will feel better.