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Depression

If a Therapist Can’t Find Help, Who Can?

Treating postpartum depression.

Key points

  • Postpartum depression is common. It's OK to not be OK.
  • CBT and IPT are evidence-based therapies for postpartum depression, but can be hard to access when needed.
  • Even with a Ph.D. in psychology, insurance, connections, and living in a major city, I ran into many roadblocks in my search for care.
  • The Momnibus Act aims to address the maternal health care crisis, particularly for mothers from marginalized communities.

As a psychologist, I have spent more than a decade treating depression and anxiety in children and adults. Yet, even with a Ph.D. in psychology, I couldn’t find therapy help when I needed it after I had my second baby during a worldwide pandemic.

The latest March of Dimes report shows that the U.S. is still one of the most dangerous developed nations for childbirth—especially for communities of color.

For those who survive and need support after birth, those in marginalized communities often are expected to find evidence-based mental health care but do not know how to do that.

Following the birth of my second daughter—an intentional pregnancy that occurred after multiple early miscarriages, invasive fertility testing, and surgery to remove a uterine polyp—I realized that I was depressed.

This may seem odd, as I had two healthy girls, a supportive spouse, and my career was progressing. I had all the things I’d always wanted, and a lot of chips stacked in my corner. So, I questioned whether I had postpartum depression.

Maybe I was reacting normally to a variety of circumstances: I was sleep-deprived and nursing around the clock; my beloved toddler was acting out in developmentally appropriate ways; my mom was rapidly deteriorating from her early-onset Alzheimer’s and no longer knows my name, and my spouse works 12-hour days which leads to a lot of solo parenting for me. Add to all that the unprecedented pandemic, climate change causing parts of the world to be literally on fire, and more.

And then I had the thought: “I want this to end.”

Putting on my clinical scientist hat, I pulled up the Edinburgh Postnatal Depression Scale (EPDS), the very questionnaire that tired mothers are handed at their infant’s well-child visits. The EPDS indicated I was depressed. I took a deep breath and thought about what I would say to anyone who listed my symptoms as their own: “Yep, you have postpartum depression.”

About 900,000 Americans who have given birth or had a miscarriage experience postpartum depression each year. Sadly, this number is likely a low estimate, with some experts speculating the numbers are twice as high.

I assumed I should know what to do, especially since I have delivered cognitive-behavioral therapy (CBT), a skills and evidence-based treatment for depression and anxiety (among others), for many years.

Beyond typical symptoms of depression--sleep and appetite changes; feeling sad, down, or irritable; poor concentration--postpartum depression is unique in that people with it are also situationally sleep deprived, experiencing major life and body changes, having intense hormone changes, and are on-call for all the needs of a completely dependent newborn.

I am fortunate to have insurance. I live in a major city full of behavioral health providers. Finding a therapist for postpartum depression should be a breeze. My goal was to receive evidence-based therapy. Both CBT and Interpersonal Therapy [IPT] have been demonstrated through multiple research studies that they help people with postpartum depression have fewer symptoms. I also wanted an assessment as to whether medication might be helpful in addition to therapy.

Searching my insurance provider’s online directory, postpartum depression was not available as a search criterion. As someone who treats depression, I knew this specialization was important; there are factors in postpartum that are unique from general depression.

I called my insurance company. The pain and concern on the other end of the line was notable as I was politely told that the operator used the same search engine I did. My insurance couldn’t point me in a clear direction beyond a list of 2,000+ providers within their system who had checked a box next to the word “depression” for the directory.

After calling friends in the field (some of the smartest, kindest, and connected clinical providers in Chicago), I soon had a list. All were paid out-of-pocket, only accepted a different brand of insurance, or had anticipated waits for months. I called medical centers I have worked in only to be told assertively that all providers had full caseloads and there were no waitlists even available at this point.

Going to the app store on my phone, my search for “postpartum depression” yielded a seemingly never-ending list of apps that would allow me to take the EPDS screener. While I do applaud that this validated measure is easily accessible on the app store, I begrudgingly reminded myself that the great, innovative evidence-based apps that are developed and tested in research studies are hardly ever made publicly available.

To be sure, I saw many links to online support groups; however, that was not what I was looking for, nor was it an evidence-based treatment strategy for postpartum depression. Many sites attempted to normalize the experience of “Baby Blues,” a short-lived experience of mood fluctuations and tearfulness following birth. This was often followed by a warning that if you feel down for more than two weeks, tell your doctor and “get more support!”

Unfortunately, my obstetrician’s office could only refer me to their medical center’s behavioral health program. The nurse who told me about this referral said it would lead me to a waitlist that was at minimum months long.

My story is not unique. While estimates vary, the Centers for Disease Control report that as many as one in five people who have given birth experience postpartum depression. Recent evidence from the National Institutes of Health also suggests that the risk period for postpartum depression is much longer than previously thought—up to years after birth.

Yet, with nearly every privilege imaginable for mental health care, I kept hitting logistical roadblocks. Not to mention that depression is a roadblock in and of itself: symptoms often include lower motivation and the ability to concentrate. If it was this hard for me, it is simply impossible for others.

This impossibility has real consequences. Depression gets in the way of parents taking care of themselves and their children. Children who have parents with depression are negatively impacted in terms of their cognitive, emotional, and physical development—and are more likely to experience depression themselves in their lifetime.

All people who have given birth—particularly Black, Indigenous, and People of Color—need support for access to care. The Black Maternal Health Momnibus Act of 2021 introduced earlier this year is a package composed of 12 bills to comprehensively address the maternal healthcare crisis.

One bill, the Moms Matter Act, aims to improve mental and behavioral health outcomes throughout pregnancy and one year postpartum. On the road to becoming a law, it next needs to pass in the US House of Representatives.

Every new mother needs access to evidence-based mental health care. I am a psychologist who treats depression and I got depressed. It happens and there are no “right” circumstances needed to justify your depression.

For all who have recently given birth: It’s OK to not be OK.

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