This guide was originally published on June 10, 2019 in NYT Parenting.
I have a history of depression, so in the weeks following the births of both of my children, my husband and mother were on high alert for any signs of postpartum depression. Not to be confused with the “baby blues” — or the feelings of worry, unhappiness and fatigue that up to 80 percent of women experience in the first weeks after giving birth — postpartum depression is a serious mental health issue that affects an estimated 10 to 20 percent of new mothers. Its symptoms include frequent crying, trouble sleeping and feeling sad, hopeless, overwhelmed, guilty, angry or disconnected from others, including your new baby.
Unlike the “baby blues,” which typically clear up on their own after a few days, postpartum depression can last for anywhere from a few months to several years.
I didn’t have postpartum depression with my first child, but because I closely monitored my symptoms with my second, I knew that I needed help a few weeks after his birth. Experts agree that recognizing the signs of postpartum depression early is key to effective treatment.
For this guide, I read several scientific studies and spoke with two ob-gyns, a pediatrician and a reproductive psychiatrist to help you understand postpartum depression and how to treat it.
Understand what postpartum depression is — and isn’t.
“The ‘baby blues’ is a normal occurrence, and even when you’re overwhelmed, you feel like you want to be with the baby and bond with the baby,” said Dr. Jen Trachtenberg, M.D., an assistant clinical professor of pediatrics at the Icahn School of Medicine at Mount Sinai in New York City and creator of the parent video guide, “Pediatrician in Your Pocket.”
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“Even though you’re really tired and may not be thinking as clearly, you want to do things and be around other people,” said Dr. Trachtenberg. “There is still pleasure in moments.”
But postpartum depression is different. “When a new mom is crying on a daily basis, when she cannot find joy with her baby, when she isn’t sleeping even if baby is asleep because of unyielding anxiety, or when she has intrusive thoughts consistently or if she has any thoughts of suicide,” said Dr. Carly Snyder, M.D., a reproductive psychiatrist in New York City, “then she is suffering from postpartum depression or postpartum anxiety.”
Dr. Trachtenberg added that women also can develop other mental health conditions postpartum, such as obsessive-compulsive disorder or post-traumatic stress syndrome if their birth experience was traumatic. Postpartum anxiety can also occur alongside postpartum depression and might include symptoms such as panic attacks, insomnia, obsessive fears about your baby’s health and safety, an inability to sit still or physical pain or discomfort, such as frequent headaches or stomachaches.
Recognize the symptoms.
Dr. Alison Stuebe, M.D., an associate professor of maternal-fetal medicine at the University of North Carolina at Chapel Hill and lead author of the American College of Obstetricians and Gynecologists’ recommendations on postpartum care, asks her patients two key questions when determining whether they have postpartum depression: Can they sleep when the baby is sleeping? And are they having any scary thoughts? Moms with severe anxiety, she said, won’t be able to sleep even when they are exhausted. Intrusive thoughts, such as excessive worry about dropping the baby down the stairs or getting into a car accident, can also indicate postpartum depression.
The major symptoms of postpartum depression, according to the Centers for Disease Control and Prevention, include:
Feeling sad, hopeless, overwhelmed, guilty or angry
Feeling numb or disconnected from your baby, not wanting to be around your baby or being worried you will hurt your baby
Feeling incapable of or incompetent at caring for your baby, including feeling guilty about not being “good enough”
Unexplained physical symptoms, such as headaches, nausea and stomachaches
Being unable to find pleasure in any activities or withdrawing from others
Having no energy and having trouble focusing
Experiencing difficulties with sleeping, including being unable to fall asleep
Learn what increases your risk of postpartum depression.
Anyone can develop postpartum depression, but some women have higher odds due to their personal mental health history or social circumstances.
Having one or more of the following risk factors for postpartum depression can increase your likelihood of developing the condition:
Stressful life events, including a traumatic birth
Inadequate social support, including being a single mom or experiencing domestic abuse
Personal or family history of depression
Pregnancy or birth complications, including preterm birth or a baby’s hospitalization
Being a teen mom
Giving birth to twins or triplets
Having had difficulty getting pregnant
Know you’re not alone.
Even though it’s not “normal,” postpartum depression is common. “The most important thing is to let moms know that it does occur and they’re not alone,” Dr. Trachtenberg said. “Often moms have this image that this must be the most beautiful, wonderful time in their lives.” When that image doesn’t match reality, it can become a “cycle that can leave them feeling out of control,” she said. That’s when you need to seek professional help.
Contact a medical professional for treatment.
If your symptoms are severe —if you feel you might harm yourself or your baby, for example — go to an emergency room. Otherwise, contact your ob-gyn, your child’s pediatrician or your primary care provider to seek treatment and a mental health referral. “Sometimes postpartum depression or anxiety can improve over time without intervention,” Dr. Snyder said, “but treatment will speed up the process and allow mom to enjoy her baby and her life now rather than waiting for months or longer.”
Treatment can involve medication, talk therapy, changes in behavior or lifestyle (such as increasing physical activity or taking breaks from your baby), or some combination of the three. Antidepressants, particularly selective serotonin reuptake inhibitors, are the “gold standard” for treating postpartum depression and are safe to take while breastfeeding, Dr. Snyder said.
Another reason to seek treatment: Untreated postpartum depression has been shown to pose long-lasting behavioral and neurodevelopmental risks to a woman’s children. “It can cause marital strife and anxiety for other children in the home who often don’t understand what is wrong but can identify that Mommy isn’t herself,” Dr. Snyder said.
Seek social support and keep yourself physically healthy.
Having a support network that can step in when you and your baby are in need is extremely important, said Dr. Trachtenberg. If you have the option, ask friends and family to help out, or ask your partner to take on additional responsibilities. This also gives you time to exercise, time with friends away from the baby, and time to get the sleep you need to recharge your brain.
In addition to a healthy diet and exercise, Dr. Snyder and Dr. Stuebe both said that the sleep issue is critical: Work with your partner to ensure you can get several blocks of consolidated sleep each day.
When to Worry
“If symptoms last longer than two weeks or if the symptoms impair a woman’s ability to care for herself or her family, this goes beyond typical baby blues and she should seek help,” said Dr. Emily Miller, M.D., an assistant professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine. If you fear you might hurt your baby or yourself and you are alone, call 911 or seek medical care immediately, including going to an emergency room if necessary, Dr. Miller said. If you do not think you will hurt your baby but cannot care for him or her, call a trusted family member or friend.
If you cannot reach anyone or don’t know who to call and it’s not an emergency, call the “warmline,” a help line operated by Postpartum Support International, at 800-944-4773 or text 503-894-9453. Instead of reaching a person right away (as you would at a hotline), you will reach a recording where you can leave a message for a call back from a trained volunteer who can provide support and help connect you with resources in your area. If you need to speak to a person right away, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text the national Crisis Text Line at 741741.
Some women don’t want to tell anyone about their symptoms because they feel ashamed or worry that their child will be taken away. But not getting treatment can lead to serious harm for both you and your child, so seek out a health care professional you already trust, such as your birth provider or primary care provider.
If you lose touch with reality, experience delusions or hallucinations, have serious thoughts of harming your child or become manic or extremely confused, you may have postpartum psychosis. Though postpartum psychosis is rare, affecting an estimated one out of every 2,000 to 4,000 women who give birth, it is considered a medical emergency. Women with a history of psychosis, schizophrenia or bipolar disorder are at higher risk for postpartum psychosis.
Tara Haelle is a health and science journalist, mother and co-author of “The Informed Parent: A Science-Based Resource for Your Child’s First Four Years.”