Postpartum Depression: Symptoms, Treatment and When to Get Help
Postpartum Depression and Postpartum Anxiety: Symptoms, Resources & Support
May 15, 2020

Postpartum Depression and Postpartum Anxiety: Symptoms, Resources & Support

Postpartum Depression and Postpartum Anxiety: Symptoms, Resources & Support

Physical, hormonal and emotional changes are a common and often expected part of postpartum recovery. Many new parents—as many as 80% of mothers who have given birth—report feeling sad, upset or overwhelmed, and that typically lasts for the first two to three weeks after having a new baby.

But what if those feelings are intense or become debilitating? What if they stick around longer than a few weeks, or show up after you thought you were out of the tough newborn phase? That could mean you’re experiencing something more serious than the “baby blues.” We talked with clinical psychologist and perinatal mental health expert Dr. Shoshana Bennett (Dr. Shosh) about postpartum depression and postpartum anxiety and what new parents can do if they’re in need of postpartum mental health support.

If you or a loved one have a new baby at home and are experiencing persistent feelings of sadness, anger, anxiety, emotional numbness or any other concerning emotions, be sure to talk to your healthcare provider about postpartum depression.

What is postpartum depression?

WebMD defines postpartum depression as “a severe form of clinical depression related to pregnancy and childbirth.” Postpartum depression, often abbreviated as PPD, is one of six perinatal mood and anxiety disorders that have been identified for research and treatment. PPD is the most common of those disorders—as many as one in five people (15–20%) will experience postpartum mood disorder symptoms.

In fact, “PPD is the most common complication of childbirth,” says Dr. Shosh. Based on averages in the US, more pregnant and postnatal people experience postpartum depression symptoms than any other perinatal complication, including gestational diabetes and preeclampsia.

Signs and symptoms of postpartum depression and anxiety

The symptoms of postpartum depression, as well as symptoms of postpartum anxiety (another very common perinatal mood disorder), are essentially the same as the symptoms of general depression and anxiety, with the inclusion of fears and anxieties about a new baby. The most common symptoms include:

  • Excessive sadness and/or crying
  • Outbursts of anger
  • Severe mood swings
  • Feeling anxious or having panic attacks
  • Thoughts of self-harm or harming your baby
  • Fear that you might harm your baby, either accidentally or intentionally
  • Feeling overwhelmed by even the simplest, easiest things like washing the dishes
  • Emotional numbness or feeling “unplugged,” withdrawn or isolated (from people in general, not necessarily just from your new baby)
  • Feeling like you’re not a good parent, having low self-esteem and/or taking your baby’s behavior personally (thinking things like “my baby doesn’t like me,” “my baby doesn’t take my milk”)
  • Trouble sleeping (even when baby is sleeping)
  • Loss of appetite

What is the difference between postpartum depression and postpartum anxiety?

Postpartum depression and postpartum anxiety are the two most commonly occurring perinatal mood disorders, and since their symptoms often overlap, they can seem like the same disorder (they’re often lumped together as PPD/PPA). What you and your healthcare provider call it depends on which of the symptoms you identify with. Some women identify much more with depression symptoms (sadness, numbness, low self-esteem and loss of appetite, among others) even though they also might be experiencing some anxiety symptoms.

Other women don’t experience as much of the depression symptoms—they don’t feel numb and they’re very productive, but they’re highly anxious, and worry about seemingly everything. So when the symptoms are manifesting more as anxiety, it’s most likely PPA, and when the symptoms are more like depression, it’s PPD. It depends on what’s affecting you the very most.

Is postpartum depression different from the “baby blues”?

As an expecting parent or a parent with a newborn, you’ll likely hear the term “baby blues” fairly often. This refers to a very mild emotional reaction to childbirth; you may be a bit stressed, teary or more dependent on others.

The baby blues are more of a time of adjustment, says Dr. Shosh, with mild mood ups and downs that don’t interrupt your sleep (the sleep interruptions are when baby wakes), and they typically last about two weeks after giving birth. After that two-week transition period of adjusting to a new schedule, a new person and a new role as a parent, the “blues” start to feel less overwhelming and your overall mood feels happier and calmer. Essentially, the baby blues are mild and transient.

The baby blues and postpartum depression are differentiated by severity. If your symptoms are severe enough to get in the way of your daily functioning, it’s more likely that you’re experiencing PPD. The onset of PPD can overlap the baby blues, and can happen as soon as immediately after your little one arrives or as far out as up to a year afterward. While the baby blues only last a few weeks at most, postpartum depression symptoms can continue indefinitely.

Who can get postpartum depression?

Any new parent can experience postpartum depression and anxiety symptoms, though the vast majority of PPD/PPA sufferers are women who have given birth (we’ll talk more about PPD in partners later). There doesn’t appear to be much difference in the rate of postpartum depression in women who had a vaginal delivery versus a scheduled C-section using local anesthesia. However, women who require an emergency C-section or receive general anesthesia are more likely to experience PPD or PPA.

What causes postpartum depression and when does it start?

For women who experience postpartum depression after pregnancy, the cause is sometimes attributed to the rapid change in reproductive hormones immediately following baby’s birth. However, there are other factors that can further increase the risk of PPD/PPA:

  • Sleep deprivation
  • Lack of self-care, such as not eating well, putting baby’s needs before your own and having a mentality of “I don’t matter anymore”
  • Lack of social support and/or lack of partner support
  • Past trauma

Keeping all these factors in mind, Dr. Shosh emphasizes that “no [one] thing should be associated with PPD. It doesn’t mean you’re not ready to be a parent. It happens to the best of us. [Postpartum depression] does not discriminate.”

Postpartum mood disorders can begin at any point after giving birth, from the moment the baby is born to up to a year later. Dr Shosh says she experienced postpartum depression symptoms as soon as she delivered the placenta; almost instantaneously, her mood dropped. It can start that quickly.

Keep in mind: Mental health disorders are more likely to surface during vulnerable times, so it’s important to mention to your perinatal healthcare provider (ob-gyn, doula, etc.) if you have a personal or family history of mental health concerns.

Can men or partners get it?

Any parent can get depressed in the postpartum stage. While research on PPD in partners specifically targets male partners (sometimes known as paternal postnatal depression, or PPND), study results can apply to all partners, regardless of gender.

So what’s the likelihood of your partner experiencing postpartum depression symptoms? Studies have found that if the mother isn’t experiencing PPD, then the chances of her partner having PPD is about one in ten. This is a big life change for both parents, so it’s important for partners to check in with themselves and acknowledge if they’re experiencing any PPD symptoms. If the mother gets postpartum depression and her partner doesn’t seek their own treatment, the risk of the partner experiencing severe symptoms shoots up to 24–50%.

In her own perinatal mental health practice, Dr. Shosh brings the partner in during the second or third session to make sure the partner is getting their own help. If they haven’t received their own emotional support during the mother’s illness, the partner’s mood can fall while the mother starts to recover. Dr. Shosh also emphasizes that it’s important for the entire family that each parent gets help.

What should someone do if they’re experiencing postpartum depression-like symptoms?

If you’re feeling excessively overwhelmed, upset, anxious or withdrawn from your baby, one of the most important things you can do is talk to your healthcare provider about your symptoms and get screened for postpartum mood disorders.

“If you feel you might be suffering,” Dr. Shosh advises, “the most loving, wise, responsible thing to do is to get help right away. Babies need a happy, healthy parent.”

Your provider should be there to support you and help you have an honest conversation about how you’re feeling. It can be difficult and maybe a little awkward to talk about for a number of reasons; you may not feel comfortable talking about how you’re feeling, or you may be worried about people thinking that you don’t love your baby. But the only way to get the help you need is to be honest with your doctor—and forgiving with yourself.

You’ll want to find an expert in perinatal mental health, too (your doctor can help you find one). They’ll be better equipped not only to treat postpartum depression and anxiety, but also to provide resources for information and support for both you and your loved ones. It’s totally okay to be picky and shop around for the right specialist for your personality, your lifestyle and your needs.

While it may seem hard to do anything when you’re feeling withdrawn and not interested in the things you usually find joy in, try your best to focus on yourself, even if that means taking just a few minutes to yourself every day. Things like light exercise, eating well and spending some time outside aren’t just good for your physical health—they’re good for your mental health too. Another key part of doing things for yourself is keeping in touch with loved ones. A phone call to your mom, sister, best friend or whoever makes you feel the most supported can help you feel less isolated.

Managing postpartum depression during the COVID-19 pandemic

With everything going on due to the COVID-19 outbreak, we understand how helpful any extra advice and support can be. We asked Dr. Shosh how parents with postpartum depression can best manage their symptoms during this difficult time:

“It’s tough enough to parent through this pandemic,” says Dr. Shosh, “let alone with the extra layer of PPD. If you are co-parenting or have other parenting help in your home, take advantage of the time that another adult is watching your child(ren).

“‘Cocooning” is a term I use for being by yourself in a nurturing way; curling up cozily with a book, TV, your dog or something else comforting. However, if you are constantly withdrawing socially due to PPD, that’s different. Push through that feeling once a day even for a short time. Make yourself answer an email, text or have a real conversation with a support person. Don’t let the PPD be in charge—this can actually lead to more depression.

“As much as possible, don’t talk to others about illness, including PPD and the virus. Instead, talk about normal life things. PPD is like wearing a pair of distorted lenses that allows the negative to enter and often blocks the positive. Now more than ever, try to control your environment by tuning out the news and surrounding yourself with as much upbeat activity as you can—especially if you’re not in the mood (that means you need it more than ever). For instance, turn on fun music, talk with positive, happy people and guide the conversation away from what brings you down. There is more happening than illness in the world and in your personal life! Some suggestions are to focus on what you’re looking forward to doing once your area opens up, a good movie you watched recently or a funny thing your toddler said.

“It can be extra challenging to have structure these days with our work and children. Do your best to set a regular wake-up and sleep time. Make sure you take a shower, get dressed and have a very short list of tasks to accomplish each day and include something for yourself. If you’re very depressed, make that list extremely simple to ensure success.

“Nibble around every three hours, regardless of if you’re hungry (protein along with a good carb is usually best). Often, especially if anxiety is present, we lose our appetites. Remember that your brain needs food on a regular basis—it’s not about your tummy.

“If you’re not already working with a perinatal specialist, don’t wait another day! Make full use of the lockdown for your healing. Many perinatal therapists and coaches are working virtually these days, which makes it even easier to get the right help.”

How is postpartum depression treated?

While seeking treatment for postpartum depression is extremely important, there isn’t one specific tried-and-true treatment; the same treatment won’t be appropriate for every person. Since different people have different factors that can trigger their PPD symptoms, individualized treatment plans are key.

So what treatment plans are available? PPD treatment typically involves therapy, medication, alternative methods or a combination. If you see a physician for postpartum depression screening and treatment, they’ll likely write a prescription and also recommend that you see a therapist and have a treatment plan first before getting the prescription filled.

If you’re nervous about taking medication as part of your PPD treatment, let your provider know any reservations you have, and discuss therapy as an option. Therapy is sometimes all that is required for recovery. And know that not everyone needs traditional therapy as a treatment; sometimes coaching and guidance can help.

The most important thing is to talk to someone as soon as possible. “This is nothing to be afraid of,” Dr. Shosh assures. “PPD is 100% treatable. And the quicker you jump on it, the better the prognosis. There’s nothing to be ashamed of, just go get help.”

Keep in mind: If you were taking an antidepressant before getting pregnant, your doctor may recommend continuing your medication treatment throughout pregnancy and into the postpartum period to reduce the risk of postpartum depression, as stopping your medication during pregnancy sometimes can lead to a relapse of depression symptoms

How long can postpartum depression and treatment last?

If you or a loved one is experiencing PPD symptoms, one of the main things on your mind might be “How long will this last?” Unfortunately, there’s no clear evidence of how long postpartum mood disorders actually stick around, and it’s not going to be the same recovery period for everyone. While many people report feeling lessened symptoms or even full recovery after three to six months, others have said their feelings of depression or anxiety lasted anywhere from six months to three years after having a new baby, especially if proper help with a specialist was not received.

Once you’re seeking treatment, keep in mind that each specialist works differently, so there’s no typical timeline for recovery or treatment. Many physicians and therapists treating PPD/PPA will work quickly to get parents feeling better as soon as possible. Their focus is on short-term therapy for people in crisis.

But if you have a longer-term history of mental health concerns or if the short-term treatment uncovers deeper issues, then a longer treatment timeline (multiple years, for example) may be necessary.

It’s important to note that, if left untreated, PPD doesn’t necessarily go away on its own; it can sometimes turn into longer-term depression.

Resources for Postpartum Depression and Anxiety

Having access to resources is an important part of learning about postpartum depression and anxiety, finding support and seeking appropriate treatment. Luckily, there are numerous qualified organizations out there that can help. Here are a few of our favorite PPD-specific websites and books to consider:

As you go through the overwhelming, seemingly endless challenge of postpartum depression and anxiety, there’s one thing we hope you’ll continuously keep in mind: You are not alone, and through loved ones, support groups and mental health professionals, you’ll get through it.

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