Mental Health 101: Postpartum Depression

August 16, 2016

Motherhood is one of the most important, impactful experiences in a woman’s life. Many will tell you that it’s a time filled with sweeping emotions and an incredible amount of love. But when the emotional connection isn’t what you thought it could be and the mental clouds roll in, some women can feel disconnected from the experience, despondent and depressed. That’s when a mental health expert can be incredibly important, and the diagnosis of postpartum depression can make all the difference for the women who struggle with the condition.

Dr. Elizabeth Fitelson, Assistant Professor of Psychiatry at Columbia University and director of their Women’s Mental Health Program is back to help lend some clinical assistance and education around this mental health diagnosis:

What is postpartum depression?

“Quite simply, postpartum depression is a major depressive episode that happens in the postpartum (post-pregnancy period,) but there are a number of things that make it different from other depressive episodes, even though it’s diagnosed the same way. The symptoms are much the same as major depression: low mood, sadness, an inability to enjoy things—which, in the postpartum period, can include the baby—changes in sleep and appetite, low energy and self-esteem, a sense of worthlessness, sometimes guilty feelings, and in more severe cases, thoughts of death or suicide.

However, in the postpartum period, there are a number of things that make it potentially more serious and also very painful. Depression is always painful, but having depression at a time in your life where you had perhaps anticipated that you might be so happy, or where everyone else is pressuring you to be so joyful when you have this horrible feeling instead makes it particularly traumatizing. You have horrible guilt that you’re not happy, and fears that there must be something wrong with you, that you’re not a good mother because you’re not feeling happy in this moment.

Brooke Shields wrote about this condition beautifully in her book Down Came the Rain. She talks about everything she went through to get pregnant, such as rounds and rounds of in vitro fertilization. She desperately wanted to be a mother, and then she was hit with this severe postpartum depression out of nowhere. I think that’s an important thing to keep in mind. Postpartum depression can happen when the pregnancy is the most desired baby on earth.

There are all sorts of myths and misconceptions about postpartum depression. People get the wrong idea that women with postpartum depression don’t love their baby, that they may hurt their baby; there are all sorts of fears about it and wrong ideas. I can tell you that having postpartum depression doesn’t mean that you don’t love your baby, it doesn’t mean that you’re not a good mother, it doesn’t mean that you didn’t want your baby. All it means is that you’re going through a really difficult illness at this time, and you need help to get through it.”


What causes it?

“As with other types of depression, it’s multifactorial; there are a lot of different causes. If you think along biological causes, there’s a huge hormone shift that happens after the delivery of a baby. The placenta has been making all these hormones that are many times what you would get during a normal period during the pregnancy, and the minute it comes out all those hormones drop down to essentially post-menopausal levels within 48 hours. If you think about how some women feel mood changes before their menstrual period, this is a much higher magnitude swing. So, we do think that in some cases, certainly not all, that hormone shift can spark some of the symptoms of postpartum depression.

That said, it should be noted that probably about half of diagnosed cases actually started during pregnancy. There are many women who have postpartum depression who have had depression at other times in their life, and having a prior major depressive episode does put you at somewhat higher risk of having a postpartum depression, as does having a prior postpartum depression.

Also, things like lack of sleep and pregnancy complications can contribute. Sleep is a major mood stabilizer and natural antidepressant, and it’s in very short supply in the postpartum period. Newborns are notorious disruptors of sleep, and there are many women who struggle with that. Some women who have had difficult deliveries or complications during pregnancy, or the baby may have medical issues or problems, and those are also some risk factors for postpartum depression.

Let’s also not forget that having a baby dramatically changes your life. The postpartum period is a real transition, especially for first-time moms, but even for mothers and parents of multiple kids. Every baby is a new transition and changes the whole family, and it’s a really exciting time. Lack of support is a big risk factor for having postpartum depression, not having a supportive partner or family to help with the baby. I think there is sort of an odd cultural myth about mother and child, that when you have the baby, all of the sudden you should be this completely self-sufficient dyad of mother and child where you can take care of the baby on your own, 100%, and if you can’t, then there’s something wrong with you, whereas in fact, of course not, we didn’t evolve that way. It’s an oddity of our culture, this idea that mothers should be able to anticipate and tend to a child’s needs all on her own. It’s a very isolating vision and, in fact, isolation is a big problem in postpartum depression.

Finally, for other women other risk factors might be previously traumatic experiences such as early childhood abuse or sexual abuse or assault. A lot of those things come back in the perinatal period. As she becomes a mother herself, she may reflect on her own childhood or her parents and whether they protected her or not, and it can be a very painful time for some women who have had trauma in their past. So there are many different things that make the postpartum period a very dynamic time and a time of higher risk for depression for some women.


How do you practice self-care if you have postpartum depression?

When you actually talk to women, there was a study, the most important factors cited by women who had had postpartum depression and recovered were practical and emotional support from their partner and family, with any sort of medical intervention appearing much farther down the list. As I said before, isolation is a big problem in depression in general, particularly postpartum depression. So, reaching out for support, telling someone you trust about how you’re feeling, getting over the shame so you can admit you’re not feeling right is the most important thing.

Also, support groups can be really helpful. It doesn’t have to be specifically for postpartum depression; it can just be meeting other moms, getting together for stroller-cise or just spending time other women. You’ll be surprised once you open up: other women are often willing to share their experience as well. So reaching out is important. Getting practical support is very important.

Please pay attention to your sleep. It’s kind of normal in the first few days not to be able to settle down and sleep, but after a while, the exhaustion will kick in, and when the baby’s sleeping, you should be able to conk out. If you’re not sleeping and getting all the rest you can at that time, this is where having some practical support can be helpful, maybe someone can take the baby for four or five hours overnight so that you can get some solid, continuous hours of sleep. You’d be amazed at how much better people feel when they’re able to get some sleep.

Also, focus on eating nutritiously, particularly if you’re breastfeeding. Feeding yourself is important. Breastfeeding takes an enormous amount of energy, and the baby is literally sucking calories and nutrition out of your body, so you need to pay attention to good nutrition, getting healthy fats and protein. Don’t worry about getting your pre-baby body back right away. You need to take care of yourself, and make sure that your body is getting what it needs.

Exercise does help. You know in the first six weeks, it’s tough, but getting out of the house if at all possible is really important, both to reconnect with the outside world and to move your body to get out of that isolation. It’s physically and mentally very helpful.

I should note that you want to watch your caffeine and alcohol intake at this time. One thing I haven’t talked about is anxiety, which is often a huge part of postpartum depression. In fact, many women who have what we call postpartum depression actually experience anxiety, and it can be very severe and debilitating. There can be a lot of anxious thoughts about the baby, about themselves, and so sometimes women reach for alcohol to help themselves settle down. Sadly, that really can end up backfiring and being harmful. The same thing with caffeine: if you’re exhausted, having a cup of coffee is fine if that helps you, but getting into the cycle of being exhausted and having too much coffee and then exacerbating the problem by not being able to sleep can make your anxiety worse.


How to support someone with postpartum depression

“Be open, non-judgmental, supportive, and acknowledging of what’s going on. Let them know you care, you think she’s a wonderful mother, and that you know she loves her baby even though she’s feeling badly. Try to get her to talk about what’s going on without shutting her down. It’s uncomfortable to hear women talk about how badly they feel, particularly if she isn’t feeling so connected to the baby right away. While depression can get in the way of immediate connection, it doesn’t mean that it won’t happen eventually or that she doesn’t love the baby. It just means depression is getting in the way. So, be open and encouraging, particularly in reaching out for help to other mothers, and/or professional help, even if it’s just her primary care doctor or obstetrician initially so they can make an assessment for the kind support she might need. In terms of professional help, some women are wary (of it,) but there are a lot of different things that help postpartum depression. They’re not automatically going to put on medication, although it can be very helpful for some people, but there are many forms of psychotherapy that can be very helpful for postpartum depression, particularly if it’s mild or moderate. In more severe cases, where we have some concerns about how bad the depression is and any concerns about safety, then, you know, they might need more intensive treatment and perhaps medication.”