During the first miserable year after my second son’s birth, I was stuck on a never-ending drive through the Eisenhower Tunnel. Every time light appeared in the distance, the 1.7-mile passage stretched a little longer.
There was powder-day-goodness on the other side, but all I noticed was a dark, disorienting world narrowing in on me.
I’d always been a pretty joyful person. I had bad days, sure, but overall I was upbeat and outgoing. Then my whole personality changed. I felt angry, anxious, and just plain sad. Picture Eeyore, the downtrodden donkey from Winnie-the-Pooh.
Fifteen percent of women will experience depression during the year after childbirth. With one in seven new moms affected, I wasn’t alone, and yet I felt isolated because I didn’t want to talk about my depression with other moms.
Postpartum depression (PPD) is a treatable mood disorder. It’s not the “baby blues”—that self-limited, emotional rollercoaster that causes you to burst into tears three days postpartum for any small mishap.
“Almost all women experience the baby blues,” explains Joyce Gottesfeld, M.D., a Kaiser Permanente Colorado OB-GYN. Two to four weeks postpartum, as hormones stabilize, the tearfulness should dissipate. If it doesn’t, that could be your first indication that something is amiss.
Just like preeclampsia or gestational diabetes, PPD is a complication of pregnancy. “If we start recognizing postpartum depression as a medical condition that can happen after pregnancy, rather than a wrongdoing, maybe we can remove some of the stigma,” says Chutaporn Charnsangavej, M.D., an OB-GYN at Pinnacle Women’s Healthcare. And that’s when the healing can begin.
PPD typically develops four to six weeks postpartum, and moms experience it in various ways.
“It feels like all the joy has been sucked out of our house,” my husband would say during my bout of depression. For months, I had so much bad mojo pent up by 5 o’clock that I’d usually rip into him before he had time to put down his backpack, rattling off an A-to-Z list of everything I hated.
I cried for several hours throughout the day. Sometimes I yelled at my toddler, or squeezed my newborn’s arm too tightly when he wouldn’t go down for a nap. The only thing happening in my bedroom at night was insomnia, but the most embarrassing admission is that I resented my newborn like crazy because he took precious time away from my toddler.
Aside from loss of appetite, I had all the classic symptoms of PPD: intense irritability, insomnia, anxiety, sadness, crying, and difficulty bonding with my baby. Some women with postpartum anxiety develop persistent fears or panic attacks. In extreme cases of depression, moms are at risk of hurting themselves or their babies.
If you have similar symptoms that last every day for more than two weeks, or you’re struggling with everyday tasks, you might be experiencing PPD. I was so caught up in motherhood, I don’t think I realized how bad things were until my son’s six-week-old appointment. I was waiting to see my obstetrician, and my baby was strapped into his carseat, crying. My doctor came in and asked, “How’s it going?” I burst into tears. She said “OK! You wait here. I’m going to get a nurse to walk around with your baby, and we’re going to talk.” When she came back, she asked, “Have you heard about postpartum depression?”
A nurse held my baby while my midwife went over initial treatment options. There was a video to take home to my husband. There were also unanswered questions about how, exactly, I’d gotten so sad.
There is no one thing that causes postpartum depression.
Most experts agree that postpartum depression arises from some combination of hormonal changes, psychological adjustments to motherhood, and fatigue. Gottesfeld says that women with a history of depression or anxiety are at a higher risk for developing PPD. And women who get severe PMS might be more susceptible to the hormonal shifts that happen postpartum, when estrogen and progesterone levels drop drastically.
Young women, and women struggling financially, are more likely to develop depression. Having access to social support is huge: A recent study from the Canadian Medical Association Journal indicates women living in big cities have the highest rates of postpartum depression, largely because they have lower levels of family support.
Most experts believe sleep deprivation plays a role in depression, and other environmental triggers might include trouble breastfeeding, an unplanned C-section, a baby in the NICU, or a fussy baby. “It can also be more surprising to people who are particularly type-A because they aren’t used to feeling that way and they’re not prepared for it,” says Gottesfeld.
To complicate matters further, some men and adoptive parents experience PPD, too.
“Some people have no risk factors at all,” Gottesfeld says. “That’s one of the ways we know there’s a biochemical component.” The big takeaway is that any number of things can lead to PPD. In most cases, it’s multiple issues piling up.
Doctors know that early intervention is important, but moms feel like it can be hard to get help.
I learned from Facebook that the birth of a child is a time of constant joy and great hair days. Imagine how I felt when the reality of stool softeners and sitz baths set in. When I didn’t look or feel like all the other happy moms I saw online, I didn’t want to let on that I was different because I feared people would think I was a bad mom. I was so good at hiding my depression that I think most people who knew me at the time, including my parents, would be shocked to hear how sad I was.
“A new mother might feel some shame that she’s not as happy as she should be or isn’t feeling the way she thinks she should feel,” Gottesfeld says. That’s one reason many moms don’t seek help. And because the symptoms of postpartum depression are broad, it can be difficult to achieve a diagnosis.
“Your OB-GYN should screen for depression at your six-week postpartum visit, with a verbal questionnaire, a written test, or observation,” Charnsangavej says. In addition to using typical screening tools such as the GAD-7 and PHQ-9 questionnaires, Gottesfeld asks her patients, “Do you like your baby?” and “Are you having fun with your baby?” The questions often spark a longer conversation. Pediatricians, spouses, partners, grandparents, and siblings can all serve as resources for new moms to help identify depression.
There are several treatment options for PPD.
“If it’s not an emergency, I feel comfortable referring patients to behavioral medicine specialists to make a plan that can involve therapy and possibly medication,” Gottesfeld says.
“There are medications that are acceptable for breastfeeding, and many patients are able to get off their medication after a few months,” says Charnsangavej.
For a variety of reasons, I was opposed to medication, so my provider and I hashed out a plan that involved psychotherapy, also known as talk therapy; lifestyle changes, like getting out of the house daily; and carving out regular time for exercise and self-care.
“Talk therapy is helpful, but it’s a personal and practical decision as to whether a new mom has time for it,” Charnsangavej points out. She’s right: I spent two hours with a therapist every week for six months. It was time consuming and expensive.
Moms with depression should evaluate their household needs. Can you afford to hire a cleaning service, or a postpartum doula to help with chores, errands, and childcare? If the answer is yes, do it, and don’t look back. You’re not less of a mom because you have support.
Other moms might be the best resource of all.
Through the Alma program at Kaiser clinics, mothers who previously experienced postpartum depression are being trained in behavioral activation, a component of cognitive behavioral therapy, so they can support new moms during the postpartum period. Mom-mentors meet with new parents via videoconference, an offering inspired by moms who voiced a need for flexible counseling while they juggled the demands of work and older children.
During the program’s pilot and test phases, three mom-mentors have worked with 37 new moms. Researchers are seeing positive results, says Arne Beck, Ph.D., a senior investigator at Kaiser Permanente Colorado’s Institute for Health Research.
Researchers at the Renée Crown Wellness Institute and community partners are working hard to expand access to the Alma peer-mentor program to support moms across Colorado. “Women who experienced depression in early parenting had an incredible sense of dedication, and were eager to support other moms,” says Sona Dimidjian, a professor in the Department of Psychology and Neuroscience at the University of Colorado Boulder and director of the Renée Crown Wellness Institute.
By the way, your depression isn’t going to ruin your child forever.
Take a deep breath, and repeat after me: Kids are resilient. “The truth is, even babies isolated in the NICU don’t show any emotional deficits long-term,” says Charnsangavej. If mom is feeling sad, ask partners, spouses, grandparents, or neighbors—whoever you trust that might be available—to help during the initial postpartum bonding period.
When a mom gets treatment, the outlook is positive, and PPD is usually resolved within a year. Women who don’t get treatment are at greater risk of developing major depression later in life.
My depression lasted nine months, and it was a lot of work maintaining a treatment plan, carving out time for self-care, learning to ask for help, and letting go of the guilt. Eight years later, my baby and toddler have become well-adjusted boys, and somehow I’m still married. After so much sadness, there I was, driving into the daylight, finally leaving my tunnel in the dust.