"This is supposed to be the happiest time of my life, but I'm miserable."
"I feel so sad, I can't enjoy things the way I used to, not even my baby."
"I feel like a failure as a mom. I can't do anything right."
"I am so irritable. I yell at my husband all the time. I can't help myself."
These are some of the common feelings women who experience Postpartum Depression (PPD) have shared. Although some women are at higher risk of having PPD, it often strikes without warning in women without a history of Depression or anxiety. It can present itself early on or months into the postpartum period, which is defined within the first year. PPD can strike a new mom after the first baby or a mom who never had a history of it with previous births, but now finds herself debilitated by PPD with a second, third or fourth birth.
Sometimes symptoms can occur during pregnancy. Approximately 1 out of 10 women experience Depression during pregnancy.
"I can't stop crying." "My memory is gone. I can't concentrate on anything." "I can't remember the last time I had more than a few uninterrupted hours of sleep. I'm so tired and have no energy." Postpartum Depression is not the same as Baby Blues. 85% of postpartum women experience what is referred to as the Baby Blues, which can begin when the milk comes in and can last anywhere between 1 day and 2 - 3 weeks. Symptoms include weepiness, feeling tired, and irritability. Baby Blues are triggered by dramatic hormonal changes, loss of sleep and the initial period of adjustment. It does not require treatment and usually goes away by itself.
Nearly 1 out of 10 women experience major or minor Postpartum Depression following childbirth. "I feel anxious all the time. I can't even sleep when my baby is sleeping." "I just lay there in bed and all of these awful thoughts are racing through my head. They won't go away." Postpartum Depression is an anxiety-ridden Depression. If Baby Blues persists beyond 3 weeks, you should be evaluated for Postpartum Depression. PPD can be diagnosed up through the first postpartum year.
The symptoms of PPD range from mild to severe. Symptoms can be experienced both physically and emotionally. Some of the more prominent symptoms of PPD, include:
"I feel like my husband and baby would be better off without me." In more severe cases, suicidality is not uncommon and must be treated immediately, including hospitalization and/or antidepressant medication. You should not be left alone.
Multiple factors are believed to contribute to Postpartum Depression. Chronic sleep deprivation severely affects mood and stability. In fact, symptoms from chronic sleep deprivation are similar to those of clinical Depression. Other factors include genetic predisposition, colicky, hard-to-care-for babies, breastfeeding difficulties, dramatic hormonal changes, medical complications, either mother or infant, previous PPD or other types of clinical Depression, absence of support from family or friends, relationship conflicts, isolation and psychosocial stressors such as illness, grief and loss, moving and financial burdens. Actual traumatic pregnancy and labor, as well as the mother's perception of the pregnancy and birth as being traumatic, also impact her mental state.
"I see all these other new moms and they seem so happy and put together. It makes me feel like something is terribly wrong with me. I stopped going to the new moms group."
Signs of PPD can often be missed because of societal expectations, which can lead to enormous shame that often prevents women from revealing how they really feel. In fact, because of this, severe cases are easier to identify and treat than mild to moderate cases, which may be overlooked by family, friends and healthcare providers. Left untreated, it could get better on its own, but more likely, symptoms can worsen. The mother-baby relationship is at risk. At the extremes of PPD, the mother may disconnect completely or have over-attachment to her baby. Either scenario causes stress for the baby. Postpartum Depression is a family illness. The mother-infant relationship suffers as does the marital/partner relationship. Treatment can help repair these early relationship disruptions.
"I'm so afraid that this will never end and I'll be like this forever. I can hardly remember the way I used to be." The most important piece of information for a woman whose identity becomes that of an inadequate, bad mother, who may even believe that her baby and partner would be better off without her, is to know that PPD is not a sign of weakness or failure. It is a biological and psychological condition. IT IS TREATABLE, YOU WILL GET BETTER, YOU DID NOTHING WRONG AND IT IS NOT YOUR FAULT.
"I can barely make it out of bed some days. The house is a mess. I can't get myself to do anything." If you have symptoms that persist and begin to interfere with daily function, you may first start by talking to your husband or partner, family member or close friend. They can help support you by listening, reassuring, giving you time for breaks, meal preparation and caring for the baby. But ultimately, you need to see your healthcare provider with whom you feel most comfortable, whether it be your psychotherapist, if you have an ongoing relationship with one, your gynecologist/obstetrician, primary care physician or pediatrician. You may be referred to a specialist.
Treatment includes a variety of options, depending on the frequency, intensity and duration of the symptoms. Psychotherapy, psychopharmacology and support groups are major treatment components. Counseling often includes at least one meeting with the partner. In some cases, couples counseling is recommended after the immediate crisis has been resolved in order to better understand each others' views and needs. Whenever possible, mothers are encouraged to bring their baby to the individual as well as group meetings. Another effective treatment consists of parent-infant psychotherapy, where parents are helped to better understand and respond to their baby's developmental cues and communications.
"Until now, I didn't think anyone else could understand what I've been going through."
Support groups are very effective in helping new moms with PPD understand that they are not alone in their suffering. Groups help to normalize their experiences and provide validation, support and structure. "Leaving the isolation of my house, and just showing up for group every week makes me feel better."
Topics that most often arise in individual therapy or groups are the multiple losses that new moms experience. "I feel like I don't have any structure or control in my life."
"I don't know who I am anymore. How do I define myself?" The adjustment and life transition to motherhood creates a sense of loss of identity. New mothers may long for the life they had before the baby arrived. Other losses include no longer being pregnant and loss of just the two of us in relationship.
"I gained so much weight. I've never looked like this. It feels like someone else is looking back at me from the mirror." Personal as well as social pressure to lose weight fosters poor body image. This contributes to a devalued sense of self, which further escalates symptoms of Depression.
Many moms who experience PPD also grieve for the loss of quality time with their babies that they cannot recapture. There also exists a loss of expectations versus reality, of dreams and fantasies about how the baby will look, his temperament, the maternal-infant relationship and the reality of what actually is. For many women who planned to breast-feed, there is an enormous sense of loss and inadequacy if they are unable to do so. Most new mothers also begin to explore how they themselves were mothered, what needs were met, what needs were not met, what they would like to model and what they would not repeat in their own mothering style.
"I feel like I'm getting pieces of my old self back again. My husband even said that my sense of humor is back." Although every individual case is unique, you should expect noticeable improvement within eight weeks of therapy and decrease or resolution in symptoms within twelve weeks. This time frame may vary, depending on external factors and severity of symptoms. Resolution of the acute symptoms refers to the relief from the symptoms that cause interference with daily living, and does not signify the end of treatment. Especially in the case of medication, although you may begin to feel better after the medications begin to take effect, it is important for you to remain in treatment during this time in order to avoid regression and to be able to make meaning of your experience in ways that are difficult to do while in a state of crisis.
It cannot be emphasized enough that Postpartum Depression is treatable. The sooner it is recognized and you get help and support, the less time the symptoms have to gain power and momentum and the sooner recovery can begin when you can take pleasure and joy in bonding with your baby.