Postpartum Depression is Not Your Fault

Postpartum depression is not your fault.

Last night as I was settling into my nightly routine and waiting for the late night news broadcast to come on, I caught the tail end of a show. It was one of those candid camera type shows where they set up an unsuspecting person by having actors act out a particular scene in public to see how people react. In the episode that I watched, there was an actress pretending to have symptoms of postpartum depression.

Through tears, she was telling her husband how she was feeling overwhelmed by motherhood. In the public setting of a restaurant, the actor playing the husband then gave a bunch of trite and not helpful comments to his wife. Comments like “look what you have,” “don’t you feel blessed?” “why are you crying so much?” “you wanted to be a mother.”

He then left to go to the restroom and the scene was set for everyone else in the restaurant to respond to this obviously hurting woman. Their helpful comments ranged from “this is not your fault” to ” I would love to help you to find some help, here is my number.”

After watching these scenes unfold, I had mixed emotions. On one hand, it restored some of my faith in humanity. On the other, it triggered deep emotions within me of a time where I battled those awful feelings myself.

In this article, we are going to look at the signs and symptoms of postpartum depression and how to find the help that you may need.

Symptoms of Postpartum Depression

In medicine, we use a manual called the diagnostic and statistical manual of mental disorders or DSM. It gives physicians and other health care professionals a framework with which to describe mental health disorders. There is a set of criteria for each disorder that helps medical professionals to have a standardized approach to diagnosis and treatment of these conditions.

The DSM defines postpartum depression as an episode of major depression after delivery of a baby. Symptoms occur for at least two weeks or more and include persistent depressed mood plus other symptoms.

Symptoms of depression include:

• Lack of interest in daily activities or unable to find pleasure in things you once enjoyed
• Significant increase in appetite or loss of appetite
• Difficulty with sleep or sleeping more than usual
• Moving slower than normal or agitation
• Loss of energy or fatigue
• Feeling worthless or guilty

How is postnatal depression different from “baby blues”?

Baby blues are normal transitional feelings of sadness or increased tearfullness in the early days after having a baby. They may be more pronounced if you are navigating motherhood for the first time. A main reason for these feelings are that there is a precipitous shift in your hormones after delivery of a new baby. Your levels of estrogen as well as progesterone experience a rapid drop over the first four days postpartum.

This shift plus navigating the newness of motherhood can leave you feeling tired and sad. However, if those feelings last longer than a couple of weeks and are accompanied by other symptoms listed above, it is wise to be evaluated by a health care provider for postpartum depression.

What are the signs of postpartum depression?

Now that we know the symptoms of postpartum depression, let’s look at some of the signs of depression that may be creeping up on you. If you find yourself fighting any of these feelings, please seek the help of a mental health provider to help you sort through your feelings.

1. Your initial feelings of sadness or postpartum blues just aren’t getting better.  If you have made it to your baby’s second week of life and you can’t shake those sad feelings, you might have postnatal depression.
2. Your thoughts are consumed by guilt. Bad days are common in the early weeks of motherhood, but if you are constantly feeling “down on yourself” or guilty that you are not a good mother, this could be a sign of depression.
3. Your interest in things and activities in minimal.  Do you find yourself chuckling at your go-to romantic comedy anymore? Does the idea of being affectionate with your partner leave you feeling dread? And what about your favorite dishes—are they still bringing you joy? Or perhaps you’ve lost your appetite altogether? If any of these resonate with you, it might be time to have a conversation with your doctor about these shifts in mood and behaviors.
4. You could care less about everyday decisions. Feeling exhausted and mentally drained? Perhaps you’re finding it hard to muster up care or motivation. Do daily tasks feel like monumental chores? When even simple decisions like getting out of bed, showering, changing your baby’s diaper, or taking a walk feel overwhelming, these could be early indicators of postpartum depression.

Additional signs of postpartum depression

1. You constantly worry that you are a bad parent. It is normal to have this thought every once in a while. All mothers worry about being good at this most important job. However, if you are consumed with this worry day and night, you may have postnatal depression.
2. You are not sleeping well or all you want to do is sleep. Of course your sleep pattern is going to be different with a new baby in the house. However, if this change in interfering with your ability to parent your little one, your lack of sleep may be the sign of a mood disorder.
3. You’ve had additional stress in your life. Have tensions been rising with your partner lately? Maybe your family’s support in caring for your baby has been lacking. Or, you could still be grieving the loss of a loved one. These challenging situations can exacerbate feelings of sadness and potentially trigger postpartum depression symptoms.
4. You have thoughts of harming yourself or your baby. Suicidal thoughts are a big red flag sign of untreated postpartum depression. Rarely, mothers with a risk of depression can have symptoms that alternate between depressive episodes and manic (or extremely happy) episodes. These dramatic mood swings can be a sign of bipolar disorder. If you’re having any kind of suicidal thoughts, you’re in crisis and need to call your doctor or the National Suicide Prevention Lifeline at 800-273-8255 immediately to get help.

What is postpartum psychosis?

Postpartum psychosis is a much more severe form of postpartum depression. Additionally, it is rare but potentially deadly. Women with postpartum psychosis have lost touch with reality. They often have extreme anxiety, confusion and agitation, hallucinations and / or delusional thoughts. These are oftentimes mothers who have homicidal thoughts towards their children as well as the desire to harm themselves.

This severe form of postnatal depression is a medical condition that requires immediate attention. Children of mothers with this condition are at great risk for harm or even death. Additionally, the mother herself if at risk. These psychotic symptoms should be considered a psychiatric emergency.

Risks of postpartum depression

There are many risk factors for postpartum depression:

• Lack of social support
• Stressful life events or recent life-changing event
• Victim of domestic violence
• Previous history of depression
• Family history of depression
• History of postpartum depression with previous pregnancy
• Difficultly becoming pregnant
• Mothering twins or multiples
• Preterm labor and delivery
• Birth or pregnancy complications

Treatment for Postpartum Depression

Often women will choose a combination of therapy with both psychotherapy and medications. Some women will choose one or the other. Breastfeeding mothers might worry about medication safety and breastfeeding.

Psychotherapy

There are many modalities in which women with postpartum depression can employ in order to feel better. Talk therapy is the cornerstone of treatment for depressive as well as anxiety disorders. There are different types of mental health counseling that can be helpful, depending on your symptoms and your health history.

Cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy are some examples of therapy approaches that can be effective in treating postpartum depression. These therapies aim to help women identify and change negative thought patterns, improve communication and relationships, and explore underlying emotional issues.

Medications to Balance Brain Chemicals

There are certain chemicals in the brain that are low in people with depression. The medications that we often use as healthcare professionals act to increase these brain chemicals. One of the most commonly used class of medications for depression is the selective serotonin reuptake inhibitors. These medications are commonly known as SSRIs and they work by blocking the reabsorption of serotonin in the brain. This will increase serotonin levels and improve communication between nerve cells. Serotonin is a chemical messenger that carries signals between nerve cells

Generally, SSRI these medications are safe and have minimal side effects.

Are medications safe for breastfeeding?

Yes, these medications are safe for breastfeeding mothers. There is some risk of the baby getting some of the dose through the breast milk, but it is often minimal.

How can I find help for perinatal depression?

There are many resources to help your with perinatal depression. There are online resources through SAMHSA. Additionally, you can reach out to your obstetrician or family medicine doctor for help. There are other health care providers or mental health professional that can help as well. Often your OB will have a list of resources. Please don’t wait until your 6 week postpartum visit to discuss your feelings with your OB or find out your treatment options. If you are having feelings of depression, find help sooner rather than later.

At 127 Pediatrics, our goal is to help postpartum women to succeed at motherhood. While the topic of postpartum depression is not a fun thing to discuss, it is important to know that you are not alone. If you are looking for additional resources, we would love the have you on our email list.

© 127 Pediatrics, March 2024

This article is for information purposes only. Please consult your own physician for medical advice.