‘It’s Not What I Expected:’ The Downward Spiral of Postpartum Depression

At first, you think it’s normal. Maybe it’s just lack of sleep, or the monotony of endless feedings, laundry, and chores. It could be the isolation, the lack of time with your partner. The baby is just one big need-machine, and she doesn’t even smile back yet. You thought it would be more rewarding, more joyful. Sometimes you even resent her and how she has changed everything. You try to accept that this is what your life is like now. You push yourself to get through it. Minutes can seem like hours when the baby cries, and hours drag on into days and weeks. Hey, what day is it anyway? Does it really even matter? Someone tells you that you don’t seem like yourself. You don’t seem to have bounced back. But everyone gets the blues after a baby, don’t they?

Well, yes and no. Many women experience feelings of sadness or mild depression after giving birth, which can last from a day to a week. This is a normal reaction. Levels of the female reproductive hormones, estrogen and progesterone, are ten times higher than normal during pregnancy but drop sharply after delivery. This rapid drop in hormonal levels can trigger the postpartum blues that as many as 50-75% of women experience. Usually this resolves quickly, and despite the stresses of caring for a newborn, most women start to feel like themselves again.

However, about 10-20% of women experience more severe symptoms of depression, occurring any time within the baby’s first year. A woman with postpartum depression may experience any or all of the following: depressed mood, feelings of hopelessness, frequent tearfulness, a sharp increase or decrease in appetite, sleeping difficulties unrelated to sleep disruptions associated with the baby, loss of interest in pleasurable activities, extreme feelings of inadequacy and worthlessness, suicidal thoughts, withdrawal from friends and family, lack of concentration, decreased motivation and energy, feelings of guilt, lack of interest in the baby, worries about the baby’s health, or fears about harming the baby—although women rarely act on these thoughts of harm.

While many women contending with sleepless nights and a crying baby may experience some of these feelings, postpartum depression is marked by its severity and intensity. Women with postpartum depression don’t just feel nervous about caring for a newborn, they feel hopelessly inadequate. They don’t just feel exhausted, they feel a complete lack of energy that isn’t restored even when they get some sleep. They don’t just worry about why the baby may be crying, they become obsessed with the idea that something is seriously wrong.

It is not entirely clear why some women develop postpartum depression while others only briefly experience the baby blues. Some identified risk factors include previous bouts of depression, a history of premenstrual dysphoric disorder, high levels of stress, or a lack of social support. An even more serious disorder, postpartum psychosis, affects approximately one in 1000 women. Symptoms include delusions or hallucinations where the woman may hear voices or think that her baby is evil. Some women with postpartum psychosis may even feel driven to harm their child due to delusional thinking. Again, this disorder is very rare, and distinct from postpartum depression.

If the symptoms of postpartum depression are all too familiar, it is critical that you get the help and support you and your baby deserve. Unfortunately, most women feel tremendous shame over not enjoying the baby enough or not “bouncing back” from their pregnancy. This cycle of shame leads to secrecy, denial, and a further increase in symptoms. In particular, if you have a history of depression, bipolar, or premenstrual dysphoric disorder, it is essential to reduce stress as much as possible and seek out support from others. If you become depressed, it is essential to let family and friends know that you need help. Speak to your health care practitioner about treatment approaches. Antidepressant medication may be useful in combination with individual or couples counseling. Take care of yourself and your child, and get the help you need.

© Copyright 2010 by Gail Post, PhD. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

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