Getting Help for Postpartum Depression

Getting Help for Postpartum Depression


Changes in mood and energy level, along with mild feelings of worry, irritability, or anxiety, are common after childbirth. About 80% of those who have just had a baby will experience the baby blues, a mild form of postpartum depression (PPD) that usually goes away after one to three weeks. But as many as one in seven women will experience PPD, which does not always go away without treatment.

It can be hard to talk about this issue. You might think your low mood will go away on its own. You might feel embarrassed or ashamed of being depressed when friends and family tell you how exciting and thrilling it is to have a new baby. You might even feel that there’s something wrong with you. Or you might not be sure what you’re feeling. You might worry people will think you can’t be a good parent if you have depression.

It’s important to know that PPD is common. It is not your fault. The exact causes aren’t known, but it isn’t the result of a choice you made or actions you took during pregnancy or childbirth. People with depression can still be good parents. In many cases, depression improves with treatment.

If you feel sad, hopeless, or worthless for more than a week, or if you have persistent worry, excessive crying, anger, irritability, fatigue, or unexplained pain and these symptoms get worse or affect your day-to-day life, seek help. A doctor can give you a referral to a therapist or counselor, but you can also use the GoodTherapy therapist directory to find a mental health professional in your area.

It can be hard to find time to make a doctor’s appointment with a new baby. It can also be hard to tell other people about depression symptoms, especially thoughts about hurting yourself or your baby. But PPD is serious and could lead to suicide. It’s also treatable, and the support of a professional can help you feel better.

Treatment for Postpartum Depression

People diagnosed with postpartum depression have many treatment options to choose from. Counseling, or talk therapy, is often the recommended treatment. A counselor can help normalize symptoms, answer any questions about PPD, teach coping mechanisms, and explore any issues, past or current, that may be contributing to depression.

Cognitive behavioral therapy (CBT) is commonly recommended. CBT helps people learn to recognize distressing thoughts and reframe them to reduce their impact.

Another type of therapy that can be helpful for some people with PPD is interpersonal therapy. This approach helps people learn to recognize, understand, and address issues in their personal relationships.

Psychodynamic therapy is another treatment that can be helpful. This therapy helps people explore the unconscious thought and behavior patterns that lead to conflict in their lives.

Other depression treatments that can be helpful for PPD include light therapy, yoga therapy, and exercise. However, these are usually used in combination with traditional therapy.

If symptoms don’t improve after several therapy sessions, an antidepressant may be recommended.

Prevention and Self-Care

As a new parent, you are likely very busy caring for a newborn. You may feel guilty or selfish for wanting time for yourself. But it’s important to take care of your needs, too.

Self-care strategies that can help with PPD symptoms include:

  • Sleep. With a newborn, it may not be possible to get the recommended 7-8 hours of sleep each night. But sleep when you can. If you’re having trouble sleeping, talk to your doctor about things that might help.
  • Exercise. Even a daily walk can help. Newborns who are difficult to soothe often fall asleep when they are in motion, so taking the baby out for a walk can help both of you feel better.
  • Avoid overdoing it. Remember that your body may still be recovering from childbirth. Ask for help when you need it. A 2016 study found that practical support from partners and family members was key to recovery from PPD.
  • Eating well. Eat nutritious foods when possible. Depression can cause appetite changes, so you might not feel hungry at all, or you might eat more than usual. Foods and beverages high in sugar, fat, salt, or caffeine can contribute to mood changes. Colorful fruits and vegetables, foods high in omega-3 fatty acids (fish, nuts, and chia seeds), and lean proteins can help improve mood.
  • Connect with yourself. Take time to meditate, write in a journal, or otherwise connect with yourself. Even 15 minutes a day can contribute to improved mood.
  • Connect with others. A quick call to a friend or loved one can help reinforce the fact you aren’t alone. The aforementioned study also found that another key factor in recovery was emotional support from friends.

It’s not possible to predict or prevent PPD, but you can take steps to reduce your risk.

Recognizing PPD early can help keep it from becoming worse. Talking about any symptoms of depression or changes in mood during pregnancy or immediately after childbirth can help. If you have any risk factors for postpartum depression, talk about them with your doctor. Share your concern with your doctor, and keep your doctor informed during pregnancy and after childbirth.

Establish social support during pregnancy. Try to stay connected, even if it’s difficult. A circle of friends, family members, or a pregnancy support group can all offer support.

Medication for Postpartum Depression

Depression can sometimes be resistant to treatment. This may be the case for some people with PPD. If therapy isn’t helping, or if PPD symptoms get worse, your counselor may suggest a referral to a psychiatrist, who can help you explore medication options. An antidepressant, combined with therapy, might be the best treatment option for some. SSRIs are most often prescribed to treat postpartum depression.

Nursing mothers may be concerned about how antidepressants can affect the baby. Psychiatrists can go over the latest research with you and answer questions you have about the side effects of antidepressants. Some studies suggest certain antidepressants may have little risk on infants. Other studies say more research is needed. A doctor can discuss options with you and offer guidance on the best choice for your health.

Postpartum Depression Test

Postpartum depression screening is urged during pregnancy and after childbirth. Some states have passed laws requiring doctors to ask about depression during pregnancy and after childbirth.

Currently, the Edinburgh Postnatal Depression Scale is the screening test used by most medical professionals. Doctors may also ask pregnant patients about their mood and emotional health and follow up at the mother’s first doctor visit after giving birth. But more than half of all PPD cases are not diagnosed.

PPD is not recognized as a separate diagnosis in either the ICD-10 or the DSM-5.

According to the ICD-10, PPD develops within six weeks of childbirth. But medical experts say it can develop anytime within a year after childbirth. If six weeks after childbirth is considered the cutoff period, PPD that develops after this time frame may not be recognized.

Postpartum depression quizzes and The Edinburgh Postnatal Depression Scale can be viewed online. Some of these tests take only a few minutes to complete, and while they can’t give you a diagnosis, they can help you identify PPD symptoms and let you know it may be time to seek help.

Another screening tool, developed by researchers at Massachusetts General Hospital, is available as a smartphone app. This test, the MGH Perinatal Depression Scale, has just 10 questions and may be more accessible to many.

Case Examples of Therapy for Postpartum Depression

  • Getting help for non-depressive postpartum symptoms: Eleanor, 40, is a first-time mother. She worried her age might affect her baby’s health, but when he was born in perfect health, she was overjoyed. During the first four weeks after childbirth, Eleanor is tired but happy. During the fifth week, the baby begins to sleep for longer periods of time, but Eleanor finds it difficult to sleep and often wakes up worrying the doctors missed a genetic condition or birth defect in her son, or that he has died in the night. She goes to his room again and again to check on him. Her partner tells her not to worry so much. As the days pass, Eleanor becomes more and more restless. She can’t focus and often forgets what she is doing. She worries something will happen to the baby if she puts him down. When her partner tells her that he’ll be fine, she snaps at her and then cries uncontrollably. This continues for three weeks, until Eleanor begins to have random, persistent thoughts about dropping the baby. She finally decides to see a counselor. She talks about the thoughts she’s been having, and the counselor diagnoses her with postpartum anxiety. Eleanor feels great relief to know what she is experiencing is real. In therapy, she learns how to use mindfulness practices and challenge her intrusive thoughts and worries and accept them, rather than pushing them away. She begins to meditate every evening, which helps improve her insomnia. She continues in therapy for several weeks, until she can manage her anxiety symptoms on her own.
  • Afraid of talking about postpartum depression: Mika, 25, has just had a baby. Her mother often comes over to help out, since Mika’s husband works long hours. At six weeks, Mika has mostly recovered from childbirth. She takes a daily walk with the baby and often does yoga with her mother. Spending time with her baby makes Mika happy, but she also feels nervous and afraid. She worries about accidentally hurting the baby or doing something wrong. Her mother assures her she’ll learn. Mika doesn’t know how to tell her mother that she feels sad and exhausted all the time. Her mother helps so much that Mika feels like she doesn’t have any reason to be exhausted, and she’s ashamed of her sadness. She makes excuses to go away and cry and spends long periods of time staring at the wall. One day her mother finds her, and Mika tries to explain, but her mother tells her it’s just baby blues, that they’re completely normal and will go away. At first Mika is relieved, but her mood doesn’t change. She begins to feel like it might be better if she weren’t there, that her mother could take better care of the baby. She calls a helpline one day when her mother is grocery shopping and the person she speaks to urges her to call her doctor right away. Mika does, and she sees a counselor a few days later. Counseling helps her sort through her feelings of loneliness, inadequacy, and boredom, as well her desire for more support from her husband and less from her mother. She resolves to reconnect with her friends and spend more time on activities that engage her brain. After a few weeks, Mika’s mood improves as she begins making these changes.

References:

  1. Bennington-Castro, J. (2018, January 29). Are you suffering from antepartum depression? Everyday Health. Retrieved from https://www.everydayhealth.com/depression/guide/pregnancy
  2. Diagnostic criteria. (2018). Epocrates. Retrieved from https://online.epocrates.com/diseases/51236/Postpartum-depression/Diagnostic-Criteria
  3. Do I have PPD? (n.d.). The Postpartum Stress Center. Retrieved from https://postpartumstress.com/get-help-2/do-i-have-ppd
  4. Fitelson. E., Kim, S., Baker, A. S., & Leight, K. (2011). Treatment of postpartum depression: Clinical, psychological, and pharmacological options. International Journal of Women’s Health, 3. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039003
  5. Gjerdingen, D. K., & Yawn, B. P. (2007). Postpartum depression screening: Importance, methods, barriers, and recommendations for practice. The Journal of the American Board of Family Medicine, 20(3). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/17478661
  6. Johnson, J. (2017, July 16). What foods are good for helping depression? Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/318428.php
  7. Levine, D. (2017, December 22). Is there a better way to screen for postpartum depression? U.S. News & World Report. Retrieved from https://health.usnews.com/health-care/patient-advice/articles/2017-12-22/is-there-a-better-way-to-screen-for-postpartum-depression
  8. Postpartum depression. (2015). Anxiety and Depression Association of America. Retrieved from https://adaa.org/living-with-anxiety/women/postpartum-depression
  9. Storrs, C. (n.d.). Do laws on postpartum depression screening help women? Retrieved from https://www.seleni.org/advice-support/2018/3/14/do-laws-on-postpartum-depression-screening-help-women-ght4k
 

Last updated: 10-31-2018

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