What to Know About Postpartum Depression

Sleepless nights and mild feelings of worry and uncertainty are unavoidable for most parents adjusting to life with a new baby. Most new mothers experience the “baby blues,” which can last for up to two weeks after delivery. But about 1 in 8 mothers experiences longer-lasting feelings of extreme fatigue, worry, depression and distress that interfere with everyday life. This condition is postpartum depression.

Health Matters spoke to Dr. Catherine Monk, the director of Women’s Mental Health @ Ob/Gyn at NewYork-Presbyterian/Columbia University Irving Medical Center, to learn how to spot the signs of postpartum depression, and what to do if you or someone you love has the condition.

Dr. Monk cautions that while postpartum depression is typically diagnosed when feelings of depression and anxiety last for several weeks, women and gender non-conforming people should seek help if they are experiencing any type of anguish.

“If a woman is feeling any kind of distress, she shouldn’t wait,” Dr. Monk says. “Reach out for more support from family and friends and be in touch with some kind of healthcare provider to say ‘I’m not feeling like myself.’ This provides the opportunity to help women before they are in a deep depression.”

What are the symptoms of postpartum depression?
When a woman who recently gave birth is feeling down and depressed and her eating and sleeping habits are changing, she may have postpartum depression.

She may feel sadness, moodiness, and anger, and cry a lot. There may be feelings of hopelessness, like: “This isn’t what I thought it was going to be. I’m not the mother I thought I would be; this is never going to get better.” A woman may have passive suicidal thoughts such as, “The world would be better without me,” or actual thoughts of harming herself or her baby.

She may be experiencing a lot of self-doubt or self-recrimination, and there also may be a significant worrying aspect to the depression.

What does that worrying aspect and self-doubt look like?
Having a baby is a huge life transition, so of course there is going to be worrying that is new, even if it’s the third baby. But with postpartum depression, it’s a kind of worrying that’s hard to shake off and monopolizes the mind. It gets very repetitive. The mother may worry about dropping the baby. Or she may experience self-doubt and have thoughts like, “It’s my fault the baby didn’t nap so long” or “I didn’t do the right thing and now there’s a rash.” There may be a lot of self-blame.

What are ways to combat those thoughts?
A lot of tools are available to help people with worrying thoughts. They take a bit of practice but can be very helpful.

One is to keep a worry book for such thoughts, jot them down, and return to them when one is not as emotional or taken over by worry. Then evaluate how realistic these worries are, and if they are, discuss them with a pediatrician, obstetrician, or someone else in your support system. Another is to practice being in the moment, which can help slow down the mind and move it out of the worrying mode. For example, focus on sensory experiences — smells, touch, tastes, sounds — for 30 seconds, and breathe deeply if that feels comfortable. Practice this several times a day so that you can use this tool as a lever to be in the moment and help slow down the mind. Seeing a mental health professional for advice on other tools can be very helpful as well.

Who is most at risk for postpartum depression?

A prior depression puts a woman at greater risk of developing postpartum depression. A history of trauma puts any woman at risk for lifetime depression, particularly if the trauma had to do with physical or sexual abuse or neglect. For a lot of understandable reasons, that trauma could be activated as one is embarking on having a family. A lack of social support may make one more vulnerable to postpartum depression.

Most people have some mixed feelings about becoming a mother, along with feelings of joy, but deep, deep ambivalence about wanting a baby is a risk factor. Some data suggests that a difficult relationship with one’s own mother can put a woman more at risk. Some women who seem more affected by hormone changes — maybe they’ve had more moodiness associated with their menstrual cycle — may be more susceptible to the hormone changes that come with pregnancy and giving birth.

Researchers are in the process of identifying several genes that may have an association with increased risk for postpartum depression. We are still learning about this.

Is there a way to prevent postpartum depression?
Making sure you have the emotional and physical support to deal with the demands of a new baby before he or she arrives can be helpful. This could include concrete ideas like a schedule of who is available to help, but also an awareness of needing to be flexible and having backup plans. Try to find tools to develop your confidence, such as discussing parenting techniques with friends or family members who are also parents, but be mindful not all techniques work for all babies, or all of the time. Practice de-stressing activities, whether it’s finding a half an hour a day for a certain TV show or taking a walk or a bath. These behavioral interventions that can reset us are really important. And these are life skills that can be helpful in general.

What else can you do to help yourself or someone you love?
There will be moodiness and difficult moments after you bring home a new baby — hopefully combined with some real highs of joy and pleasure. Be sensitive: Ask how she’s doing, offer support, and really validate that this is a huge life transition, as it is for the partner, too, if that person is in the picture.

If you notice things aren’t going well, before getting stuck there, be in touch with your obstetrician or midwife or a professional to get support and be directed to a mental health professional. Also, for those with postpartum depression, there is a new medication approved to treat the condition.

What should a woman expect when she reaches out to a professional for help?
It may not mean she has to go on medication. Psychotherapy is extremely effective on its own, particularly for mild to moderate depression.

The professional may start the first session with a more formal overview of your life or be more open-ended and ask what is going on now. There may be forms to fill out about one’s mood and mental health history. By the end of the session, the patient should feel some relief that they have found someone who understands what they are feeling and instills confidence, with a focus on behavioral/talk therapy and possibly medication, as well as ideas for lifestyle adjustments. It is important that the patient feels a good fit with the therapist, though this sometimes can take one to three sessions to know.

It’s worth mentioning that it may take some time to find the right therapist, so don’t give up or get frustrated if you don’t find the right person right away.

What is the most important thing to know about postpartum depression?
That there is nothing to be ashamed of — our bodies register stress and challenges in life. Understand that stress gets under the skin and contributes to conditions, and that is just as true in the mental health realm as it is in physical health. There is no reason to be ashamed; we should be taking care of our mental health the same way we do our physical health. If you’re diagnosed with gestational diabetes, you make adjustments in your life to address that. If it looks like you’re having some mental health issues, let’s take care of that as well. We want to help families get off to the right start.

Catherine Monk, Ph.D., is chief of women’s mental health in the Department of Obstetrics & Gynecology at NewYork-Presbyterian/Columbia University Irving Medical Center and the inaugural Diana Vagelos Professor of Women’s Mental Health. She holds a joint appointment as a professor of medical psychology in Psychiatry. She is a research scientist VI at the New York State Psychiatric Institute. After completing her National Institutes of Health postdoctoral fellowship in psychobiological sciences at Columbia in 2000, Dr. Monk joined the faculty and established the Perinatal Pathways Laboratory. She directs Women’s Mental Health @Ob/Gyn in ColumbiaDoctors Ob/Gyn practices, specializing in the treatment of women during the perinatal period, with a focus on depression, anxiety, pregnancy loss, and infertility.