January is Postpartum Depression Awareness!
Symptoms of PPD
PPD is generally diagnosed in the first three months postpartum, but for some women, diagnosis can take a year or more. Moms who are diagnosed later will have likely shown symptoms of PPD for quite some time — long before getting an official diagnosis.
The symptoms of PPD are very similar to the symptoms of the baby blues. Because of this, I kept insisting (to myself) that I just had a really bad case of baby blues. This turned out to be true, since a “really bad case” of baby blues can be called “postpartum depression.” (Not always, of course, but baby blues can lead to PPD.)
Symptoms of PPD can include:
- Severe sadness, emotional numbness, crying spells
- Withdrawal from family, friends, and once-enjoyable activities
- Constant fatigue/sleepiness or insomnia/trouble sleeping
- Overeating or loss of appetite
- Strong sense of failure/inadequacy
- Intense concern about the baby or a lack of interest in the baby
- Thoughts of suicide or fears of harming the baby
I’ll take a moment here to say that, contrary to popular belief, PPD is not postpartum psychosis. Postpartum psychosis is a severe postpartum mood disorder, but it’s rare.
Causes of PPD
In my case, I ignored my symptoms for a long time. I thought that maybe I just couldn’t cope. Or maybe I was selfish. These were things people told me to get me to “snap out of it;” maybe they were true. So I thought it was my fault, that I’d somehow caused it. But I didn’t.
I had to repeat that many, many times, though, because I had a hard time believing it. But I didn’t cause it. It’s hard to believe and can be difficult to accept, especially when you’re at your lowest point. But…it’s not your fault. (Really.)
So if you or I aren’t the cause, what is? Hormonal changes are a possibility. Pregnancy and childbirth cause major upheaval. There are a lot of hormonal changes during the nine months of pregnancy and in the months after delivery. Those hormonal changes may lead to changes in brain chemistry (which is another possible cause).
Other possible causes of PPD include:
- Family history of depression
- Sleep deprivation, fatigue, tiredness
- Difficult or high-maintenance babies
- Medical changes in the mother or baby
- Self-criticism or doubting the ability to be a good mother
- The need to be a perfect mother
- Previous PPD or clinical depression
- Absence of support
- Stressful life events or general stress
- Feeling overwhelmed
Basically, no one really knows what causes PPD. There are many possible causes, but nothing has been definitively proven.
There are also possible factors that can increase the risk of getting PPD. Those risk factors are:
- Personal history of mental illness
- Lack of support system
- Anxiety or negative feelings about pregnancy and motherhood
- Problems with a previous pregnancy or birth
- Marriage or money problems
- Stressful life events
- Substance abuse
- Antenatal depression (depression during pregnancy)
- Baby blues
- Postpartum stress syndrome (adjustment disorder)
Please note that having any of these risk factors does not mean you’re guaranteed to develop PPD. It does, however, mean you’re at higher risk.
The Negative Feedback Loop
I call it a negative feedback loop. Others may call it something else. But for me, and I imagine most women, postpartum depression was like a vicious cycle. It started with my high (and unreasonable) expectations of motherhood, which of course I never met. Then I developed what’s known as distorted self-perceptions, where I thought I was a terrible mother for all sorts of reasons. (I also thought my kids would end up screwed up beyond all hope. Which might still be true, but not because of my PPD.) And then I fell into the “cycle of despair,” where each thought feeds back into and intensifies the original negative thought.
It’s like a Ferris wheel gone horribly wrong.
Yes, the negative feedback loop can be difficult to break. (Okay, it is difficult.) But breaking the cycle is possible, and many women have done it. You can stop the Ferris Wheel of Hell. (Really!) It may take a while, and it will probably be one of the hardest things you’ve ever done, but you can do it.
According to the World Health Organization, depression is one of the leading causes of disability worldwide. It’s also the fourth leading contributor to global disease. So PPD — and any other postpartum mood disorder — is an illness, and don’t let anyone tell you otherwise. The good news is, because it’s an illness, it’s treatable.
Your treatment plan is something you should decide with your doctor. There are different treatment options available, but you and your doctor will be the ones to decide what is best for you.
Pregnancy books and online resources will have suggestions. These are usually along the lines of sleeping when the baby sleeps, going out on date nights with your husband, getting out of the house, talking to someone, or trying not to do it all.
Those suggestions make sense on the surface. But I know that when you’re in that pit, these suggestions can be rather unhelpful. This is why I strongly suggest you speak with your doctor or another medical professional.
Treatments for PPD can include medication and counseling. The decision to take medication is one you’ll have to make for yourself, with your doctor’s input. Some people decide not to take medication and use herbal remedies instead. Others don’t take anything at all. This works for some people, but not for others. Please discuss it with your doctor first.
And despite what anyone might say, taking medication is a treatment, not a weakness.
Therapy or counseling is another possibility. This can be done in conjunction with medication, though some people only use therapy. If you decide to go this route, it’s important to have a good rapport with your therapist. And it’s totally okay to go “therapist shopping!” After all, you’re going to be sharing a lot of details of your darkest moments with your future therapist — you want to be absolutely sure you’re comfortable with him/her.
Developing a supportive social network is also recommended. For me, this has been the most difficult. I’ve always been able to talk to my husband, but I’ve had a hard time finding anyone else to talk to. I know it’s important to have supportive friends, people to confide in who won’t laugh at me or tell me it’s all in my head. But I also know that reaching out is hard. Unfortunately, I don’t have any tips to make it easier.
Everyone’s treatment plan will be different. Your plan is what’s best for you. As trite as it may sound, I know you can get better. It might take you a while before you’re ready to get help, and that’s okay. When you’re ready to ask for help, you can. There will be people willing and able to help you.
Just know that you can get help. You don’t have to feel guilty. And remember, there’s nothing to be ashamed of. We can all get through this.
Follow Charlotte’s journey with PPD on the PPDA’s Blog
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Hitti, M. (2008, April 10). Postpartum Depression: How Common? Retrieved from http://www.webmd.com/depression/postpartum-depression/news/20080410/postpartum-depression-how-common.
Kleiman, K. and Raskin, V. (1994). This Isn’t What I Expected: Overcoming Postpartum Depression. New York: Bantam.
National Women’s Health Information Center. (2009, March 6). Depression During and After Pregnancy. Retrieved from http://womenshealth.gov/faq/depression-pregnancy.cfm.
Stevens, L.M. (2010). Postpartum Depression. Journal of the American Medical Association, 304(15). Retrieved from http://jama.ama-assn.org/content/304/15/1736.full.
World Health Organization. (n.d.). Depression. Retrieved from http://www.who.int/mental_health/management/depression/definition/en/index.html