Feeling More Than Blue: The Reality of Postpartum Depression

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There is no easy way to say this…the postpartum period can suck. It can be awesome and awful, exhilarating and exhausting, and precious and painful all at the same time. You will find strength you never knew you had to get through those long days and even longer nights. But while nearly 40 to 80% of women feel postpartum blues, about 10 to 15% actually suffer from postpartum depression. It is a serious illness that requires serious attention. We want to address it with all the gravity that it deserves.

The emotions following the birth of a baby are as labile as the weather in the tropics. In minutes, you can go from elated to dejected. While it is quite common for women to experience what is called postpartum blues (a.k.a. the baby blues), the symptoms of depression are usually mild and short lived. Why it happens is not clear; most of the research points towards those crazy hormones that are flooding your system post-delivery. Women report sadness, tearfulness, irritability, anxiety, insomnia, and decreased concentration.

In the first two to three days following delivery, about 40 to 80% of women report feeling blue. In most cases, the symptoms of being “blah” (medical term = dysphoria) will peak over the next few days and then resolve within two weeks, basically, like a blip on the radar. So while some moments—and days—will be harder than others, all in all your mood and emotions should be stable.

Postpartum depression is in many ways the baby blues magnified by 100. Unfortunately, because the symptoms often overlap with the typical postpartum pleasantries, many women are misdiagnosed or undiagnosed and suffer in silence. Fatigue, difficulty sleeping, change in appetite/weight, and low libido (to name a few) are often seen in both processes. Again, what fuels postpartum depression is largely unknown; however, much like the blues, hormonal changes are thought to be the culprit (although here genetics is also thought to play a role).

While we are all at risk, there are specific risk factors that make us more likely to develop this disease: a history of depression, history of abuse, stressful life events, lack of a partner or social/financial support, family history of psychiatric illness, and childcare stressors (inconsolable infant crying). If postpartum depression is left untreated, it can often develop into chronic depression. It can also have a major impact on our ability to bond with the baby and can impact the development and mental health of infants and children.

To minimize the negative domino effect for both mother and baby, we as OBs need to ask the right questions and encourage you as moms to share your emotions. While we can’t definitively prevent who develops postpartum depression and how it affects them, we can identify women who are at significant risk and start treatment early. For example, if you have a history of major depression and were successfully treated with antidepressants in the past, you may be a candidate for immediate medical treatment postpartum. Bottom line, don’t be afraid to share your past history (physical and mental) with your doctor; this sort of information may make a big difference on how you weather the postpartum storm.

The “fourth trimester” (aka the postpartum period) is largely dominated by breastfeeding. Therefore, taking medications for both depression and anxiety while breastfeeding has become a hot topic. As moms we don’t want to take anything or do anything that could affect the health or development of our baby. We martyr ourselves to the umpteenth degree for our children; what we ingest, be it food or medicine, while breastfeeding is no different. But the reality is an unhappy mom makes for an unhappy baby. While medications may not be the first or only step (cognitive behavioral therapy is recommended initially) they are a close second. And in cases of severe major depression or mild/moderate depression that is not treated with psychotherapy alone, medication should be initiated. In general, for women who are breastfeeding SSRIs (selective serotonin-norepinephrine reuptake inhibitor) are the preferred class of medications as they present the lowest risk to your baby.

Everything in medicine (and in life) has a risk-benefit ratio. It’s like a seesaw; sometimes you are up, and sometimes you are down. Our goal when prescribing treatment is to find a balance. For example, while breastfeeding on an antidepressant may pose a small risk to your baby, the benefits of breastfeeding appear to outweigh the small risk of the antidepressant on the baby. All medications will make their way into your breast milk, but the amount can vary.

Here are some pointers to reduce the exposure:

  • Select medications that are in your system for a shorter amount of time.
  • Take medications immediately after you nurse (so that the levels in your milk are the lowest).
  • Work with your OB, your mental health provider, and your pediatrician and see what is best for you and your baby. You wouldn’t stop taking medicine for your blood pressure if it was high. Your brain is no different!

The problem with post-partum blues, depression, and the feelings of being down and out is that we are afraid to admit things are not perfect and that maybe motherhood is not all that we imagined. We feel guilty for wanting to scream when the baby won’t stop screaming or drink a bottle of wine when the baby won’t take the bottle. We feel guilty about not loving every second of what is supposed to be the most precious moments of our lives.

But the reality is, we all feel like this. For some of us, they are transient, and we quickly return to our baseline. But for others, the feelings remain and can worsen. Don’t be afraid to share your feelings; help is available. You are not a bad mother for feeling this way. In fact, admitting there is a problem and getting help makes you bold, courageous, and actually a pretty badass mom!