Postpartum depression (PPD), as well as postpartum anxiety (PPA), have both become common terms. It’s talked about frequently before hospital discharge and the Edinburgh postpartum depression scale is almost always part of a postpartum visit with your provider. But even if you’ve heard of it, it doesn’t always mean that you recognize all the forms or how it may show up for you.
What PPD is NOT
A good first step to understanding postpartum depression is knowing what is “normal”--or not as severe or long-term as PPD. Of course this is always unique to each person, their mental health history, and their support system. PPD is not the “baby blues”, which occurs for a short period of time after a baby is born. As a mother’s hormones switch from taking care of the baby inside of the body to caring for the baby outside the body there is a huge hormonal shift. This drastic change in hormones often contributes to a feeling of sadness a few days after having the baby and lasts 2-3 weeks. Feeling various insecurities and worries is also completely normal after having a baby.
There are other dysfunctions that can mimic PPD as well. Dysphoric Milk Ejection Reflex (D-MER) is a 30-90 second feeling of dysphoria during a let down. It is uncommon so not much is known about it, but some feelings that occur are extreme sadness, hopelessness, irritability, and anxiousness. Breastfeeding Aversion and Agitation (BAA) happens right when baby latches. A woman may feel anger, self-disgust, irritability, rage, feeling trapped, wanting to run away, or an urge to remove the baby. Because the feelings are gone after the baby unlatches the mother may feel guilt and shame afterwards for the thoughts she had during feeding. Postpartum Thyroiditis can also mimic PPD because of the dysfunction of the hormone release in the thyroid. Testing your TSH, T4, anti-TPO, and antithyroglobulin can help determine whether or not you are suffering from postpartum thyroiditis.
What PPD IS
PPD is feeling down, irritable, anxious, angry (or many other symptoms) that lasts more than 3 weeks, limits your ability to function, and limits your ability to take care of your baby and/or yourself. Any mental health disorder you can be diagnosed with outside of pregnancy can show up as a postpartum mental health disorder. Postpartum depression can also occur during pregnancy or many months after birth. It also affects adoptive parents and spouses/partners. Postpartum depression may show up in one pregnancy and not in others.
There are many forms of PPD that show up with various levels of intensity and combinations for each person:
“Baby Blues” that lasts longer than 2-3 weeks. Postpartum depression signs include:
Sad a majority of the time with feelings of guilt and hopelessness
Inability to concentrate
Sleeping too much or inability to sleep at night
Loss of sex drive
Change in appetite (loss of appetite or overeating)
Discomfort with baby
Inability to experience pleasure
Physical problems without apparent cause
Differs from postpartum depression because the symptoms include far more anxious behaviors than primarily depressed behavior. Symptoms include:
Persistent fears and worries
High tension and stress
Inability to relax
Postpartum Obsessive Compulsive Disorder
Many people are ashamed by the thoughts that accompany postpartum OCD so it often goes unreported and untreated. Symptoms include:
Intrusive and persistent thoughts
Thoughts often involve harming the baby
Compulsive habits, such as repetitive cleaning or changing of the baby
Intense shame and disgust about the negative thoughts
Distrust of self
Mothers with OCD are still usually able to discern between right and wrong, therefore they are unlikely to actually harm the baby.
Postpartum Panic Disorder
Panic disorder includes extreme anxiousness and panic attacks. Panic Attack symptoms include:
Shortness of breath
Tightening of the chest
Consistent and excessive worry/fear
Fears generally involve dying, losing control, or going crazy
Postpartum Post-Traumatic Stress Disorder
Like general PTSD, postpartum PTSD is caused by some real or perceived threat to the person. This could be triggered by birth complications, the baby being sent to the NICU, unplanned cesearan, or other injuries that occured during delivery. Symptoms of PTSD:
Reliving the trauma in flashbacks and memories
Avoiding trauma triggers
Anxiety and panic attacks
Feeling detached or numb to reality
Postpartum Psychosis is the most serious form of any postpartum mood disorder, though it is extremely rare. It typically begins within the first 2 weeks following delivery. Postpartum psychosis causes mothers to be unaware of their actions and behaviors, therefore parents with these behaviors are at serious risk of suicide or infantcide.
Hallunications (both tactile and visual)
Postpartum (peripartum) Bipolar Disorder
This mood disorder is characterized by cyclical mood episodes varying from mania, hypomania, and depression. Bipolar disorder, peripartum onset, is not as frequently heard of or discussed. Symptoms include:
Periods of severely depressed mood and irritability
Periods when mood is much better than usual
Little need for sleep
Racing thoughts, trouble concentrating
Continuous high energy
Grandiose thoughts, inflated sense of self-importance
Treatment for postpartum depression
Just as everyone is unique in their PPD symptoms and diagnoses, everyone is unique in what approach is best for healing. Start by communicating with your partner and/or other family members, friends, or provider. As hard as it may be, you can’t always wait for others to see the signs that you are struggling. You will have to make some effort to get help. These support people can help as you start the process to implement self-care techniques and to find a therapist, if needed. Sometimes medication is needed as you navigate recovery from a mood disorder and there are options available even if you choose to breastfeed.
There are many other online resources you can refer to, as well as local support groups. Here are a few resources to help you get started
Rhea Women’s Health postpartum classes
There are so many joyful aspects about having a baby, but it is also a major adjustment. There is no shame if you are struggling. You did not cause your postpartum depression, but there is help out there. All forms of PPD are treatable and the sooner you can identify and reach out for support the sooner you can start healing.
*I gathered my information from two online articles: “Postpartum Depression Types” from PostpartumDepression.org’s website and “Postpartum Disorders” from Anxiety and Depression Association of America’s website, and from a class on mental health with Rhea: a self care program for postpartum women.