There’s something you should know about depression: It lies.
Depression tells you that feeling hopeless and overwhelmed is normal, and you don’t need help. Or that therapy and medication won’t do anything because this is just who you are. In fact, a 2016 study in The American Journal of Psychotherapy backs this up, showing that cognitive distortions (false or exaggerated thoughts) are more commonly experienced in those with depression. I’ve experienced this firsthand, and it almost prevented me from getting the help I needed.
After my second son was born, I was diagnosed with postpartum depression (PPD). This is a common mental health issue associated with “significant negative effects not only on depressed women themselves, but on the physical, cognitive and emotional development of their children,” according to a study of treatment options in the International Journal of Women’s Health.
Postpartum Support International states approximately 15% of all women (or about 1 in 7) experience PPD following the birth of their child and up to 10% will experience depression or anxiety during pregnancy. It can also last longer than a year after giving birth.
Despite its prevalence, an article in the American Journal of Obstetrics and Gynecology reports the condition is often under-recognized and under-treated.
Reaching out for help
Most of my postpartum doctor visits revolved around my baby, and the one geared toward me focused on my physical health. I did fill out the Edinburgh Postnatal Depression Scale at my son’s pediatrician’s office, and I revealed that I often cried for no reason, did not find the same joy in things I used to, and felt overwhelmed most of the time. However, he told me I was going through the “baby blues,” and it would naturally go away.
At my six-week postpartum checkup, my OB-GYN told me to call her back if I still felt symptoms when the baby was sleeping through the night. When I called my OB-GYN later to talk about my continued feelings of depression, the on-call nurse told me to try going outside and exercising more to fix it.
I convinced myself that I was probably overreacting or what I was feeling was normal and there was nothing to be done about it. However, my husband convinced me to keep reaching out for help. After I talked to my general practitioner about what I had been feeling, she diagnosed me with postpartum depression.
Without my partner’s support, I may not have realized that I needed help for postpartum depression—or found the strength to talk to four different providers about it before finally getting the care I needed to manage my symptoms.
Asking your partner to be your PPD spotter—and coming up with a plan together to navigate PPD if it comes up—could help you feel better sooner. Here are some tips to help.
Common signs of postpartum depression
“PPD is a major depressive episode that can occur during pregnancy or after giving birth, and may negatively impact maternal, birth and infant outcomes,” says Kristina Deligiannidis, MD, director of Women’s Behavioral Health at Northwell Health and associate professor of Psychiatry and Obstetrics & Gynecology at Zucker School of Medicine at Hofstra/Northwell in New York. “PPD is one of the most common medical complications of pregnancy/childbirth.”
She explains that women with PPD may experience a mix of emotional, physical and/or behavioral symptoms.
Symptoms to look for include:
- Depressed mood
- Loss of interest or pleasure in hobbies and activities
- Difficulty sleeping
- Abnormal appetite
- Weight changes
- Feelings of guilt or worthlessness
- Difficulty concentrating, remembering or making decisions
- Thoughts about death, suicide or harming oneself or the baby
Differences between PPD and baby blues
Up to 80% of all new mothers experience the baby blues, according to the March of Dimes. Baby blues are normal feelings of sadness you may experience in the first few days after having a baby, which may be caused by the many hormone changes your body goes through after giving birth. These feelings usually go away within one to two weeks after giving birth.
“PPD can be differentiated from the baby blues by the severity, onset and/or duration of symptoms,” explains Dr. Deligiannidis. “The baby blues are characterized by mild symptoms that peak several days after childbirth and include mood changes, feelings of worry, tearfulness, irritability and sleep difficulties, but do not impact a mother’s ability to care for herself or her family.”
In contrast, Dr. Deligiannidis notes that symptoms of PPD can persist for months or over a year when left untreated or undertreated. “PPD isn’t the same for every woman and goes beyond sadness or baby blues.”
Risk factors for PPD
Although PPD can affect anyone, there are several risk factors that might make you more prone to developing the condition. One of these? Not getting the postpartum support you need.
“Moms are more likely to experience PPD if they receive no support or minimal support from family, friends, or community after the birth than women who receive appropriate support,” says Dr. Deligiannidis.
Social support goes beyond PPD, as good social support is associated with “lower rates of a variety of illnesses and even greater longevity,” according to Dr. Deligiannidis. “This is also true for emotional health, since motherhood requires a lot of support in a variety of forms, for example, financial, physical and emotional, from a variety of sources, including family, partners and peers. Support reduces many forms of stress which is a risk factor for PPD.”
Risk factors for PPD may include:
- Previous history of depression and anxiety
- Risky pregnancy
- Young age
- Thyroid dysfunction
- Lack of social support
- Education and low income
- Unhealthy diet
- Sleep deprivation
- Not enough exercise
Challenges of recognizing PPD and asking for help
According to a 2021 survey by HealthyWomen of new moms, more than one-third cited “not wanting to bother anyone” as the reason for not discussing their PPD symptoms with anyone; other reasons included guilt and embarrassment.
“Many women I treat for PPD note that they didn’t seek care sooner because they just thought the depression would go away on its own,” says Dr. Deligiannidis.
According to the HealthyWomen survey, most moms do not plan ahead for their own mental health in the weeks that follow birth. The study noted that while 76% of pregnant women created a birth plan leading up to their baby’s arrival, only 21% created a plan that focused on their own maternal mental health after the baby was born.
“It is my impression that women are aware that childbirth can often be associated with changes in mood and sleep, but that they don’t think it would happen to them,” remarks Dr. Deligiannidis. “Many new moms feel pressure to ‘do it all’ on their own after the baby is born. If that’s what women believe, then why would women make a plan for support following birth? Unfortunately, this misbelief leads to women not planning ahead.”
How to prioritize maternal mental wellness
Mothers who’ve just given birth do not need to do it all. Partner and community support is important.
Talk to your partner and family. “PPD affects the mother, child, family, and community,” states Dr. Deligiannidis. “That’s why it’s important for the family, especially the spouse or partner, to understand the signs of PPD, so they can help recognize potential symptoms and encourage their partner to seek the care they need from their healthcare provider.” Designate a PPD spotter who can pay attention to your needs.
Make a maternal wellness plan. Before your baby is born, aim to clearly outline your list of personal needs, every day to-dos, and postpartum priorities to give clear examples for your friends and family to activate their support. Try the Check on Mom program, which Dr. Deligiannidis says is “focused on helping new and expectant moms create a maternal mental wellness plan for the first twelve weeks after baby is born, form a mom team, and connect to resources, inspirational content, and community to help navigate the early stages of motherhood and beyond.”
Be sure to continue to check in with your healthcare providers. Dr. Deligiannidis notes that having a plan does not replace discussions with a medical provider, who is the best resource for individual medical advice.
How PPD is treated
If you are diagnosed with PPD, start by taking a deep breath. Know that while what you are feeling and experiencing is not normal, it is common—and it can be treated.
“There are a variety of evidence-based talk-therapies (psychotherapies), either individual or group-based, and medication options (e.g. antidepressants) which are effective in treating PPD,” says Dr. Deligiannidis. “Receiving peer support from moms who survived PPD can also be helpful.”
There are several different PPD treatment options, including but not limited to:
- Antidepressant medications
- Hormone therapy
- Interpersonal therapy (IPT)
- Cognitive behavioral therapy (CBT)
- Nondirective counseling
- Peer and partner support
Be sure to speak with your care team about treatment options that may be best for you.
Action items for the PPD spotter
If you’re a designated PPD spotter for a new mom, here’s a checklist of what to do and how to help.
- Get informed about PPD and be involved before and after delivery.
- Check for signs and symptoms of PPD that go beyond the two-week baby blues.
- Get the mom medical help if she needs it.
- Try to alleviate mom’s stress and anxiety by taking a larger role in caring for the baby and family.
- Let the new mom know that she’s not alone and offer her support every step of the way.
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Kristina Deligiannidis, MD, director of Women’s Behavioral Health at Northwell Health and associate professor of Psychiatry and Obstetrics & Gynecology at Zucker School of Medicine at Hofstra/Northwell in New York.