Postpartum depression may last for much longer than we thought

Pediatricians are advised to assess women for postpartum depression for 6 months after giving birth. The American College of Obstetricians and Gynecologists (ACOG) recommends that obstetric providers assess for depression "at least once" during pregnancy, and again at the postpartum visit (which usually happens 6 weeks after giving birth). This is based on the idea that postpartum depression usually presents within the first year of parenthood.

But a recent study found that that may not be enough.

The study was done by the National Institutes of Health and included 5,000 women. Their findings were staggering: About 25% of women experienced "high levels of depressive symptoms" in the three years after giving birth.

In short, postpartum depression is even more common—and more significant—than we thought. One in four women. Three years. This is huge.

Of note, the researchers found that women who had previous mood disorders or who had gestational diabetes were more at risk for experiencing depressive symptoms for longer. It's also important to note that the study included mostly white, non-Hispanic women, so more research on women of color is urgently needed.

In the meantime, these findings indicate that health care providers need to continue to screen for postpartum depression and other mood disorders well beyond the first six months of new parenthood.

It also means that people who have given birth need more support. While the stigma around mental health is lessening, it is still pervasive enough in our society to have detrimental consequences. It is so important that we continue to discuss what postpartum depression feels like so that people can get the help they need and deserve.

First, let's talk about the difference between the baby blues and postpartum depression.

As I share in The Motherly Guide to Becoming Mama, "The baby blues are very normal; around 70 to 80 percent of new moms experience them. One moment you feel overjoyed and full of love, and a minute later, you are sobbing because you have no idea what you were thinking or how you are going to actually be this child's mother."

People find that these big emotional swings last for about two to three weeks and then taper off.

Postpartum depression is different. If you find that these negative emotions and emotional swings persist longer than that, if you are sad frequently or if you are just worried that something feels off, it could be postpartum depression (or another postpartum mental health concern like anxiety or mania). And, now we know that these symptoms may come up years after giving birth.

Postpartum mental health issues aren't always obvious—remember that it's not your job to diagnose yourself. Your job is to get in front of a provider or mental health therapist. That's it.

Here are signs to look out for (excerpted from The Motherly Guide to Becoming Mama):

  • Feeling sad for long periods of time without an easy-to-pinpoint cause
  • Lack of desire to do the things you used to love
  • Difficulty getting out of bed
  • Difficulty falling asleep
  • Lack of motivation
  • Feeling guilty often
  • Anger or rage
  • Worrying about things that seem odd or that you did not use to be worried about
  • Repetitive thoughts or actions, such as the need to clean something over and over or ensure that a door is locked multiple times
  • Fear of being left alone with your baby
  • Reliving difficult aspects of your birth
  • Not wanting to talk or think about your birth at all
  • Inability to make decisions
  • Periods of being extremely energized (lots of talking, moving, cleaning)
  • Feeling invincible or that you have powers beyond human ability
  • Hallucinations
  • Intrusive and disturbing thoughts; violent thoughts. Examples might be:
    • "My baby doesn't love me."
    • "I am not a good mom."
    • "I want to run away."
    • "I don't deserve to be happy."
    • "Something bad is going to happen to my baby. I know it."
    • "My family would be less burdened if I weren't around."
  • Unable to sit still
  • Not feeling bonded to your baby

Again, if you have any concerns about your mental health, whether or not they appear on a list, please seek help—even if you gave birth years ago. And know that you can go to the emergency room or call 911 if you have thoughts of harming yourself or someone else.

It is so vital that you know that these feelings are not your fault. In the same way that migraines or asthma are illnesses that we don't have any control over, postpartum depression and other mental health concerns are not something to be ashamed of. You are a good mother. You are deserving of support. And treatment is available—and so effective.

So whether you had your baby a week ago or three years ago, remember that it's okay to advocate for yourself and your mental health (and to help your friends and family members do the same).

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