When Jane gave birth to her baby 10 years ago, she very quickly began experiencing significant postpartum depression. It felt as though her brain had been abruptly “rewired,” and her symptoms grew worse over time.
“It felt like there was this thing in me that took root and grew,” said Jane, 47, who asked to use only her first name for this story. “Especially feeling suicidal. Those thoughts had a life of their own.”
As the months passed after giving birth, Jane found herself making clearer and clearer plans for how she’d take her own life. She recalls at one point, when her son was 3, nearly pointing out an overpass from which she could easily jump while strolling with her toddler and husband — then immediately recoiling. Not from the thought itself, but from the fact that she had almost casually given her “secret” away.
When her son turned 4, Jane finally recognized her own need to get help and got a prescription for Prozac. Practically overnight, her thoughts of suicide disappeared. And despite the fact that it was years after she had given birth, the roots of her depression felt obvious.
“For me, it could not be more clear that what I had was postpartum depression,” said Jane, who often worried she’d sound “crazy” if she opened up about what she was experiencing — particularly because she adored her son. “It felt almost like my brain was rewired during pregnancy.”
New research published in the journal Pediatrics this week supports what parents like Jane, as well as mental health professionals who specialize in the issue, have long known: that “postpartum” depression is not just something that strikes in the weeks and months immediately following childbirth. It can last for years and grow worse with time.
In the study, which tracked 5,000 mothers in New York over time, one-quarter of the women experienced elevated depression symptoms at some point in the three years after giving birth.
Of course, up to 80% of new moms experience some version of the so-called “baby blues” in the first few weeks after delivery. They may feel sad, anxious and cry a lot. Their moods may shift rapidly as their hormones fluctuate and they learn to care for a vulnerable new infant on extremely little sleep.
Postpartum depression may be more severe (though not always) and lasts longer, often appearing weeks after giving birth but sometimes not for a full year — or, as this new research suggests, even longer. It builds on a recent scientific review that found up to 50% of moms with postpartum depression struggle beyond the first year.
“'Postpartum' depression is not just something that strikes in the weeks and months immediately following childbirth. It can last for years and grow worse with time.”
Expanding our collective understanding of how long postpartum depression can persist is important largely because of screening.
The American College of Obstetricians and Gynecologists — which sets the guidelines OB-GYNs and other women’s health providers often use — recommends at least one screening for postpartum depression using an official tool or questionnaire. The American Academy of Pediatrics recommends pediatricians screen for mental health issues in patients at various points in the first six months after they’ve given birth.
But that timeline may not do enough to catch those who are struggling, particularly because many patients with postpartum depression are reluctant to speak about what they’re experiencing out of a sense that their symptoms somehow mean they are bad parents.
That is why the authors of the new study clearly state that screening within the first year after giving birth is insufficient and that pediatricians should consider assessing patients for at least the first two years after they have a baby.
“We know that if a PMAD [perinatal mood and anxiety disorder] is untreated, it can continue. The symptoms can become worse, and many women can ride them right into a subsequent pregnancy,” echoed Paige Bellenbaum, chief external relations officer for The Motherhood Center, a mental health clinic based in New York City.
Even so, Bellenbaum believes far too few pediatricians, OB-GYNs and midwives meet even the current bare minimum recommendations for screening patients for depression and anxiety — to say nothing of assessing how they’re doing years down the road.
“It’s egregious how few practices do this,” Bellenbaum said. “I can’t tell you how many OBGYNs I have spoken to over the years who have said, ‘Oh, I don’t need to screen. I know my patients well enough to know if they’re struggling.’”
But she has seen again and again that it is often the patients who appear the most composed and the most able to juggle the demands of a new baby who are struggling the most.
That certainly was the case for Jane, who kept her depression and her suicidal thoughts wrapped tight around herself for years, even as friends asked how she was doing. She could not bring herself to open up. And she could not see clearly beyond the depression she felt rooted inside her.
“It became my secret, that this alternate element of me was taking root in my brain,” said Jane. “I kept waiting for it to go away. I thought it would. When it didn’t go away, for a long time I just accepted that it was a part of me. And I’d just have to live with it.”