Postpartum depression, which affects an estimated 9 to 16 percent of new moms, is better understood than ever before, meaning there is more awareness about the condition and access to treatment.
But in other ways, it's still shrouded in mystery and misinformation.
"I'm convinced the whole world thinks we now know everything about postpartum depression and everyone's on board and supportive [of affected women], but I don't think that's true -- not yet," said Katherine Stone, founder of Postpartum Progress, a blog and non-profit. "We know more, and there's certainly more discussion, but given what I hear from women on the ground, there's still a huge lack of understanding."
That means a lot of women struggling with postpartum depression find that their friends, family and partners either say the absolute wrong things to them, or nothing at all.
The no-nos:
1. "Oh, that happens to everyone."
The "baby-blues" -- feelings of sadness, fear or anger within the first one to two weeks after birth -- are extremely common, affecting nearly 80 percent of new moms, according to the American College of Obstetricians and Gynecologists. But postpartum depression is a very different thing, both in terms of how severe it is and how long it lasts.
"All women who are mothers understand that new mom stress is universal. You have this baby that can't tell you what's wrong, you're not getting rest -- it's a huge transition, no matter what. But there's a vast difference between that and maternal mental illness," Stone said. "That can be very hard for people who have not experienced it to grasp."
And other moms aren't the only ones who try and assure women that what they're going through is typical; many doctors write postpartum depression off as new mom nerves, said Karen Kleiman, founder and director of the Postpartum Stress Center in Pennsylvania. "They think they're helping someone feel better by normalizing it. But if you're not getting help, you might feel better for about three seconds, then you're just thinking, 'I don't think you understand just how bad I feel.'"
2. "You'd feel better if you did X."
A glass of wine, a walk outside, a quiet bath while someone else watches the baby -- these will not make things right for a woman who is in the midst of a major depressive episode. "Opinions are really dangerous, like, 'If you stopped breast feeding you'd feel better,' or 'If you did this,'" said Kleiman.
Stone said she is astounded by the number of people that both she and her readers have encountered who suddenly become "experts" in reproductive psychiatry and offer up tips. "Easy solutions drive me crazy," she said. "It's really not that simple and if it was that simple, we'd all be doing it."
If you're truly eager to share something that made a big difference for you personally, try framing it as, "I tried this and it helped me," then leave it at that, Kleiman said. No matter how good your intentions, suggestions should never be framed as musts or shoulds.
3. "When I had a baby, I didn't have time to be depressed."
"This is one I heard 100 years ago when I was talking to a woman about the work I do," said Kleiman. "So many people just don't understand this [condition]."
Women with postpartum depression aren't lazy and they're not somehow less than other new moms, but that's how many of them feel, Stone said. "A lot of times, when you're going through something like this you feel so bad about yourself. There's guilt and shame and you feel like you're incapable of being a mom." A little sympathy goes a long way.
4. "You've always wanted a baby, you should be happy!"
"I think things like, 'You should feel blessed to have a baby, you should be happy' ... stuff like that is just, UGH," said Stone. "As if we don't know? If we could, we would."
The antidote, Stone argued, is education, and it's even easier to educate yourself these days given the abundance of information about postpartum depression online. "There's so much you can learn about what women are going through if you really care to take the time to sit and learn about these illnesses," she said. "You're probably going to do a much better job in terms of how you offer support and empathy."
5. "You don't need medication."
A lot of very loving partners are surprised when their girlfriends or wives start talking about medication, particularly if they've always been very healthy or generally presented themselves as "anti-meds," Kleiman said.
And of course, in some cases medication may not be necessary to help treat postpartum depression. In others, however, it absolutely is. Be mindful that this is a complex and extremely personal calculation made by a woman, her health care providers and close friends and family -- as she sees fit.
What to say instead:
1. "I can come over at 3 to hold the baby ... drop off food ... mow the lawn ..."
"A mistake people make is they say wonderful, open-ended things, like, 'Call me if you need anything,' or 'Let me know how I can help,'" said Kleiman. "[But] moms struggle because they already feel guilty and overly dependent on help." It's better to be specific about what you can do to help -- offer to bring over a meal at a particular time, run a load of laundry, or sit with the baby for an hour so mom can take a break.
"That doesn't mean that offering help is bad," echoed Stone. "Just figure out concrete ways you can do it."
2. "These are your symptoms, not you."
Kleiman said that one of the hardest things for a lot of women with postpartum depression is understanding that they are not the bad things they are feeling. Those feelings of sadness, anxiety and anger are symptoms of their disorder, much like a cough is a symptom of a cold.
"Helping her understand that her symptoms will go away when she gets treatment -- that [she] will feel better again," can make a big difference, Kleiman added. It's not taking denying the seriousness of what she's experiencing; it's reminding her, however briefly, that there is light at the end of the tunnel.
3. "I know how hard you are trying."
Oftentimes, there's nothing you can really say to help a woman struggling with postpartum depression. But assuring her that it's okay to make mistakes and that you recognize how hard she is working to deal with both a new baby and her mental health issues can go a long way in making her feel supported, Kleiman said.
4. "I am here for you, as long as it takes."
A big misconception, Stone said, is that once a woman has been diagnosed with postpartum depression and begun treatment, she will get better fast. But treatment takes time. "I think people start getting frustrated. You take an antibiotic, and 10 days later you're better. That is not how this works," said Stone. "It can take months. It took me until my son turned 1 to really feel like I'd turned the corner." Don't just offer your support in the first two weeks; let her know you'll be around for as long as it takes.
And make it clear you're okay with hearing about the hard stuff. "Family members and friends have a hard time with this, because the knee-jerk reaction is to make [the pain] go away," said Kleiman. Acknowledge that she might feel bad for a while, she said, then say: "If you need to cry, I can sit here while you cry."
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