Each person’s body and mind react to pregnancy, childbirth and its aftermath differently. As with any major life change, adjusting to motherhood can be difficult, especially when other factors may affect how you cope. It’s important to know when certain behaviors should be addressed with therapy or medical attention.
A 2009 study published in The Journal of Perinatal Education found that more than half of the women with postpartum depression go undetected and undiagnosed. The study showed that mothers may not want to reveal how they’re feeling to those around them out of embarrassment or fear that their baby will be taken away from them.
Below, we talked to several psychologists who specialize in treating women’s and postpartum issues to explore what normal motherhood changes look like and when you should seek mental health treatment. Consider this a primer on how to identify which feelings are typical adjustments to motherhood and which require a more serious look.
More Than Just Baby Blues
Elise Feldman, a licensed clinical psychologist in New York, described postpartum depression as “the experience of feeling down or depressed most of the day, for most of the days, in at least a two-week period after giving birth.”
Feldman said that postpartum depression usually begins within the first month after giving birth, but can occur anytime within the first year.
While it’s not unusual to experience some level of anxiety and worry after becoming a parent, Feldman said that the frequency, duration and severity of these thoughts and feelings are what marks the difference between baby blues and postpartum depression.
“Baby blues” include mood swings, crying spells, anxiety and difficulty sleeping. They typically begin a few days after giving birth and can last up to two weeks, according to Mayo Clinic.
“Some moms with postpartum depression may have trouble bonding with their baby, feel isolated and disconnected even when continuing to socialize with other adults, and/or fantasize about abandoning their families or think about suicide,” Feldman said.
“Some moms with postpartum depression may have trouble bonding with their baby, feel isolated and disconnected even when continuing to socialize with other adults, and/or fantasize about abandoning their families or think about suicide.”
Other symptoms of postpartum depression include feelings of worthlessness, overwhelming fatigue, loss of appetite or eating way more than usual, severe anxiety and panic attacks.
Four to six weeks after birth is when most women usually begin to feel less overwhelmed with the changes a new baby brings, according to Linnea L. Mavrides, a clinical psychologist in private practice based in Brooklyn, but some women continue to feel bad or even worse.
“It’s one thing not to be able to get out of the house with a newborn because you haven’t figured out their daily routine quite yet, or you haven’t found a way to bathe and dress yourself when the baby cries every time you put them down,” Mavrides said. “It’s another thing not to be able to get out of bed for days at a time because you are overwhelmed by all the decisions you have to make for the baby’s care and you just want to hide and cry.”
What Causes Postpartum Depression?
“The first few months after birth are tremendously [intense] hormonally and behaviorally, making for a very vulnerable time in any woman’s life,” said Cassie Kaufmann, a licensed clinical psychologist and director of Greene Clinic in Brooklyn.
After birth, a woman’s estrogen and progesterone levels drastically decrease, resulting in an onset of unexplained sadness and tiredness. Despite these extreme changes, mothers are expected to immediately begin tending to their newborn around the clock, Kaufmann said.
“The mother is [still] recovering from the birth process, which can be fatiguing, and beginning to adjust to this new relationship and responsibility, and for new mothers, a new identity,” Kaufmann said.
And of course it’s not just birth mothers who can experience postpartum depression Research also has found that dads can experience the condition, which is usually brought on by not getting enough sleep or having a history of depression or mental illness in their family. Additionally, adoptive parents can also experience postpartum depression due to unmet expectations once the child is placed in their home, according to Karen J. Foli, an assistant professor at the Purdue University School of Nursing.
“Adoptive parents also may experience feelings about their legitimacy as a parent, or even surprise if they don’t readily bond with the infant or child,” Foli told Psych Central.
Aside from hormonal changes in the body, there are several other factors that contribute to a woman developing postpartum depression. Stressors such as conflict with or lack of a supportive partner, financial problems and clashing with other family members can also play a role. A previous history of mental health challenges, trauma and domestic violence increases the risk of a woman having postpartum depression, Mavrides added.
“Women with a history of depression and premenstrual dysphoric disorder are sensitive to hormonal shifts, making them more likely to experience postpartum depression,” said Cristina Dorazio, a licensed psychologist in New York.
How Can It Be Treated?
While postpartum depression is often a debilitating condition, it can be treated. Yet 60 percent of women with depressive symptoms after a child’s birth do not receive a clinical diagnosis, according to a 2017 report from the Center for Disease Control and Prevention.
Dorazio said she believes that many women don’t seek help for postpartum depression because they think they’re supposed to be able to handle everything alone.
“If women who just gave birth feel like they just aren’t themselves and it’s been two weeks, it’s OK to ask for help,” Dorazio advised. “A lot of women power through their symptoms because they think they’re being selfish if they seek help.”
“If women who just gave birth feel like they just aren’t themselves and it's been two weeks, it’s OK to ask for help. A lot of women power through their symptoms because they think they’re being selfish if they seek help.”
The lack of treatment is even worse for African-American and Latina women, who have higher rates of postpartum depression than white women in the U.S., but are less likely to receive treatment for it.
Mavrides said this is partly due to lower rates of screening for it at follow-up appointments, greater stigma in their communities around mental health problems, fears about having their children taken away and lower rates of follow-up care.
The journey to getting help for postpartum depression can begin by talking to an obstetrician or midwife about any symptoms at the six-week post-birth appointment. Mavrides said that now many doctors are even screening for postpartum depression at that appointment and if any red flags are noticed, they will refer them to a mental health professional.
The most common mental health treatments for postpartum depression are psychotherapy and psychiatric medication.
“Medication can help with regulating their mood, and talk therapy can offer both concrete tools for coping and space to process the huge life change,” Kaufmann said. “Group therapy can also be helpful for reducing social isolation and increasing social support.” You can search for therapy groups in your area.
If you need urgent help or fear you will harm yourself or your baby, reach out to the National Suicide Prevention Line at 1-800-273-8255 or via online chat.
In other words, you don’t have to deal with it alone.