As psychiatrists, one of the most common questions we are asked by new moms struggling with their emotions is, “What exactly is postpartum depression and what makes you say that I have it?” We then explain to our patients the details of the diagnosis, why they may be at risk, and the effective treatments that can help them feel better and finally enjoy life with a newborn.
New moms and their families are often relieved when they are able to give the constellation of negative and scary feelings and thoughts a name: postpartum depression (PPD). They no longer feel that they are alone, “going crazy” or are “unfit to be a mother.” Gaining an understanding of the illness is often a huge first step in the recovery process.
So, let us tell you the story of PPD that we share with the women who we see.
You are not alone.
Women are at high risk of developing depression. About one quarter of all women will become depressed at some time in their life, and at any point, nearly 10% of women will be depressed. Women are about twice as likely as men to develop depression.
We don’t know exactly what causes depression but we have several working theories. A combination of biological, psychological and social factors likely interact at a specific time to trigger depression. Biological causes are likely linked to women’s distinct hormones, which change throughout their lives; along with genetics and brain chemistry. Psychological causes are influenced by women’s style of coping with stress and personality factors. And social factors, such as the increased likelihood of women being abused, oppressed or impoverished may also contribute to depression.
We used to believe that pregnancy was a protective time for women, when they were at lower risk of developing depression. However, we now know that women develop depression at about the same rate (20%) whether they are pregnant or not. And after pregnancy ends, rates of depression remain elevated.
Postpartum depression affects about 10 to 20% of all new mothers. Women who have had a history of psychiatric illness, such as depression, anxiety or bipolar disorder, are at an even higher risk of developing PPD (60 to100%). Unfortunately, PPD is among the most common complications of childbirth.
When does postpartum depression start?
PPD is a treatable illness that can begin anytime within one year after having a baby. Although medical studies have demonstrated that the highest risk time for PPD to begin is 30 days after delivery, it can start as soon as a mom delivers her baby and is still in the hospital, or it may take a few weeks or even months to begin. Even if the illness does not begin in the immediate postpartum period, a woman may still have PPD.
About 25% of women with PPD actually start having symptoms of depression during pregnancy that never get addressed or treated. If a woman has symptoms of depression during pregnancy, these symptoms often get worse in the postpartum period because of the mother’s fluctuating hormones, lack of sleep and the tremendous stress of being a new mom.
What postpartum depression DOES NOT commonly look like….
PPD can be slow to reveal itself. Unlike what many people think, it does not manifest as “crazy” behaviour or as something that begins as soon as the baby pops out.
When told they have PPD, women often fear they will suddenly lose their minds and find themselves standing over their baby with a knife in hand. Or they fear that they will suddenly wake up to find themselves, with babe in arms, standing on a busy street about to jump in front of a bus. They worry that this illness starts suddenly, takes over your mind, and makes you do “crazy” and dangerous things. They also fear that social services will deem them unfit mothers and take their baby away.
Many patients mistakenly associate the scary stories that we sometimes hear in the news with PPD. They assume that the story of the woman in Texas who drowned her five children in the bathtub or of the Canadian woman who jumped onto the train tracks with her newborn baby in her arms are example of PPD. However, dramatic examples like these are much more likely to be caused by postpartum psychosis, or very severe untreated PPD that developed into psychosis.
And NOW, what postpartum depression DOES commonly look like….
In reality, PPD tends to begin slowly with feelings of sadness or worry. These negative feelings may gradually build over time, and can worsen if left untreated. Although PPD sometimes comes on more rapidly, it does not all of a sudden overtake a woman’s mind or present with intense suicidal feelings and homicidal thoughts that cause a mother to lose touch with reality.
If new mothers and moms-to-be are aware of PPD symptoms, they can seek help early in the course of the illness, which will help prevent a serious depression from developing.