Scary Shit Series – Postpartum Depression

Postpartum depression is nothing to mess around with. Find out what it is and what to do about it.

I’d like to start this by saying whoever coined the phrase “baby blues” needs a throat punch. It has such a condescending tone – “someone’s got the Mondays” – and even at it’s very mildest, it’s shitty and deserves a real description. What’s worse is that it lays the groundwork for dismissing an even more serious issue – postpartum depression.

I suspect I had PPD the first time I gave birth but I didn’t want people (including my doctor) to think I wasn’t handling motherhood so worked very hard to hide it.

Because I can’t officially say I had postpartum depression, I wanted someone who was diagnosed with PPD to write this post so Claire was kind enough to step up to the plate.

Not only do I think it’s important for you to read this, but for your friends and family to read it too. That way everyone is in the know.

Have you heard of postpartum depression (PPD)? It’s one of those catch phrases that new moms and doctors toss around and, thanks to Brooke Shields, people seem to generally understand that it has to do with a mom being super bummed out after childbirth.

And even though Brooke did us all a great service by making it a recognizable term, most people (including me when I was pregnant) don’t really get what it means and how it looks in a living, breathing woman.

So let’s start with the facts about PPD: it is common. Studies vary a bit, but somewhere between 1 in 8 and 1 in 6 moms experience PPD. It is caused by a number of physical, emotional, or environmental factors. Physically, there is a huge surge of hormone before birth and then a huge drop afterward and you are completely sleep deprived and your body is healing and all, ‘wtf just happened here?’ Emotionally there is a lot to adjust to—you may feel overwhelmed and anxious by the responsibility of caring for a newborn or feel out of control of your own life. Or there may be some external conditions contributing to PPD, such as juggling older siblings, financial problems, or lack of family support. Any and all of these things, alone or combined, can contribute to a woman developing PPD.

Symptoms of PPD include pretty serious things like overwhelming sadness, anxiety, feelings of inadequacy, sleeplessness and trouble bonding with your baby. But symptoms of other disorders often present with PPD, too, such as obsessive compulsive disorder or paralyzing anxiety. Moms may also feel rage, regret, or feel generally numb about everything. There is also a range in intensity with these symptoms—some people feel general melancholy while others are prone to full-on fits of rage. Some women think about hurting themselves; others think about (accidentally or on-purpose) hurting their new baby. It’s all bad news.

There is also a thing called Baby Blues. Baby Blues are even more common, occurring in 60-80% of women. The symptoms of Baby Blues are initially similar to PPD: sadness, crying, irritability, anxiety. The difference is that Baby Blues symptoms show up within a couple days of delivery and are gone by about two weeks postpartum. Any mood changes that stick around longer than two weeks are then considered PPD.

The most common treatments for PPD are therapy with a mental health professional and prescription antidepressants. They can both work wonders, alone or together. If you are nursing, please know that there are antidepressants that are safe to take while breastfeeding!

It is also important to note that PPD symptoms usually crop up anytime in the first year. Yes, even if you sailed through the first 6 months of motherhood you can still get PPD. And PPD can also be triggered by weaning, thanks to the sudden drop in hormone. I had a friend with a 1.5 year-old who weaned and had a few weeks of mild PPD afterward. Hormones are crazy bitches, man.

PPD can happen to anyone. I’m going to repeat that. PPD CAN HAPPEN TO ANYONE. Yes, I’m yelling that at you because there is a stigma attached to PPD and it is bullshit. People want and expect you to be happy after your baby is born. They tell you that you are lucky and blessed and your baby is perfect. And then those people leave and you are left wondering, if you are so lucky why can’t you stop feeling sad, or anxious, or why you have no appetite or why you can’t sleep at night, even when the baby sleeps? That is the heinous bitch that is PPD.

The only real risk factor is having previously had depression or anxiety—either during you pre-pregnancy life or a previous bout of PPD from a prior pregnancy. But it happens to a lot of women who have never had depression before. Also, for almost half of women, PPD begins during pregnancy.

I think the biggest problem here is there is no built-in system in our society for PPD screening. Right now in the States the way it works is that your OB or midwife may give you a screening survey (something like the Edinburgh Postnatal Assessment Scale) at your 6-week postpartum checkup asking if you feel depressed. That’s it. Does that seem weird to anyone else? The main goal for your OB/GYN at this checkup is to make sure your cervix has closed, your stitches have healed, and oh yeah, lets throw in a psychiatric screening tool that really only a mental health professional should administer. What the crap!?

Not to mention that you would actually have to be honest with your doctor for that appointment to work as a screening tool. I completely lied to my OB after the birth of my second child (“Everything is great! He’s such a wonderful baby! I’m so HAPPY!”) and then suffered for months afterward with depression. After the birth of my third child last year I didn’t lie on the survey that my OB’s nurse handed me. I wrote down that I wasn’t sleeping well; that I was having feelings of hopelessness; that I often felt anxious and overwhelmed. When my doc came in a few moments later he brought the nurse back in with him and said, “Is it OK if my nurse stays? She is going to hold your baby for you while we talk about this survey.” And I just lost it. I started snot-sobbing all over my gown and the paper covering on the table. I couldn’t even choke a sentence out. I left that appointment with names of therapists and a prescription for anti-depressants and I felt about 50 pounds lighter (I wish) from just letting it all out, finally. But what if I had decided to lie again? What if my doctor had been an asshat and not cared that I had PPD?

All of this is to say: the first line of screening is going to be your family and friends. Those people who know you and will be able to recognize any changes are going to be the ones who are able to say, “Hey there. Are you OK? Let’s go see a doctor.” For those of you who are pregnant as you are reading this, talk to your partner and besties about PPD *now*. Send them this blog post or print up a list of symptoms or just have a talk about how you may need some help getting some help after this baby is born. And if you are reading this and hiding from your own PPD then honey, please, please call your doctor. Tell your partner. Call your bestie. It can get so much better, but you need some help. I don’t know a single mother who doesn’t.


Great SITES, POSTS & BOOKS:


Also, check out my post on placenta encapsulation. There aren’t a ton of studies on its effects on PPD, but many, many women swear it helps.


Claire Goss is a stay-at-home mother of three (ages 6, 4, and 1) who lives in suburban Boston. She has MA degree in child development, which doesn’t come in handy at all when your child has just ripped open 10 packets of infant oatmeal and dumped them on the floor. She is also known as Guru Louise at Rants from Mommyland and was also a regular contributor at Babble.com. She has been reading Pregnant Chicken for years and loves writing for the Burd because she gets to use all those curse words she is forced to edit out of daily preschool vocabulary.

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47 Comments

  • Great article! I felt fine at the 6 week appointment with the one page survey. It wasn’t until my baby was 3 months old that I realized I wasn’t okay. Then I found out my baby has plagio and I spiraled way down into the black hole of depression.
    I wanted to read "How my child’s food allergies sent me into a deep depression and changed my life – Ali Blair" but the link isn’t working. 🙁

  • I SO appreciate you putting everything out in the world for everyone to read. I know how vulnerable it makes you to do that, but how much you just helped SO many women by putting that out there. I felt so crazy and lost when I had my bundle of joy months ago, but seeing things like this helps so much.

  • Thank you so much for this piece. It’s insightful and honest. My husband of six years, and partner of 10 didn’t support me and backed off from me and our relationship. I suffered for 15months before breaking and seeking support from my GP. I have an amazing counsellor and prescription anti- Ds that support my serotonin depleted mind through the healing/recovery process. 8weeks after diagnosis he walked out on me and our 16 month old IVF miracle (which he had pushed for) having secretly rented a flat and spent a month furnishing it in secret.
    He has blamed me for the whole break up, citing that my behaviour made him fall out of love with me. I drowned under guilt, the crushing loss of my "soulmate", being back at work f/t, having no family closer than 200miles away and coming to terms with my condition.
    I survived. I focused on recovery and what I needed to do to proved for our son-not lose my job, continue to pay the mortgage, stay healthy.
    I discovered a support network that I never knew I had. I reached out for help in ways I never would have before. My relationship with my Mum is better, and once I was honest about diagnosis, she started coming down every weekend to support/help. Our son has access to his Daddy and is a happy little boy, if not a little clingy to Mumma, but I’m his constant and his rock, and our home is his safe place. I now have more good days than bad. When it’s bad, I feel like I’m wading through treacle, but I try to focus on how far I’ve come, and putting one foot in front of the other, and that I feel this way because of my depression and anxiety.
    Today was a bad day, and that’s why I read this post. I wish that I could show it to my husband back then and scream at him "Why didn’t you help me?!!!! How could you not see??? You were my one, final safety net. I needed you to help me when I repeatedly told you I couldn’t cope. Why didn’t you help me? Why didn’t you stay? Why wasn’t I worth it? WH weren’t me and our son worth it?? I will get better and be the old me again, I just needed help"
    Now that I’m recovering, I understand that it wasn’t just my illness, but that he didn’t know how to cope, and was a coward and ran away. Like his Father before him, but I have to ask; if he had been more aware, if he had read this type of article or we both had adequate knowledge of PPD, would things have been different.
    So, wonderful Mummyies, Daddies, sisters, brothers, and friends please be aware of this crippling condition, and if you spot any of the signs in a loved one, talk to them, support them, but critically, take them to see their GP
    ?Xx KJ

  • PPD is always diagnosed in people who have options. A parent who goes right back to work, right back to life doesn’t have that luxury/time to be depressed. Yes, we can be depressed because of the responsibility but we need to suck it up and face the damn reality. The kid is not going anywhere. Me being depressed or whatever is hurting the baby. Another thing I realized as parent, after you have a baby, you live his/her life. Your life is more or less over unless you are selfish. You no more can do things you did before the baby came along. So, depression has no place in my life.

  • I suffered from depression during my 2nd pregnancy. I was only in my first trimester but I wasn’t sleeping and felt anxious all the time. I remember one Saturday I got desperate and called the on call doctor because I couldn’t function. The on call doctor was so rude and made me feel like an complete idiot for even calling that I never bothered to follow up. I did call my regular doctor to follow up on the not sleeping thing and he said to take Benadryl. Once I did that the anxiety went away so I never bothered to mention the rest of it. I’m now pregnant with my 3rd and while excited, I have been sick for almost the entire first trimester and while not depressed, I am frustrated. Thank you for writing this. I know I definitely need to do a better job of being more honest with my primary OB.

  • You know after reading your blog I feel like not only did I go through an undiagnosed PPD with my 1st born but also my second 12 years ago!! And I feel like – "You know what? I bet EVERY SINGLE WOMAN OUT THERE HAS SUFFERED, IS SUFFERING, or WILL BE SUFFERING PPD in the future; but most of all I decided that 100% of woman go through "some small form – whatever it may be), but looking back I bet we can all say "huh, so THAT’S what it was!!" THANKS for a great read and the motivation to get my own blog started!

  • Great post. Would like to add that depression can hit at any time, even while pregnant (again, hormones, physical discomfort, sleeplessness, anxiety- all the ingredients for depression are there too). I was in my 5th month of my second pregnancy when I totally lost it one night. I was crying hysterically and couldn’t pull myself together, as I was sure my life was crumbling around me. Thankfully, when I told my husband "I think I’m depressed" he was so supportive. My OB referred me to a psychologist, gave me an Rx for antidepressants and within 2 days I was a totally different person. Like the author said, we often explain away moodiness as normal, but you know yourself and what’s normal for you.

  • It would be nice if articles like these would also speak about PPD because there ‘isn’t’ a baby. PPD can also happen after a miscarriage, a pregnancy termination, a stillborn baby,… In that case it can remain even more hidden because people expect you to feel bad, and it may be hard to tell the difference between ‘normal’ mourning and PPD.

    • That’s what I was going to add! I’ve heard it’s actually a lot more likely for a woman to develop PPD after a miscarriage than after a live birth, but I know my doctors gave me PPD pamphlets as a matter of course with my healthy pregnancy, and not with my miscarriage. Not only is there the grief, but the messed up hormones, possibly some trauma from what your body just went through (not all experiences are the same, but I know for me: SO. MUCH. BLOOD.)…

      I was still nursing my older child at the time, which seemed to just mess things up even more. My period wouldn’t come back, but every four weeks I’d get the cramps from hell (seriously, it was almost as bad as childbirth)… I was worried that suddenly weaning would make me even more depressed, but in my case weaning (not TOO suddenly, but definitely quickly) seemed to help my body, um, get back into whack, so to speak.

      One article that helped me: http://www.apa.org/monitor/2012/06/miscarriage.aspx

      I particularly liked, "In addition, couples should be reminded that pregnancy hormones can continue to cause emotional turbulence, Swanson says. ‘Prior to the menstruation post-miscarriage, there is a physical component to the sadness where it almost feels like the sadness owns you,’ Swanson says. ‘After the hormones get resettled, there is a shift and it will start to feel like you own the sadness.’

      That was basically my experience. Oh, disclaimer that parts of the section on "early loss" in the above link made me mad. Mine was fairly early, and my first ultrasound was the one where I found out the heart had stopped, but I still definitely felt grief, and would have noticed without the help of modern technology. That level of bleeding would be, um, kind of hard to miss. To vastly understate things.

      Also if I recall correctly, a previous loss is one of the risk factors for prenatal depression or PPD with later pregnancies. …Yes, that’s in the above link, too. And complications in general are a risk factor for the prenantal depression.

  • I had no screening for PPD and I definitely had it. I’m still scarred from it. I try to blog about it so that others in the same situation as me won’t feel the stigma I felt. I had a new baby and I was anything but happy. Not sure if it’s appropriate to share my blog link or not (not trying to take away from this post) but for those experiencing PPD or thinking they might be, my blog is christinenestrick.blogspot.com Hang in there!!!

  • I shared your post on FB with this comment…

    "I thought that what I felt must be what every other new mom felt and went undiagnosed with #1. With #2 I lied at my 6 week check up and told them that I was happy and fine (much like the author of the article) only to call the office a week later in tears begging for help. With #3, I just said "Screw the stigma. I am not leaving this hospital without a Rx for meds… I will not go to that dark place again." Depression is not a character flaw. It is an illness as real as high blood pressure or diabetes. I have learned in the last few years how to deal with it through diet and exercise, but I am so very happy those medications were available when I didn’t have the ability to plan past the next dirty diaper."

    The only thing that I would add is that my husband was as clueless as I was. He just thought this was the new normal and we were doomed to life with me being mad at the world and hopeless. That must be what all other families with a new baby were like… they were just hiding it. He even said when my oldest (of 3) was 6 months old "there will be no more children."

  • Claire thank you so much for writing this. It really resonated with me. I suspect I had PPD after my first and I could pretty much write your experience as my own, ver batim. Except I was honest on that survey after my first and when the OB marched in with her nurse she asked a couple of very leading questions about how I was probably struggling because breastfeeding wasn’t going well and wouldn’t I feel better if I just got over that? And that was that. Not a very open dialogue. I was practically screaming for help and then she made me feel silly about it and I never pursued the help I really needed. Thank god for a supportive husband!

  • Very useful collection of sites, books and posts related to Post Partum Depression – all at one place. Amy G. has rightly pointed out that men are not expected to show their "soft" side to society, so even if they are suffering from PPD, it’s overlooked.

  • This is probably the best post I’ve read on PPD, pretty much ever. …and I’ve read MANNNNNNY! You summed up the symptoms, the situation in the US and gave accurate information all in one post. Brava!

  • Having had depression my whole life, I want to add one more thing: do everything you can to be patient and compassionate with yourself. Make it a priority.

    It literally took me years to figure out how to manage depression. I had help, but ultimately everyone needs to figure it out for themselves. Its much easier to work through this when you are at least kind to yourself. And since PPD may not last for years while you figure yourself out, at least you didn’t beat yourself up in the meantime.

    Toughing it out has NEVER made any situation better. Believe me, I tried for years.

  • With my first baby, the pediatrician did the PPD screening at every visit. I think that’s a great system, since you’re there every couple of months. I don’t know why they all don’t do it.

  • Thank you for writing this—this is such an important topic. One thing I wanted to add is that new dads can get PPD, too. And because they’re not being screened for it at all (and because our society expects men to be all strong and self-reliant and whatnot), it’s extra important for family and friends to be aware that it exists and to be willing to talk about it.

    • Yes! My hubby with a pre baby anxiety disorder ended up with major panic attacks and bouts of depression, which didn’t help my own mental health. I tried to stay strong for the both of us to keep our shit together. Pretty crazy first 18 months of our son’s life…

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