HOW DO I KNOW IF I HAVE A POSTPARTUM MOOD DISORDER

AND WHAT CAN I DO ABOUT IT IF I DO?

by Ellen Krug, MSW, LCSW

“I’m so tired. Who has time for anything?”

“I love breastfeeding.”

“Breastfeeding is so challenging.”

“My husband is so calm with the baby.”

“My husband doesn’t have a clue.”

“I can’t remember where I put anything.”

“I can’t believe how much I love the baby. I never expected this feeling.”

“The baby cries all the time.”

“I never even get to take a shower.”

These are some of the things I’ve heard from new moms in my practice. You’ve probably heard them too, or even said them yourself. After having a baby everyone wants to know, “When will things get back to normal?”

Life will never return to exactly the way it was before you had children because your family structure and responsibilities have changed, so I call life post-children the “new normal.” For most of us, the intensity of the newborn period decreases and life gets easier after a few months, but for some women this time is complicated by Postpartum Mood Disorders (PPMD).

Postpartum Mood Disorders refers to a spectrum of disorders, which includes Baby Blues, Depression and/or Anxiety, Panic Disorder, Obsessive-Compulsive Disorder, and Psychosis. Symptoms may actually occur during pregnancy or begin during the first year after the birth of a baby (or later if weaning from breastfeeding occurs after one year) and may change in type and severity over the course of the illness. Postpartum Mood Disorders affect 20 – 30 % of postpartum women and occur in virtually all cultures and cut across racial, ethnic, class, and educational lines.

While there’s still a lot that’s not known about PPMD, there are probably multiple causes, including hormonal imbalance, stress, and isolation.

Some Risk Factors for Postpartum Mood Disorders may include:

Personal and/or family history of anxiety, depression, bipolar disorder, schizophrenia

History of PPMD in mother or other close female relative

Previous episode of PPMD (50 – 80 % chance of recurrence)

Complications of pregnancy and childbirth

History of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) and menstrual problems

Mood changes while taking birth control pills or fertility medication

Thyroid dysfunction

Abrupt weaning

History of trauma, physical/sexual abuse, personal and/or family substance abuse

Unresolved losses, including recent loss of a parent

Recent stressful life events

Ambivalence about pregnancy and/or maternal role

Unrealistic expectations

Social isolation and poor support

Remember, though, risk factors do not necessarily lead to or cause PPMD; they just make it more likely that a new mother will experience one. Some new moms with risk factors do not develop a PPMD; other new moms with few or no risk factors do develop a PPMD.

Here are some Symptoms of Postpartum Mood Disorders:

Sleep difficulties - often inability to sleep when the baby sleeps

Appetite changes – usually loss of appetite

Extreme fatigue

Difficulty concentrating and making decisions

Feeling overwhelmed

Irritability

Oversensitivity

Restlessness

Sadness

Weepiness

Anxiety

Excessive worry

Lack of feeling for your baby

Loss of normal interests and pleasure

Decreased interest in sex

Hopelessness

Comparing yourself unfavorably to other mothers

Panic attacks – shortness of breath, palpitations, dizziness

Intrusive thoughts – often fears of harming yourself or your baby

Repetitive behaviors – counting, checking, cleaning

Delusions and/or Hallucinations – these are considered a psychiatric emergency and the woman should receive immediate attention and treatment

A majority of new mothers will experience some of these symptoms of PPMD. In fact, Baby Blues is so common (up to 80% of new mothers) it is usually considered to be “normal,” not really a disorder. Its onset is within the first week postpartum, with symptoms that persist up to three weeks and decrease without treatment. Support and reassurance, from a postpartum doula, for example, can be invaluable in helping the new mom (and family) adjust to life with a baby and become more confident in her mothering.

When symptoms do not resolve within the first several weeks postpartum or begin after that time, you may be experiencing one or more of the other Postpartum Mood Disorders.

Some Suggestions for Coping Strategies and Prevention of Postpartum Mood Disorders:

Hire a labor doula and postpartum doula

Have health care providers in place for baby and for parents

Get informed about birth, postpartum, and parenthood

Nurture, follow, and trust your instincts

Take care of your physical needs

Sleep when the baby sleeps

Eat well – Did you know that breastfeeding moms need even more calories than when they were pregnant? Prepare food in advance or have friends and family bring healthy food

Exercise (as soon as you’re given the ok by your health care provider)

Join a new mom support group

Stay connected with your partner

Try to postpone major life changes (such as a new home or new job)

Acknowledge (express and accept) negative feelings and pay attention to positive feelings as well

Nurture your sense of humor

Have realistic expectations

Be flexible about schedules (in fact, be flexible about everything!)

Don’t overload yourself with unimportant tasks

Don’t be over-concerned with keeping up appearances

Be careful about planning for and hosting events like naming ceremonies, briss, and baptism

Try to continue some outside interests and take some breaks

Have a plan for your days, but keep it flexible

Get outside once a day, if possible (take a walk with your baby, for example)

Treatment of Postpartum Mood Disorders

A mother who is experiencing symptoms of PPMD should have a physical exam to rule out other causes, such as a thyroid condition, as well as an evaluation by a mental health provider so she can begin appropriate treatment. Counseling or psychotherapy, support groups, and journaling are valuable treatment modalities. If necessary, psychotropic medications (such as antidepressants) can also be used, even during pregnancy and breastfeeding. It is important to see a psychiatrist who is familiar with treating PPMD, especially during breastfeeding if you are and want to continue to do so. Safe and effective alternatives (or adjuncts) to psychotropic medications that may be used include homeopathy, some herbal remedies (not all herbal remedies are safe during pregnancy and breastfeeding), acupuncture, massage, and light therapy. In addition, practical support and parenting education are always helpful.

Most importantly, if you’re wondering whether or not you’re suffering from a PPMD, you should talk to someone (your partner, health care provider, friend or family member) and get help. You can be treated and you can feel better!

© 2013 Ellen Krug

A version of this article was originally written for and appeared on Hip Slope Mama Blogazine.