How to recognize the signs of postpartum depression


by Lori Atkins, MD   and Andrea Palmer, MD

Mar 27, 2019

It’s time we talk openly about a condition that affects more women than you might realize — postpartum depression.

It often starts something like this…  

Here you are. Mother of two. Living the dream. Two weeks ago, you delivered your second baby, your newest miracle. Of course, you aren’t sleeping well, but that you expected. You’re no rookie this time. But now, your firstborn really wants to spend time with you, and you with her, but alas, the new baby needs your attention and your milk.

You’re worn and frazzled, the laundry pile has taken on a life of its own, and you have semi-malicious thoughts toward your husband who casually strolls in and asks benign questions that seem to cut you to the core (i.e. “What’s for dinner?”).

You feel like this should be a most joyous time. But you find you are tearful, anxious, maybe even frightened. You start to doubt your ability to care for these two small people who need you. All at once, you suddenly feel inadequate, lost, angry and very alone.

Sound familiar? Take heart and keep reading. There is hope — and help — waiting for you.

What causes postpartum depression?

Postpartum depression affects about 15 percent of women with no prior history of depression. If you have a personal or family history of depression of any kind, the rates are even higher. And even if you don’t have true depression, the “baby blues” — a mild and transient form of postpartum depression that self-resolves — occur in up to 80% of women.

If that’s you, you are definitely not alone.

Why does postpartum depression happen? No one knows the exact mechanism for sure. We do know that in women who experience postpartum depression, there is an increased sensitivity to the normal hormonal fluctuations that occur after delivery. During pregnancy, your estrogen, progesterone, cortisol and thyroid hormone levels are high. After you deliver, those levels all plummet. Each woman reacts to these changes differently and may even react differently from pregnancy to pregnancy. 

Related: Fact or fiction: 6 common myths about pregnancy

Your likelihood of developing postpartum depression depends on your sensitivity to these changes, your genetics, your personal history of depression, your life stressors and how well you cope with chronic sleep deprivation.

Diagnosing and treating postpartum depression

In most OB/GYN offices, we use a depression screening tool that is specific for the period of time around pregnancy and delivery. If the screening test is positive for depression, we typically recommend treatment in the form of:

  • Counseling
  • Dietary changes
  • Exercise
  • Meditation
  • Medication  
  • A combination of the above

I’ve discovered over the years that one treatment itself is not nearly as effective as a combination of these modalities. I’ve also discovered that many women have had a low level of depression for years, but do not realize until we screen for it, identify it and address it.

Many women worry about starting medication — Is it safe? Is it okay to breastfeed while I take it? The answer to both is “yes.” Talk to your OB/GYN about your specific concerns. 

Another natural question may be — If postpartum depression is a hormonal problem, why not treat with hormones? Here’s the answer: Sometimes we do. If your thyroid is truly not functioning well, thyroid replacement can work wonders. Some women who aren’t nursing can take combined contraception, which can correct the loss of placenta estrogen and progesterone quickly.

Another common concern regarding antidepressant medications is that you may have to take it forever, or that you’ll become addicted. But selective serotonin reuptake inhibitors (the most common type of antidepressant) are not addictive. The good news is that medication often only has to be used for a few months.

Normalizing the mental health conversation for new mothers

Once sleep and your new structure of life can be restored and when your normal hormonal function returns, many women find they can stop treatment. Yes, you heard me right. For most women, “normalcy” will return.

It is so hard when you are in the throes of newborn baby care to really evaluate how you “are.”

I have had two children. Although I’ve been fortunate enough to not experience postpartum depression, sleep deprivation is real, and I am by no means immune to its effects. In hindsight, I know that I didn’t make my best decisions during the times I was up all night with my babies and still trying to be a normally functional human being during the days. I didn’t see it then, but it’s clear now.

So, moms, please know you are not alone. We have all been there, walked through the fire and lived to tell the tale. You will too.

But if you are experiencing symptoms of sadness, fear, anxiety or withdrawal, please talk to your doctor. You may or may not need medication. But you definitely need an ear to listen, a hug, maybe a good cry, and someone on your team fighting for you, your safety and your peace of mind. Find that someone today.

About the Author

Lori Atkins, MD, is an obstetrician-gynecologist (OB/GYN) on the medical staff at Baylor Scott & White All Saints Medical Center – Fort Worth.

Andrea Palmer, MD, is an obstetrician-gynecologist (OB/GYN) on the medical staff at Baylor Scott & White All Saints Medical Center – Fort Worth.

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