It's common to feel stress and anxiety after welcoming a new baby, but postpartum depression is more than just the "baby blues."
As awareness of this serious but treatable mood disorder rises, resources and information for those with postpartum depression become more widely available. We chatted with Dr. Sarah Homitsky, a psychiatrist who specializes in postpartum depression, to get the essential answers to our questions.
1. How many people are affected by postpartum depression?
Dr. Homitsky: Postpartum mood and anxiety disorders are the number one complication of pregnancy, affecting an estimated 1 in 7 women. More than half the time, a woman starts experiencing symptoms of depression during her pregnancy, which is why universal screening for depression is so important during pregnancy. Universal screening during pregnancy improves the identification of women with depressive disorders and allows for earlier treatment.
2. How does postpartum affect individuals of different ages or ethnicities?
Dr. Homitsky: Postpartum mood and anxiety disorders can affect any woman, regardless of age, education level, ethnicity, or socioeconomic status. With that said, trauma, financial problems, lack of social support, and having a baby with medical problems can increase one’s risk for postpartum depression.
3. During pregnancy, what chemical or hormonal changes in the body happen that cause postpartum depression? And what chemical changes happen after delivery?
Dr. Homitsky: Both estrogen and progesterone levels increase during pregnancy. We suspect that the rapid decline in these two hormones that coincides with delivery can trigger postpartum depression in susceptible women. A metabolite of progesterone called allopregnanolone may also play a key role. Allopregnanolone helps to keep our mood positive and keep us calm, so some women may feel restless and sad postpartum because of the abrupt decline in allopregnanolone.
4. What are common signs to be on the lookout for?
Dr. Homitsky: Some of the signs to look out for are a loss of pleasure or interest in activities, a feeling of sadness most of the time, a change in appetite, feeling guilty about not being a good enough mother, feeling irritable or having a low frustration tolerance, struggling to interact or connect with your baby, isolating yourself from family and friends, or a change in your sleep. Postpartum depression typically lasts longer than two weeks and does not go away without treatment.
5. Why do you think women are hesitant to address their feelings after having a baby?
Dr. Homitsky: There is a preconceived idea that the postpartum period should be the happiest time in a woman’s life. Therefore, it is easy to understand why women often feel embarrassed or guilty about their sadness, often saying things like “There must be something wrong with me." It is our job as medical providers to educate women and families on the fact that it is common for women to feel sad postpartum and good treatment exists.
6. Can a woman not have postpartum with one pregnancy but then experience it with a second?
Dr. Homitsky: Postpartum depression occurs in both first-time mothers and mothers of more than one child. A prior episode of postpartum depression can increase a woman’s risk for another episode — however, it is not a necessity. No pregnancy and delivery is exactly the same. Therefore, if a woman with no prior history of postpartum depression delivers her second child amid family and/or financial stress following a traumatic delivery, she is at increased risk for postpartum depression given her current circumstances.
7. What are common misconceptions around postpartum depression you’d like to address?
Dr. Homitsky: Postpartum depression is not a choice, it is not uncommon, and it is treatable. If you are struggling with depression, this does not mean you are a bad mother! Specialized perinatal mental health treatment is available, so ask your OBGYN or primary care provider for a referral.
8. What language should we use to empathize with someone going through postpartum?
Dr. Homitsky: It can be helpful to say simple things like “I love you, and I am here to help you. What can I do to help you today?” Make sure she understands that it is not her fault that she is suffering from postpartum depression.
9. How can I approach a loved one who I think might be suffering from postpartum depression?
Dr. Homitsky: Being a new mother is exhausting! Saying things like “Just snap out of it” or “It’s all in your head” doesn’t help her feel better and can cause increased guilt. Also, try not to compare her to other mothers. Tell her she is not alone and ask what you can do to help. Offer to watch the baby for a few hours so that she can do something that she enjoys, like taking a walk or a warm bath. It is also important that you help her get the mental health treatment she needs to start feeling better.
10. What resources are available for women, family members, and friends to learn more about postpartum depression?
Dr. Homitsky: MotherToBaby is a great resource for women who are prescribed psychotropic medication during pregnancy and/or postpartum. Postpartum Support International has a lot of quality information about the symptoms of perinatal mood and anxiety disorders, as well as helpful resources for new mothers and families. [Editor's note: PSI's helpline is available 24/7/365 at 1-800-944-4773.]