A 38-year-old, married woman presents to her OB-GYN four weeks postpartum feeling overwhelmed, anxious, depressed, unable to cope and feeling hopeless and guilty regarding her ability to handle her new baby.

With each birth, many varied emotions are elicited in a new mother. These emotions include intense happiness and elation, but for a certain percentage of mothers, these emotions include feelings of depression, intense mood swings, insomnia, excessive crying, severe anxiety and panic attacks and difficulty bonding with the baby. The first thing a doctor must decide is if these symptoms are consistent with a more severe postpartum depression which occurs in 10-15 percent of all births, or are these symptoms more consistent with postpartum blues, aka “baby blues,” which is a rather common phenomenon occurring in 60-80 percent of births. This begins within a week or two of birth and usually resolves within a week. The symptoms include: sadness, anxiety, mood swings, irritability, crying, feeling overwhelmed, appetite problems, difficulty sleeping and poor concentration. These symptoms resolve on their own and are a normal phase many postpartum mothers go through when adjusting to the birth of a new baby.

Postpartum depression can occur after the birth of any child, not just the first one, and can begin up to six months after the baby is born. The symptoms may appear initially as baby blues, but they are more severe and do not abate within a week or two of delivery. These symptoms can reach great intensity and can interfere with one’s ability to care for themselves and their newborn. They include:

Depressed mood and mood swings

Severe anxiety and panic attacks

Reduced ability to concentrate

Socially isolating oneself

Severe fatigue and loss of energy

Loss of appetite or increased appetite

Insomnia or hypersomnia

Crying uncontrollably

Anhedonia or reduced interest in pleasurable activities

Feelings of being an inadequate mother

Extreme irritability and anger

Feelings of guilt, shame or inadequacy

Thoughts of harming yourself or your baby

Recurrent thoughts of death and suicide

It is important for individuals to realize that baby blues and postpartum depression are not a shortcoming, or something to be ashamed of, but a rather common result of the hormonal shifts (estrogen and progesterone) that occur after birth. In addition, one’s levels of thyroid hormone may drop as well after birth, prompting one to feel sluggish and exhausted. These levels should be checked and some new mothers will need to take a thyroid supplement during this time in addition to their peri-natal vitamins. In addition, there is the overwhelming responsibilities of caring for a newborn, which involves round-the-clock feedings and sleep deprivation that understandably wears at one’s psyche. Individuals simply don’t perform as well when they are sleep deprived, and even small problems can become difficult to tackle. A new mother is trying not only to care for herself and recuperate from a sometimes difficult delivery or C-section but she is now also caring for a newborn and she may doubt her ability to competently perform these tasks. In addition, the added weight that comes from pregnancy may be more difficult to lose than many women realize, especially if one is nursing and needs to increase her calorie intake. Many women start to feel frustrated about how they look and not feel as attractive, which contributes to their sad mood. The sooner the new mother gets the attention and treatment she needs, the better able she will be to manage herself and her baby, and the more positive she will feel about this special time in her life.

The first thing to do after noticing these symptoms are not resolving after a week or are making it difficult for you to care for yourself or your baby is to call your doctor. If you have any thoughts of hurting yourself or your baby call 911 or reach out to your doctor right away. They will refer you to a psychiatrist or mental health worker. If it gets to this stage you need medical assistance immediately; don’t wait and assume things will get better. Untreated postpartum depression can sometimes turn into a full-blown chronic major depressive disorder. In addition, it is important for mothers and their partners to realize that once one goes through a bout of postpartum depression they are at increased likelihood of it recurring during future pregnancies.

Treatment

Baby blues will typically abate on their own after a week or two. The first and most important thing to do if you feel these symptoms is to get as much rest as you can. There really are neurological benefits of rest, especially during this stage, so the popular saying, “Sleep when the baby sleeps” very much applies to this time period. If you see your baby sleeping, shut off your TV, close your book and get as much rest as possible. Secondly, it is very important to connect with others, be it family, friends or other new mothers. Most people have been through what you are going through at one time or another and their support and friendship during this time is invaluable. Thirdly, take good care of yourself. Your body is recuperating and you want to make sure you take the time to eat well, get a massage or manicure to boost your spirits, go for walks outside with your baby or do whatever else you need to keep your mood positive.

The treatment of postpartum depression is two-fold. It involves the combination of psychotherapy, performed by a trained therapist. Here you will be able to talk over your concerns to someone who understands what you are going through and can offer support as well as practical steps to make this stage more manageable and even enjoyable. The second part of treatment involves pharmacology, or medications, specifically antidepressants, anti-anxieties and sleep-aids. Many new mothers are very reluctant to start on medications because they are breastfeeding, but some of the SSRIs can be used during breastfeeding with minimal risk to the baby. Many postpartum women who were initially very reluctant to start on medications were so grateful once they finally started on a low-dose SSRI and were amazed at how much better they felt after just a few weeks.

Once again, as with baby blues, it is important to get enough sleep, make time for yourself, stay connected to friends and family and ask for help when you need it. You don’t have to do it all yourself, but rather reach out to your partner and other family members to help you care for the newborn so you can rest. Finally, be realistic about what needs to get done around the house. Many new mothers use this time to tackle projects around the home; instead, let things go, most things can wait, and use this time to focus on healing and getting yourself back on your feet.

By Shani Stein, MD