Women are most vulnerable to depression and anxiety during pregnancy and postpartum (the first year after a baby comes). If depression or anxiety is going to surface, it will almost certainly happen during this time. There are so many feelings and thoughts during pregnancy and postpartum, so how can Mom tell, for instance, if she’s experiencing the normal Baby Blues or the disorder postpartum depression (PPD) or postpartum anxiety (PPA)? Here are two major ways to identify the difference.
Most Moms Experience Baby Blues
Most new moms experience the Baby Blues — normal ups and downs, tearfulness, forgetfulness, vulnerability, and stress when their babies are born. Baby Blues don’t feel good, but they are temporary. They should be gone by about two weeks after the baby comes. If they continue, even if the symptoms are mild, this is no longer Blues – the mom should be assessed for PPD and PPA.
The second way we differentiate the Blues from a disorder is by the severity of the symptoms. If the symptoms are intense enough to get in the way of her daily functioning, even if they occur during the first two weeks postpartum, the mom should seek help for possible PPD or PPA. If the mom is experiencing symptoms for much of the day such as loss of appetite, difficulty sleeping at night when the baby sleeps, hopelessness, anxiety, anger, deep sadness, low self esteem, overwhelm, or lack of energy (that rest doesn’t take care of), she should get help right away. The only thing to worry about here is if the mom does not get help.
Postpartum Depression Warning Signs
- missing her doctor’s appointments
- worries excessively about her health or the health of the baby
- looks unusually tired
- requires a support person to accompany her to appointments
- loses or gains a lot of weight
- has physical complaints without any apparent cause
- has poor milk production
- evades questions about herself
- cries easily
- shows discomfort being with her baby
- is not willing to let another person care for the baby
- loses her appetite
- cannot sleep at night when her baby is sleeping
- expresses concern that her baby does not like her
Warning signs in the baby include excessive weight gain or loss, delayed cognitive or language development, decreased responsiveness to the mother, and breastfeeding problems.
Treatment is Important
It is extremely important to treat postpartum depression or anxiety, because if it continues unhandled, it can hang on for a long time and become harder to treat. Twenty-five percent of mothers untreated for PPD remain depressed after one year, which means all the family members and all the relationships within the family can been affected. There are many important reasons why a new mother with depression or anxiety should receive help as soon as possible. If she remains depressed or anxious, there is an increased risk of her child(ren) developing psychological, neurological, or behavioral disturbances, and there is a negative impact on the marriage and on the family dynamics.
The serious consequences of untreated maternal depression on children have been studied extensively. Infants with depressed mothers often weigh less, vocalize less, have fewer facial expressions and higher heart rates. They may be less active, slower to walk, fussier and less responsive to others. Toddlers with depressed moms are at higher risk for affective disorders. Studies show an increase in poor peer relationships, poor self-control, neurological delays and attention problems. Their symptoms mimic the mom’s depressed behavior. At 36 months, children with depressed mothers are often less cooperative and more aggressive. They also exhibit less verbal comprehension, lower expressive language skills, more problem behaviors and they perform poorly on measures of school readiness. Only one to two months of exposure to severe maternal depression increases the child’s risk to develop depression by age 15.
Find an Expert
Treating PPD and PPA is a specialty, so the mom should make sure she contacts a perinatal therapist who specializes in the field of maternal mental health in order to receive a complete assessment.
The recovery plan should include support, both personal and professional. It should address specific nutrition, a few hours of uninterrupted nighttime sleep — even breastfeeding moms can do this — medication if necessary, and regular breaks for herself. If her depression is so severe that she cannot exercise, just going outside, standing up straight, breathing deeply and getting some sunshine can help her. In addition, there is expanding research about complementary and alternative methods of treatment. Since each woman’s circumstances and symptoms differ, it is important for each to receive an individual assessment and wellness plan. For instance, one may need more uninterrupted sleep at night and breaks during the day, and another may require more social support and thyroid balancing.
It’s Not Just Moms
Although not caused, of course, by reproductive hormones, new fathers also experience depression at the rate of at least 10 percent. Their symptoms differ from the fluctuating moods that moms with ppd exhibit. Fathers seem to have more tension and short-temperedness as their main symptoms, accompanied with some fear, anger, frustration, and feelings of helplessness. Dads with postpartum depression are often concerned about their partners, disrupted family life, and finances. They typically have increased expectations for themselves and confusion about their new role.
The strongest predictor of whether a new dad will become depressed postpartum is the presence of ppd in the mother. A father whose partner has ppd has between a 24 and 50 percent risk of developing depression after the baby is born. The onset of his ppd is usually later then the onset of ppd in the mother. In Chapter 16 of Postpartum Depression For Dummies I discuss why partners, if they aren’t receiving adequate help themselves, sometimes become depressed as the moms recover.
When fathers suffer from depression after the baby is born, their baby boys are negatively affected the most. These boys have been found to have twice as many behavioral problems in their early years as other children without depressed fathers.
You Can Get Well!
One thing is sure — it is possible to achieve 100% wellness when provided proper help. The earlier mom (or dad) receives help, the faster the recovery and better the prognosis. The sooner new parents start enjoying their lives, the better it is for the whole family.
Shoshana S. Bennett, Ph.D. (Dr. Shosh)
Clinical Psychologist, Perinatal Specialist
Author of 4 books including, Postpartum Depression For Dummies
P.S. Dads and parents who adopt can also develop PPD and PPA, but that information will be saved for another post! In the meantime, if you want to contact me with questions or concerns, feel free through www.DrShosh.com and I’ll respond quickly. I look forward to hearing from you.
P.P.S. In case you missed it, Kim West (The Sleep Lady) and I did an interview on Facebook Live. You can see that here.
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