I know that I don’t exude excitement and joy, but I don’t know how to process what I am feeling. I just want to have one really good cry and let it all out, but I’m ashamed to. I’m afraid that if I start crying I won’t be able to stop. There’s so much love going on around me, and all I feel like doing is screaming until my head explodes. I don’t know how to share any of this with anyone, so I cry alone when I get a chance; just a few minutes here and there.
Many women who experience postpartum emotional difficulties are afraid to discuss their negative feelings for fear of being seen as a bad mother or crazy. But postpartum mood disorders are both common and treatable, and it is important, both for our own sake and for the sake of our families, to seek help.
Postpartum mood disorders can include severe depression (sometimes mixed with anxiety), as well as other seriously disabling problems labeled with terms such as anxiety/ panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and, very rarely, psychosis. Postpartum depression is by far the most common of postpartum mood disorders, affecting about one in seven new mothers. It can start anytime in the first year after giving birth. Symptoms of postpartum depression can include hopelessness, suicidal thoughts, sleep and eating problems, inability to feel good or be comforted, and withdrawing into oneself. A woman experiencing postpartum depression may have a hard time caring for her baby or meeting the other demands of daily life.
Besides postpartum depression, women sometimes experience other postpartum mood disorders. Feelings of intense anxiety, fear, or panic, along with rapid breathing, an accelerated heart rate, hot or cold flashes, chest pain, and shaking or dizziness are symptoms of an anxiety/panic disorder. Recurrent frightening thoughts, including obsessing over the baby’s health or acting out repetitive behaviors such as compulsive hand washing, are symptoms of an obsessive-compulsive disorder. A combination of depression with anxiety/panic disorder or obsessive-compulsive disorder is also possible.
Women who experienced fear, powerlessness, or a sense of being mistreated during labor and delivery are at greater risk of developing post-traumatic stress responses. These women may develop unpleasant repetitive thoughts, nightmares, agitation, fear of interactions with others, or an ongoing sense of panic.
A very small percentage of women (about one or two per thousand new mothers) experience a serious illness called postpartum psychosis. Women with postpartum psychosis may experience hallucinations and delusions and other symptoms including insomnia, agitation, and bizarre feelings and behavior. Postpartum psychosis generally develops within one to four weeks after giving birth and is considered a medical emergency.
Who Is at Risk?
Any women can develop a postpartum mood disorder. The hormonal changes that occur during pregnancy and birth appear to play a strong role in the development of these problems.
However, certain factors are linked with a greater likelihood of experiencing a postpartum mood disorder. These include severe or ongoing postpartum pain; health problems in the mother or baby; a high-needs baby; relationship, financial, or other major stresses; isolation; and a lack of social support. Ongoing sleep deprivation is also a risk factor.
Women who have a past history of physical or emotional trauma, depression, sexual abuse, severe premenstrual syndrome, substance abuse, or other mental health issues are at increased risk of postpartum mood disorders. Adolescent mothers are also at increased risk of postpartum depression.
If you are experiencing postpartum emotional problems, ask for support and practical help taking care of your baby and yourself. If you have a partner—or other support people—available, ask him or her to share household chores and nighttime feeding duties. Do only as much as you can, and don’t blame yourself for leaving nonessential things undone.
Isolation can contribute to depression and anxiety, so try to find at least one family member or friend with whom you can honestly share your feelings and your experience of motherhood. Meeting with a new-mother group can be a great way to connect with other women facing the same challenges. Many support groups and online chat rooms focus specifically on helping women with postpartum depression.
Sometimes, however, the support and help of friends and family is not enough. If this is true for you, consult with your primary care physician or ob‑gyn or seek out a social worker, psychologist, or psychiatrist who is knowledgeable about postpartum mood disorders.
Besides getting more support from the people around you, the two basic types of treatment offered by mental health professionals for postpartum depression and anxiety disorders are talk therapy and medication. Talk therapy involves regular sessions with a counselor or therapist, discussing your feelings and developing constructive ways to meet the challenges of being a new mother. Medications—including antidepressants, anti-anxiety drugs, sleep medications, or a combination of the three—can sometimes be helpful.
Counseling or Therapy
Therapy sessions can help you express and understand your feelings more fully. They can also help you explore possible solutions for postpartum challenges and learn better ways to communicate your needs and get them met. Therapists and counselors can direct you to other community resources for new mothers and families.
Although antidepressant medications are commonly prescribed for postpartum mood disorders, surprisingly there has been only one small study (involving 87 women) that actually tested the effectiveness of drug therapy for postpartum depression. This study showed that fluoxetine (Prozac) and six sessions of counseling (cognitive behavioral therapy) were equally effective in relieving depression. Cochrane Reviews summarizes this limited evidence about drug therapy for postpartum depression as follows:
It is not possible to make any recommendations for antidepressant treatment in postnatal depression from this single small trial. More trials are needed, with larger sample sizes and longer follow-up periods, to compare different antidepressants in the treatment of postnatal depression, to compare antidepressant treatment with psychosocial interventions and to assess adverse effects of antidepressants. Treatment of postnatal depression is an area that has been neglected despite the large public health impact.
Despite the lack of good scientific evidence about such an important issue in women’s health, many health care providers and the general public believe antidepressant therapy to be a proven treatment for postpartum depression. And drug companies have little incentive to do clinical trials that risk having a negative effect on sales of their drugs.
Especially in light of the paucity of scientific evidence supporting antidepressant therapy for postpartum depression, it is important to remember that antidepressants (like other medicines) can produce negative effects, such as sleep, digestive, and sexual problems, and, rarely, more serious effects. Unfortunately, finding unbiased information about the effectiveness and safety of antidepressants is challenging, as much of the widely available material on the Internet and elsewhere is produced or sponsored by drug companies.
Women in severe crisis sometimes find that only talk therapy combined with medication is helpful. (For more information on the potential benefits and harms of antidepressant medications, see Depression and Other Mental Health Challenges During Pregnancy.) If you are breastfeeding, be sure to tell your provider. Though commonly used antidepressants do pass into breast milk, their short-term negative effects on babies, if any, appear to be transient. Additional research, particularly on the long-term safety of antidepressants for breastfed babies, is needed.
To learn more about the effects of medication on breast milk, work with a provider who is knowledgeable about medications and breastfeeding and consult Thomas Hale’s book Medications and Mothers’ Milk. Another excellent resource is LactMed, a free online database of research on the effects of different drugs on breastfeeding.