Every new mom has mood swings – overjoyed one minute, drained and worried the next. So how can you tell if your feelings are normal or you need treatment for postpartum depression or anxiety? In recognition of Depression Awareness Month, read on to find out…
Melia Gordon’s world came crashing down after the birth of her second child four years ago.
“I had no energy and desire to do anything,” says Gordon, an Austin, Texas, birth coach. “It took me 2-5 hours to get out of bed in the morning.”
As months passed, her depression didn’t improve and her thoughts turned violent.
“When the baby was inconsolable, I’d have to fight back images of throwing him into a wall or holding a hand over his mouth until he was silent,” she says. “Fear of acting on those thoughts made me withdraw further.”
By the time Gordon sought professional help, her son was 15 months old. Medication and talk therapy helped get her emotions – and her life – back on track. But she regrets that she “lost my son’s entire first year,” she says.
Many new moms have a mild, passing case of baby blues. But, like Gordon, 15%-20% experience serious depression or anxiety, according to Postpartum Support International (PSI), a nonprofit that helps women with post-pregnancy mental disorders. Serious depression is when the usual fluctuating emotions are more upsetting and paralyzing than normal and show up any time in the year after giving birth.
“Such feelings make it difficult to function and rob you of motherhood’s joys,” says psychologist Pamela Wiegartz, Ph.D., author of The Pregnancy and Postpartum Anxiety Workbook (New Harbinger).
Genetic factors, hormonal swings, and physical and psychological demands of your infant all play a role in post-pregnancy mood depression and other disorders. Fortunately, with treatment, you can become the new mom you want to be.
Here are warning signs of five mood and anxiety disorders and treatments that will conquer them.
1. Postpartum Depression
“Most new moms experience some [short-term] ‘baby blues,’ characterized by mood swings, irritability, weepiness and feeling overwhelmed,” says Margaret Howard, Ph.D., director of the postpartum depression program at Women and Infants Hospital in Providence, R.I. These feelings, however, are manageable and disappear in 2-3 weeks.
In contrast, postpartum depression is more intense, and it may stick around for months if not treated. It can interfere with your ability to care for your baby.
How to recognize it: Watch for these warning signs:
Feelings of sadness or emptiness
Feelings of hopelessness or pessimism
Irritability or a short fuse
Loss of interest in things you once enjoyed
Lack of interest in your baby
Oversleeping, or not being able to sleep even when your baby does
Overeating, or loss of appetite
Trouble concentrating or making decisions
Feelings of guilt or worthlessness
Thoughts of suicide
How to treat it: If you’re having suicidal thoughts, get help right away. A good starting place is the National Suicide Prevention Lifeline (800/273-TALK), a free, 24-hour crisis line.
“For milder cases of postpartum depression, psychotherapy is a good first-choice treatment,” Howard says. “Support groups can also be helpful, especially for moms who are socially isolated.”
Postpartum Support International (800/944-4PPD, www.postpartum.net) can help locate community or Internet support resources.
For more severe symptoms, antidepressants may be prescribed, even during breastfeeding, says psychiatrist Michael Banov, M.D., author of Taking Antidepressants (Sunrise River Press).
“Zoloft (the antidepressant sertraline) is one of the best-studied in breastfeeding women, with very little detected in breast milk,” he says.
Work with your doctor to find the best medication for you.
2. Postpartum Anxiety or Panic Attacks
“Just about every new mother worries about her parenting abilities, baby’s health, and responsibilities of being a mom,” Wiegartz says.
When excessive worries and anxiety control you, however, it crosses over into an anxiety disorder.
Panic disorders are signaled by repeated, unexpected feelings of panic – sudden, intense rushes of fear – when there’s little or no threat. They’re accompanied by physical symptoms, such as a pounding heart, chest pain, sweating, trembling, shortness of breath, choking sensation, nausea, lightheadedness or hot flashes.
“You may wind up in the emergency room thinking that you’re dying,” says Birdie Gunyon Meyer, a registered nurse and a former PSI president.
How to recognize it: Anxiety, like depression, is common in new moms. Yet it doesn’t get nearly as much attention. A 2008 study in Depression and Anxiety found that only 20% of ob-gyns said they screened for anxiety.
Because doctors are less aware of the problem, it’s crucial to speak up if you’re having symptoms. Watch for these warning signs:
Constantly worrying and blowing everyday issues out of proportion
Expecting the worst at every turn
Feeling restless or nervous
Feeling tense and unable to relax
Trouble sleeping, even when your baby sleeps
Physical symptoms, such as headaches, muscle aches or fatigue
Panic attacks
How to treat it: Cognitive-behavioral therapy (CBT), which aims to reverse negative thoughts, is the preferred treatment for anxiety, says Wiegartz.
“With therapy, you can learn how to manage physical symptoms and understand anxious thoughts,” she says.
In some cases, medication may also be prescribed.
3. Postpartum OCD
Obsessive-compulsive disorder (OCD) is marked by recurring, disturbing thoughts, called obsessions. People with OCD perform repeated, ritualistic actions, called compulsions, to control the anxiety.
For women with postpartum OCD, obsessive thoughts often involve harm to the baby.
For example, “a woman who has distressing thoughts of drowning her baby may insist that her husband take over bathing duties,” Wiegartz says. “Or a mom who obsesses about her newborn becoming ill from germs may stay up all night cleaning the house with bleach.”
How to recognize it: If not recognized and treated, obsessive thoughts can take over your mind, and compulsive behaviors can exhaust you and eat up hours.
Also watch for:
Repetitive, ritualistic actions, such as washing hands, checking the baby, cleaning the house, putting objects in order or counting things
Feeling powerless to stop such behaviors, even though you know they’re excessive or irrational
How to treat it: Again, CBT is generally recommended.
“With therapy, you’ll learn that your thoughts aren’t dangerous and you’ll confront situations you’ve avoided,” says Jonathan Abramowitz, Ph.D., a University of North Carolina at Chapel Hill psychology professor. “And you’ll gradually reduce the use of compulsive rituals.”
Medication may also be prescribed.
5. Postpartum Post-Traumatic Stress Disorder (PTSD)
PTSD usually develops after a traumatic event that involved actual or threatened bodily harm to you or another person. In women with postpartum PTSD, the trigger is often a traumatic birth where the mom felt that she or her baby was in danger.
For example, “the mom may have had an emergency C-section or a postpartum hemorrhage,” Meyer says.
Another potentially traumatic situation for new parents: having a baby in the neonatal intensive care unit (NICU). Fifteen percent of moms and 8% of dads developed full-blown PTSD a month after their babies were admitted to the NICU, according to a 2010 study in the Journal of Clinical Psychology in Medical Settings that included 86 mothers and 41 fathers.
Virtually all mothers who have a difficult birth or a newborn tethered to wires and tubes find it upsetting. Yet, not all develop PTSD.
That’s because “women more likely to develop PTSD have a personal or family history of anxiety, depression or another psychiatric disorder,” says head researcher Debra Lefkowitz, Psy.D., a psychologist at Children’s Hospital of Philadelphia.
Another risk factor is other simultaneous stressful events – such as job loss or money troubles.
How to recognize it: It’s normal to be anxious after a terrifying ordeal. But see a doctor when anxiety persists for a month or longer and makes it hard to function. Here are warning signs:
Reliving the trauma through flashbacks or recurring nightmares
Avoiding people, places or things that remind you of the trauma
Unwillingness to think or talk about the trauma
Inability to recall key parts of what happened
Emotional numbness or detachment from others
Living in a constant state of high alert; for example, having trouble sleeping, startling easily or being quick to anger
How to treat it: CBT has been effective for treating PTSD, says Lefkowitz. So has medication in some cases.
5. Postpartum Psychosis
Women with postpartum psychosis have distorted thoughts or perceptions that are seriously out of touch with reality. This severe condition is rare, affecting only 1 in 1,000 new moms. Yet because it’s dramatic – with sometimes tragic consequences to the baby or mother – it grabs more than its share of headlines.
Andrea Yates, the Texas mother who drowned her five children in 2001, was diagnosed with postpartum psychosis.
How to recognize it: Postpartum psychosis is a medical emergency. Most people with postpartum psychosis don’t hurt themselves or others, according to PSI. But there is a 5% rate of suicide or infanticide.
If you’re having thoughts about harming yourself or your baby – even if your thinking makes sense to you – tell someone immediately. Because thinking is distorted in psychosis, you may not recognize symptoms in yourself. If your family or friends are worried about you, heed their concern. Watch for these signs:
Delusions – holding false, often bizarre, beliefs that have no basis in reality, but that seem true and real to you; for example, believing that the baby is possessed by demons
Hallucinations – seeing or hearing things that aren’t really there; for example, hearing voices that tell you to hurt yourself or the baby
Hyperactivity, irritability or decreased need for sleep
Rapid mood swings
Confusion or disorientation
Attempts to harm yourself or the baby
How to treat it: “Often, an antipsychotic or mood-stabilizing medication is needed, and sometimes hospitalization is necessary for your safety and your baby’s,” Banov says.
In some cases, electroconvulsive therapy (ECT) is recommended. The procedure involves passing a small, carefully controlled amount of electrical current through the brain, which can trigger chemical changes that reduce symptoms.
Getting Past Postpartum
Some mothers with postpartum emotional disorders have trouble taking care of their baby.
“However, many go through the motions and get the job done, but still feel horrible,” Meyer says.
If you’re suffering silently, get treatment so the joy of motherhood can be more than an empty promise.
Linda Wasmer Andrews is a freelance writer who specializes in health and psychology. She’s author or coauthor of four books about depression and three about anxiety disorders, including Encyclopedia of Depression (Greenwood) and The Thought That Counts (Oxford University Press).
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