Psych Services: Postpartum Depression (PPD) is NOT a hopeless condition

Lisa Garmezy

Chrissy Teigen is the latest celebrity to open up about postpartum depression. Thrilled with her new daughter and her husband, singer John Legend, she thought she couldn’t have it. But a year after Luna’s birth, there were still tears, irritability and unexplained aches.

“When I wasn’t in the studio, I never left the house–I mean, never,” she admitted in Glamour’s April issue. 

After she was diagnosed and started on medication, she told her story because “I had never, ever—in my whole life—had one person say to me, ‘I have postpartum depression.’”
Her story is important because you’re familiar with postpartum depression. That wasn’t a typo. In 2001, the ultimate dead-baby call presented five small corpses murdered by Andrea Yates in the grip of postpartum psychosis. Every Houston cop knows PPD can become a psychiatric emergency.

But one in nine women gets postpartum depression, or PPD. Given the Yates case, you may not realize it’s more of a garden-variety weed choking joy out of life than a deadly toadstool popping up when the moon is full.

 

Old and New Clues

 

PPD is present when depression begins any time in the first year after delivery. In a quarter of cases, it actually starts during pregnancy.

Classic symptoms of depression are present, usually including a sad mood most of the day, most days. Women have disturbed eating or sleep patterns, although it’s hard to tell with a newborn in the house. Other signs are negative thoughts about the future, loss of interest in pleasant activities, withdrawal, and thoughts of death or suicide.

In addition, women with PPD may feel numb or disconnected from their babies. They may not want to hold the baby. These new mothers may feel plagued with guilt or self-doubt, or feelings of loss. Psychiatrist Alexandra Sacks points out that while motherhood ultimately brings joy for most women, they can miss their freedom, their prepregnancy bodies, or the jobs that gave them friends, self-esteem and financial independence. Anger is common in PPD, particularly at people perceived as making too many demands or not helping enough.

Stressing about the baby’s welfare or being a good mother is normal. Unstoppable obsessive anxiety, however, is a part of PPD. Cutting a tomato, for example, a woman’s mind might fill with thoughts about how easily the baby’s flesh could be cut. These thoughts don’t come from any wish to harm the child; in fact, they stem from concern for the baby.

Cases of PPD differ. Women show more or less anxiety, and many physical symptoms or few. There can be significant loosening of one’ s hold on reality, or much more often, none at all.

Sadly, however, postpartum psychosis isn’t rare, occurring in one or two in a thousand women and typically presenting two to four weeks after birth. Hallucinations or thoughts of harming herself or her child mean a woman needs help immediately.

 

Is My Family at Risk?

 

As Chrissy seemed to know, PPD—as it’s usually seen, without psychotic symptoms—affects women more in the absence of a supportive spouse. It occurs more often when babies are sick, premature, difficult to soothe, difficult to breast-feed, or don’t come one at a time. Other risk factors include problems getting pregnant, an unwanted pregnancy and complications during pregnancy or birth. A history of depression or mental health problems or a biological relative who has had them makes you more vulnerable. So do substance use, teen pregnancy and adoption.

Wait, adoption? Doesn’t an abrupt shift in hormones after delivery cause PPD? It can, but PPD is a syndrome with multiple causes. Not all are biological. PPD is also about adjusting your identity and having negative thoughts about how you’re parenting your unique child. You don’t have to give birth to feel sad, anxious or inadequate.

Truly, many new fathers get a version of PPD, particularly those who are young or under financial stress. Both sexes are capable of blaming themselves because they feel every other parent since the dawn of time did a better job.

A lot of PPD is judging yourself. Karen Kleiman and Valerie Raskin in their wonderful book This Is Not What I Expected explain that women fall into a “perfection trap,” because they want everything to be exactly right.

A patient of theirs imagined blissful first moments with her newborn. She confessed, “I pictured this great moment of bonding. We’d gaze into each other’s eyes and the love would flow. I just didn’t feel it . . . it took a while to feel anything toward that funny-looking creature.”

 

It Isn’t Hopeless

 

If you see yourself, or your wife or daughter here, get to the doctor, or insist that she go. Her physician will help her make a recovery plan. As with any depression, the belief that nothing will help is a symptom.

New motherhood is isolating, and support groups help enormously. Find groups, on-line support and more, including resources in Spanish at mhahouston.org (click “Find Help), or call Mental Health America of Greater Houston. The Yates Children Memorial Fund supports their PPD project.

Talk therapy helps. When a colleague of mine welcomed very much wanted twins, now cherished middle-schoolers, PPD struck. Her therapist persuaded her to accept help. She realized, “It’s okay not to enjoy every moment of being a new mother—or even not to enjoy 99% of it.”

Most cases of PPD will respond to medication. For a nursing mother, using medication is a complicated personal decision that should be made with the help of her obstetrician and pediatrician (not a Google search). While meds will be passed to nursing babies, some are viewed as safe. Other women opt to stop breast-feeding, keeping in mind that having a depressed mom also affects babies.

This Is Not What I Expected offers symptom checklists and practical advice. Pro tip: Maybe you can’t afford more skilled help, but a high school kid can watch the baby or do housework while a parent resting at home offers back-up if it’s needed.

Consider that some of us fell in love at first sight and some equally happy people fell in love with a friend, or got there in time. Both are great.

If you don’t love your baby instantly, you’ll fall in love over time. That’s normal.

You’ll get there. You’ll feel attractive again. There are no perfect parents, so don’t worry about screwing up. Forget Instagram.

Chrissy Teigen wrote, “I felt selfish, icky, and weird saying that I’m struggling—sometimes I still do.”

Speak out, as she did. You need help, and your family needs you to find it.

 

__________________________________________________________________________

 

This timeless message and opinion appeared in a previous issue of the Badge & Gun.