What's Postpartum Depression And How Do I Cope With It?

The months following the birth of a baby are ones of great adjustment. Changing body chemistry and shape (do stretch marks go away?), lack of quality sleep, and numerous other stressors lead many people to experience postpartum depression in the year following childbirth and delivery. Depression is a mental health condition, and chronic depressive disorder can be serious. You may be wondering, "can online therapy improve postpartum depression?" and the answer is yes. 

Sadly, inadequate information, postpartum depression statistics, and a pervasive stigma in our society about postpartum depression’s exact cause often leaves many who experience it to navigate it alone. Postpartum depression, also called PPD, is a mental illness and is never anyone’s fault - nor is it an indication of a person’s worthiness as a parent. However, it is a condition that impacts the mental health of new parents. Let's talk about what PPD is as well as how to identify it in yourself or others. 

How Many People Experience Postpartum Depression?

PPD is incredibly common. The National Institute of Mental Health encourages those experiencing postpartum depression to get professional help. One study estimates that as many as 20% of women experience postpartum depression, though prevalence is likely higher. This is because many women may not seek treatment for PPD; additionally, men can also experience PPD following the birth of a child. 

People with a history of depression are more susceptible to acquiring postpartum depression. In some situations, people have been known to develop drug addictions when using drugs to cope with depression on their own, but that’s never the best way. Professional help is needed to support people living with depression.

When Does Postpartum Depression Occur?

Postpartum depression signs can happen at any time during the baby's first year of life - not just immediately after giving birth. In fact, postpartum depression tends to spike around the time the baby is five months. It is understandable that many new parents feel a strong need for emotional support after going through nine months of pregnancy, the process of labor, and welcoming a new human life into the world. Sometimes, treatments like antidepressants and psychotherapy can help new parents feel better adjusted. Postpartum depression can be especially difficult to manage if there were pregnancy complications before the birth or there were difficulties with a previous pregnancy.

What Are The Symptoms Of PPD?

Most people who give birth experience some level of sadness during the first two weeks after childbirth due primarily to the hormonal shifts that occur during that period. The primary symptom is an underlying feeling of sadness and lack of energy.

Postpartum depression, however, is marked by persistent feelings past the initial two-week mark, and the symptoms are much broader than simply "sadness." In fact, many people don't recognize that they may be going through postpartum depression simply because sadness isn't their primary symptom. Postpartum depression often doesn't look like people think it does. Symptoms of postpartum depression often include:

• Anger, rage, or irritability

• Difficulty sleeping or restlessness - even when exhausted

• Lack of pleasure in any or all regular tasks and activities

• Shift in appetite or behaviors around food

• ”Flat” feelings of neither happiness nor sadness

• Unexplained crying and hopelessness

• Extreme worrying, fear, or anxiousness

• Intrusive thoughts of serious harm or death coming to the baby

• Lack of connection or love toward the baby; inability to experience bonding with the baby

• A general feeling of "this isn't what I expected it to be"

Furthermore, due to the difficulty of parents with postpartum depression to appropriately tend to their children, children may have a delay in language development within the first year. Research shows that with treatment, this is preventable.

In more extreme cases of untreated postpartum depression (typically associated with postpartum psychosis), symptoms and side effects of mental health conditions can include:

• Hallucinations

• Paranoia

• Thoughts of suicide or of harming the baby

• Confusion/disorientation

These are all signs of a treatable mental health condition. Anyone who has thoughts of suicide or harming themselves or their infants should call the National Suicide Prevention Lifeline at 1-800-273-talk (8255) immediately for help with these risks. It is available 24/7 and can be lifesaving. Alternatively, you can text the word “HOME” to 741741 to reach the Crisis Text Line.

Postpartum depression has symptoms similar to bipolar disorder, which is one of the more well-known mood disorders that also causes rapid mood swings. Both bipolar disorder and depression are listed in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) as mental health conditions. It’s important to get a proper diagnosis from your doctors so as not to mistake postpartum depression for bipolar disorder or vice versa.

It's important to note that many high-profile media stories highlight women who experience postpartum psychosis, giving many the impression that if they are not experiencing these extreme symptoms, they're not experiencing postpartum depression. This is simply not a true statement about postpartum psychosis. The truth is that postpartum depression symptoms occur on a spectrum, and someone may only experience a few of the symptoms described earlier. A mental health provider can help people of all genders regardless of the severity of their symptoms.

Postpartum psychosis is actually quite rare in comparison with postpartum anxiety or postpartum depression. Having noted that, postpartum psychosis surfaces quickly after labor and birth, and it can be quite serious.

A healthcare professional will usually ask some important questions related to postpartum depression behavior at an early postpartum checkup, or they may ask parents to complete a depression screening questionnaire. Health care providers are interested to know if parents have a history of depression, experienced major depression, or have had any other types of mental disorders. A health care provider may also ask if they have symptoms of depression such as extreme sadness, depressed mood, or other health problems. 

It’s important to be honest about these questions so you can get the proper help and advice for how to handle your newfound needs. 

What Causes Postpartum Depression?

There isn't one single cause or predictor of postpartum depression, but rather it is caused by a combination of complex risk factors. Here are some of the culprits:

Hormones

After delivering a baby, hormones can cause severe mood swings and intense emotions. People undergo vast physical changes during pregnancy, which can also impact how they feel about themselves.

There are many physiological changes that occur during and after pregnancy, not the least of which are incredible fluctuations of hormones that cause very profound chemical changes in a person’s body. In many ways, these are miraculous. In other ways, they can cause significant disruptions to someone’s life and ability to control their own emotions and thoughts.

More specifically, the hormones estrogen and progesterone are significantly elevated during pregnancy, and then have a rapid drop down to standard levels within 24 hours of childbirth. Fluctuating hormone levels are a major adjustment for a person’s brain chemistry to adapt to, and they are the primary contributor to postpartum depression.

In addition to having issues with hormones, people can also experience problems with their thyroid gland after pregnancy. Postpartum thyroiditis is a condition where the thyroid gland becomes inflamed after a birth. Only a small percentage of parents acquire this condition.

Lifestyle Factors

Some of the practical challenges of parenting a newborn exacerbate the hormonal effects, and the net result can be postpartum depression. These include:

• Lack of sleep

• Added stress of parenting a newborn

• Added challenges in the parental relationship

• Loss of flexibility/free time

• Lack of a good support system

• Lack of time to exercise

• Poor nutrition

• Confusion about one’s newfound role as a parent/loss of sense of self

• Strong desire or pressure to be the "perfect parent"/Type A personality

Social Factors

Teen parents and people living in poverty have higher rates of postpartum depression. It's likely that the added stress experienced by these groups of people as they enter parenthood exacerbates the other factors and leads to their increased risk of postpartum depression. To compound things, some teen parents lack the support of their own parents, a close loved one, or others in the family. Such things can also contribute to postpartum depression or another mental health condition. Human services are usually a good resource for women’s mental health and child health.

Medical History And Genetics

Just as with traditional depression, there is a genetic component, and people who have a family history of depression or postpartum depression are at an elevated risk to struggle with the illness themselves. Similarly, people who have experienced depression in the past have a higher likelihood of struggling post-birth, as well as those who experience premenstrual dysphoric disorder (PMDD) with their regular menstrual cycles. PMDD is an extreme form of PMS and an indicator of a woman's chemical brain response to hormonal fluctuations.

Struggles with fertility and difficulty conceiving also increase a person’s likelihood of experiencing postpartum depression. Finally, a traumatic or medically difficult birth experience is also a risk factor. Regardless of the cause, it’s important to get postpartum depression treatment as soon as possible.

How Can I Overcome PPD And Make Positive Progress?

It’s always best to take good care of your mental health, especially when experiencing postpartum depression. Hormone levels may eventually go back to pre-pregnancy levels, but until they do, interpersonal therapy can be of immense help.

There are many things you can do to combat postpartum depression - it's not something you just have to go through alone. If you believe you are struggling with symptoms of depression, the first step is to speak with your doctor about your concerns. Your primary care provider will ask you more detailed questions to see if a diagnosis of postpartum depression is right for you, and they can give you information about postpartum depression facts to help you make informed decisions about the benefits and costs of each treatment option.

Some people can manage their postpartum depression with simple lifestyle adjustments - others benefit from more comprehensive medical intervention to treat depression. Regardless, it's important to remember that postpartum depression is, at its core, a chemical issue - and if you are not able to improve your symptoms of depression without medical support, it is not a personal failure. Support groups are designed to help with all kinds of issues including postpartum depression, and they can be very helpful along with individual therapy.

Sometimes, mental health treatment is helpful for both parents. Healing is available for postpartum depression, and no parent, regardless of gender, should feel shame for pursuing treatment or medicine as help for this medical condition. It is real; it is common; and it is treatable.  Here are some things you can do to treat the illness and return to wellness.

Develop Support

Be open about your struggle with postpartum depression with other parents in your social circle. Your family and friends may want to help, but it may be harder for them to identify with you. While you might have to battle illness, you do not have to battle shame. Think about it - if as many as one in five women experiences postpartum depression, the likelihood that you know others who have gone through it is incredibly high.

Make it a priority to spend time with friends and family. While it might not be possible to do all the things you did pre-baby, gathering with others in a social setting is healthy. If you don't have a lot of friends who are parents, contact your birthing hospital or your obstetrician and ask them about local parent/baby groups in the area. They are a great way to connect socially (and commiserate about the challenges of parenting a baby) with other parents. 

Unfortunately, not all friends and family will be supportive. Online support groups or online education videos can also help patients who are coping with stress after a child’s birth. You may also be able to find a support group for mothers or fathers (specifically) who need support after having a child. Online support groups can be a convenient and time-saving option for both you and your partner when you need support. Many people may find that joining support groups is incredibly helpful.

You may also want to consider a local support group for people struggling with postpartum depression. These are often very supportive, non-threatening groups that allow you to learn more about the illness and what it looks like in everyday life, so you might feel less alone in your struggle. The groups can also provide a wealth of information on local professional resources to help you. You don't need a diagnosis to attend - they welcome all new parents. Ask your local hospital, doctor, or obstetrician for help finding one in your local area.

Make Simple Lifestyle Adjustments

Physical and emotional issues can take a toll on a new parent, but there are a few things you can do to try and combat postpartum depression on your own. These include:

• Ask your partner to take an overnight feeding (pump if you're nursing) to help you get a longer stretch of restorative sleep

• Schedule regular exercise

• Get outside in the sunshine and go on walks 

• Pay attention to your nutrition; eat healthily and avoid alcohol

• Eat a small piece of dark chocolate (yes, really!)

Seek Professional Help

Sometimes lifestyle adjustments don't help, or adequate social support is hard to come by. A primary care provider may not be equipped to address a mental illness such as postpartum depression.

The Preventative Services Task Force and the Centers for Disease Control recommend getting therapy for postpartum depression. Counseling or talk therapy has been proven to be incredibly helpful in treating postpartum depression. A counselor or therapist can not only help you work through the major lifestyle transition of adding a newborn to your family, but they can also help you to find ways to implement some of the lifestyle changes listed above - because it can seem overwhelming to do it on your own.

A trained online counselor at BetterHelp can help you identify the root causes of your negative feelings, give you guidance to process them effectively, and coach you on ways to improve those specific aspects of your life. And while there are many options available, the reality is that making time for appointments while caring for a newborn can be incredibly challenging. Navigating nursing and napping schedules, along with finding childcare, can make it feel challenging to leave the house. Thankfully, there is quality and professional therapy available online to provide postpartum depression treatment, which is a great solution for a new parent to get the help they need. You can schedule appointments during times when you know your infant will likely be sleeping, and you can attend from the comfort of your own safe space, as long as there is a reliable internet connection.

Online therapy has shown effectiveness in treating parents with PPD. In one study, researchers implemented online therapy workshops for 403 mothers with PPD during the height of the COVID-19 pandemic. Results indicated that those who engaged in the session were four times more likely to experience a clinically meaningful improvement in PPD symptoms than those assigned to the control group. The workshops took place over videoconferencing – similar to how BetterHelp sessions are run – and included activities like group exercises, role play scenarios, identifying and changing thought patterns, and learning strategies to improve mood and anxiety. 

Medications are also available to help with postpartum depression. Your doctor can recommend and prescribe one that will work best in your situation, but even if you choose not to try medication, make sure you keep them in the loop. Explain to your doctor that you feel you are experiencing signs of postpartum depression but would like to try non-medicated strategies to treat it before deciding whether you need medication. They will be able to tell you what symptoms to watch for to tell if your illness is getting worse and if you might need additional medical support.

Takeaway

The bottom line is that you don't have to go through PPD alone. Postpartum depression is a common illness mostly caused by hormonal changes in the body or genetic factors that are generally out of a person’s control. That said, PPD can be treated in many ways. If you are struggling after the birth of a baby or having trouble sleeping, seek help. Call your doctor. Contact a counselor. There are people who can stand in your corner as you navigate the exciting, yet often complex journey of becoming a new parent or adding a new child into your life. Take the first step today.

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Resources

Postpartum Support International

Office on Women's Health - U.S. Department of Health and Human Services

National Institute of Mental Health

Mayo Clinic