Postpartum Depression

When I had cancer, I thought those were the worst days of my life. But I was wrong. With cancer, I allowed myself to ask for help—depression was expected. My friends and family gathered around me: they brought me food, cleaned my house, and supported me in every possible way. Now, during postpartum depression (PPD), I feel guilty asking for help and ashamed of my condition. Everyone thinks I should be happy and doesn’t believe my state is related to an illness...

Pregnancy and Postpartum Psychiatric Disorders
The authors of the book point out that perinatal emotional disorders are primarily caused by hormonal changes that affect brain neurotransmitters. Stressors such as moving, illness, lack of support from a partner, financial difficulties, and social isolation can negatively impact a woman’s mental health. Emotional and social support, as well as help with household tasks, can aid in her recovery.
The book discusses six postpartum disorders, which can also occur during pregnancy. A key feature of these disorders is hormonal instability. Women experiencing postpartum disorders often cannot predict how they will feel from one moment to the next. For example, at 8:00 a.m. she may feel anxious, by 10:00 a.m. she might feel completely fine, and by 10:30 a.m. she could be in deep despair.
In the words of the author:
Our clients who have experienced depression say that postpartum depression (PPD) is very different from the types of depression they had before. One of our clients had breast cancer. During a support group meeting, she vividly described the difference:

When I had cancer, I thought those were the worst days of my life. But I was wrong. With cancer, I allowed myself to ask for help—depression was expected. My friends and family gathered around me: they brought me food, cleaned my house, and supported me in every possible way. Now, during PPD, I feel guilty asking for help and ashamed of my condition. Everyone thinks I should be happy and doesn’t believe my state is related to an illness.

Women experiencing similar symptoms need to talk about them and be persistent in getting the care they need. In the past, these issues were often overlooked. Research shows how important it is to treat postpartum mental health disorders for the well-being of the mother, the baby, and the entire family.

On Mental Health Issues During Pregnancy
Contrary to popular belief, pregnancy is not always a joyful time. Approximately 10–20% of pregnant women suffer from depression. It can be misleading that many of the physiological symptoms typical of pregnancy are similar to depressive symptoms. It is easy to overlook them, mistaking them for normal pregnancy features. It is essential to distinguish between pregnancy-related characteristics and signs of depression.



When symptoms of depression or other emotional disorders limit daily functioning, intervention is necessary: traditional (counseling and medication), alternative (yoga and acupressure), or a combination. The goal is to use whatever a particular woman needs to feel like herself again. Depression during pregnancy can affect birth weight (under 2500 grams) and may lead to preterm labor (before 37 weeks). Increased anxiety during pregnancy can also harm the growing fetus due to placental vessel spasms and elevated cortisol levels.
Some women become pregnant while already taking antidepressants or other psychotropic medications. Many of these drugs are considered safe for use during pregnancy. In many cases, it is safer to continue the medication than to risk the return of symptoms. The relapse rate of major depressive disorders among women who discontinued medication before conception is 50–75%.

Mental Disorders
The authors identify six postpartum disorders. It's important to note that the symptoms and their severity can affect how the illness unfolds (see Appendix 1).

Consequences of “Not Treating” Disorders
Maternal depression ranks highest on the list of "The Most Significant Mental Health Problems Threatening Children’s Readiness for School" (Mental Health Policy Panel, Department of Health Services, 2002). A large body of evidence documents the negative impact of maternal depression on infants, toddlers, preschoolers, school-aged children, and teenagers. It is associated with an increase in child psychiatric disorders, behavioral problems, reduced social engagement, and diminished cognitive and language development. When maternal depression goes untreated, every family member and the family dynamic suffer. The sooner treatment begins, the better the prognosis for the entire family.

Perinatal Loss
It does not matter how a pregnancy ends—whether through natural causes or by choice—anxiety and depression typically follow. Medication may help alleviate the symptoms commonly associated with loss. In the case of stillbirth or neonatal death, depression is, of course, expected. Couples counseling can be helpful. Women who have experienced such a loss need close emotional monitoring in future pregnancies and during the postpartum period.

Women with Postpartum Disorders
Women suffering from postpartum disorders may express their pain in various ways:

• I feel completely alone. No one understands me.
• I reject being a woman, a mother, a wife.
• I will never be the same again.
• I made a terrible mistake.
• I feel all over the place (emotionally).
• I feel like I’m disappearing.

Women may experience all of the above or only some. The authors offer several reminders for women facing postpartum depression (PPD):

• I will get better (We have never met a woman who didn’t recover with proper treatment.)
• I am not alone (1 in 5 women experiences a postpartum response more intense than the “baby blues.”)
• It’s not my fault (You are not the cause of this illness—it's biochemical.)
• I am a good mother (Even if you are hospitalized, you are still caring for your family by improving your quality of life.)
• Taking care of myself is necessary (Your job now is to care for yourself; once you're better, you can care for your family.)
• I’m doing the best I can (No matter your current level of functioning, you’re moving forward—even if it’s just baby steps.)

Depression will interfere with your ability to believe these statements, so it’s important to repeat them confidently. As you recover, this will get easier.

Finding Support
During difficult times, we often overlook people who could support us. Support can take different forms:

• Physical: cooking, cleaning, child care, grocery shopping, walking with you, visiting
• Emotional: sitting with you and listening, hugging you, encouraging you

Write down anyone who comes to mind, regardless of the type of support they might offer. Keep the list near your phone in case you need it.
Common sources of support include:

• Partner
• Family and extended relatives
• Neighbors
• Coworkers
• Religious communities
• Professionals (doulas, lactation consultants, nannies, housekeepers)
• Hotlines
• Online forums and chats (Caution: not recommended for women with high anxiety)
• Postpartum support groups

Nutrition
Women with PPD and anxiety often crave sweets and carbs. If possible, eat something nutritious—especially protein—each time you feed your baby. This helps stabilize your blood sugar, which supports mood regulation. We understand appetite may be lacking, so do what you can. If eating solid food is too difficult, try liquid options like protein drinks or smoothies. Avoid caffeine. Ask your supporters to keep the fridge stocked with yogurt, sliced meat, cheese, hard-boiled eggs, fruit, and pre-cut veggies. Don’t forget to stay hydrated—dehydration increases anxiety. Appetite issues are common with PPD and anxiety. Talk to your doctor and consider seeing a nutritionist when you're ready.

Sleep
Nighttime sleep is the most restorative. Five hours of uninterrupted sleep (a full sleep cycle) are necessary for brain recovery. You need to be “off-duty.” Alternate nights with your partner or take shifts. If your partner can’t help, someone else must. When off-duty, sleep in a different room and use earplugs. Many clients also use white noise machines or fans to drown out baby cries. Sleep disturbances are common in emotional disorders. If you can’t sleep when others do, speak to your doctor.

Physical Activity
Even 5 minutes of light activity can improve mood. If you're physically able, choose something doable (e.g., walking, dancing, biking). If even thinking about a walk feels overwhelming, don’t despair—it will pass as you recover. If you think activity could help but can’t motivate yourself, ask someone to do it with you. Avoid intense cardio if you’re sleep-deprived or suffering from insomnia. Wait until your sleep stabilizes (at least two weeks) before pushing your limits.

Rest
The myth that if we truly love our children, we won’t need a break from them is pervasive. We believe that taking time for ourselves is selfish, and then feel guilty for even wanting it. The truth is: all good mothers take breaks—that's how they stay good mothers. We strongly recommend scheduling your own time at least 3 times a week for 2 hours. Every other job allows for breaks—so should motherhood. You are not the only one who can care for your baby. Your partner and family members also benefit from bonding with the child. Everyone wins. If you’re too tired or down to leave the house, go to a different room and use earplugs or headphones.

Leaving the House
When you’re anxious or depressed, the four walls can feel suffocating. Our bodies reflect this with slouched posture and downward gaze. Get outside once a day, even if it's just standing by the front door in a robe. Look up at the sky. Stand tall. Breathe.

Caring for the Baby
Depending on the severity of depression, someone else may need to take over much—or even all—of the baby's care. This can be a family member, doula, nanny, or friend. Gradually increase your involvement in caregiving. Even if you feel robotic and emotionally numb, participating helps restore your sense of connection. Confidence will build, and you will eventually enjoy it.

Giving Instructions
You may not know what you need when people ask, “What can I do for you?” They can’t read your mind. Figure out what you need and communicate it. For example, if anxiety overwhelms you, you don’t want to hear “Just calm down.” Instead, ask your supporters to say or do the following:

• “I’m sorry you’re hurting.”
• “We’ll get through this.”
• “I’m here for you.”
• “This will pass.”
• Offer hugs.

These instructions empower your support system to give you what you truly need. Those who love you want to help—you just have to show them how.

For Women with Anxiety and Intrusive Thoughts
Information can be triggering. Turn off the news and avoid upsetting books or websites about postpartum issues. If you go to the movies, choose comedies. Seek calming or distracting activities instead of those that increase anxiety.

External Stimuli
When everyday sights, sounds, and activity feel overwhelming, it’s time to simplify your environment. Remember, you're in recovery. Be gentle with yourself. Don’t force it. If a family gathering (which you used to enjoy) feels too much—don’t go.
Highly anxious postpartum women are often hypersensitive to all kinds of stimulation: visual, auditory, tactile. In that case, dim the lights at home. (If you’re more depressed than anxious, brighten your space—open the curtains, turn on lamps.) If noise is overwhelming, use earplugs or headphones. Tactile sensitivity may increase too—clothes may feel itchy or irritating. Be kind to yourself and make your comfort a priority.
The book also includes a chapter dedicated to the partner, their feelings related to the mother’s postpartum depression, and sections for other family members, including siblings.
Here, it is appropriate to share the authors’ recommendations for helping professionals—doctors, midwives, neonatologists, doulas—who are often in contact with postpartum women. The authors urge professionals to treat observed symptoms of PPD like any other illness—such as gestational diabetes. Remember, warning signs in a woman’s behavior are often hidden. Shame, guilt, and fear of judgment may lead her to conceal her feelings. She may present more “socially acceptable” complaints: fatigue, headaches, marital issues, a fussy baby. A smiling, well-groomed woman is not necessarily well. PPD is a hidden illness.
Though risk factors for PPD are known, there is no specific “type” of personality prone to it. A woman may feel accused of being a bad mother and employ defensive strategies. However, if you speak neutrally and without judgment, she can accept the information. You will save time and ensure quality care.

A chapter from the book dedicated to the partner:

Culture and Language
Although postpartum disorders are equally common around the world, the response to them varies depending on cultural context. In cultures where shame is a major personal threat, discussing symptoms of disorders requires significant trust from women. Helping professionals must consider that nonverbal forms of communication vary significantly across different cultures. For example, a simple nod might mean understanding or silent agreement with authority.
It’s important to clarify that your role is to appropriately avoid unrealistic expectations. Socio-cultural factors and educational levels must be taken into account. Responses to stress, types of stressors, and coping behaviors are culturally influenced. This also affects how women respond to recommendations about which treatments to use or accept.
The level of simplicity or “scientific language” you use should match the patient. Do not assume that a highly educated woman will automatically understand her condition better than one with a lower level of education. Avoid self-diagnosis questions like, “Do you think you have postpartum depression?” even if the patient is highly educated. The patient’s understanding of the term may not reflect the actual condition. Instead, ask specific questions about her mood and behavior that can help identify symptoms.

What to Say and What Not to Say
Say:
— These feelings are completely normal
— This is treatable
— You will get better
— Here’s some information that may help you
Do NOT Say:
— Join a “new moms” group
A depressed woman feels “different” and inferior compared to other moms. Attending such groups may intensify her sense of isolation. If you know the group leader is sensitive and open to discussing emotional issues, she may be fine. Ideally, the group should be specifically for moms with postpartum disorders and anxiety. Many of the author's clients attend two types of groups: one for everyday “new mom” topics, and another for openly expressing more complex emotions.
— Go on a vacation with your husband!
While a change of scenery can be helpful, the woman “takes her mind with her.” Her anxiety and depression may worsen due to expenses, leaving the baby behind, and guilt if the trip doesn’t “cure” her.
— Exercise!
These moms often feel overwhelmed. Some barely have the strength to wash a bottle, let alone go to the gym. Suggesting exercise to chronically sleep-deprived mothers can have the opposite effect and trigger insomnia. Endorphins offer only temporary relief. Exercise doesn’t cure depression. When she’s able to leave the house for a short walk, support her in that. But until then, it’s just one more step toward perceived failure.
— Do something nice for yourself!
This is always good, but not enough to regulate brain chemicals in a depressed woman. This suggestion should only be part of a much broader treatment plan, not a quick fix.
— Sleep when the baby sleeps!
Even mothers without postpartum disorders may find it hard to fall asleep when the baby naps. For anxious women, this is nearly impossible. Nighttime sleep is far more important.
The authors go on to provide an interview framework for assessing the risk of postpartum disorders.

Behavioral Signs in the Mother to Watch For:
— Missing appointments
— Excessive worry (often about her own health or the baby’s)
— Appears unusually tired
— Insists that her partner accompanies her to appointments
— Significant weight gain or loss
— Complaints of feeling unwell with no clear medical reason
— Inadequate milk supply
— Avoids questions about her own well-being
— Tearfulness
— Unwillingness to hold, care for, or engage with the baby
— Doesn’t allow others to care for the baby
— Obsessive concern for the baby despite reassurances of health and development
— Rigid, obsessive thinking regarding the baby
— Preoccupation with her appearance or the baby’s appearance
— Beliefs that the baby doesn’t like her or that she’s a bad mother
— Complaints of insufficient support from partner

Signs in the Baby to Watch For:
— Excessive weight gain or insufficient weight gain
— Delays in cognitive or language development
— Decreased responsiveness to the mother
— Breastfeeding difficulties

Questions to Ask:
— How are you doing? (Maintain good eye contact when asking this.)
— How do you feel about being a mom? (Women who feel like they’re failing or dislike the “job” often suffer from depression.)
— Do you have any specific complaints?
— How are you sleeping (both in quality and quantity)? At least 5 hours of uninterrupted sleep per day is necessary.
— Are you able to sleep when everyone else is asleep? (Insomnia is a symptom of any mental disorder.)
— How does your baby sleep?
— Who gets up at night with the baby?
— Do you ever have unusual or frightening thoughts? (If yes, refer the woman to a perinatal psychotherapist for evaluation. Some thoughts are normal, others may indicate OCD or psychosis.)
— Do you receive physical and emotional support?
— Does your partner share household and childcare responsibilities? (Remind her that it's not solely her responsibility, even if she plays the lead role.)
— Do you feel like yourself? (Women with postpartum disorders often feel like a different person.)
— How is your appetite? (Significant changes in appetite are a warning sign.)
— What and how often do you eat and drink?
— If you’re breastfeeding, how is it going? (Low milk supply may indicate thyroid dysfunction or anxiety.)
— If formula-feeding, how quickly and when did you stop breastfeeding? (Abrupt cessation can lead to mental health issues.)
— When was your last period?
— Are you taking any medications or herbs regularly? (Women self-medicating for insomnia, depression, or anxiety should be referred to a perinatal psychotherapist.)
— Can you describe your levels of irritability, tearfulness, and anxiety?
— Do you or your baby have any health problems?
— How do you feel about your baby? (Ambivalence and aggression are two emotions often associated with postpartum disorders.)