How to support a person suffering from postpartum depression

The birth of a child can be an exciting and overwhelming time for a family. It’s normal for a new mom to experience mood swings and sleep disruptions as her hormones and body recover. But for some, overwhelming feelings of sadness, anxiety, depression or anger don’t go away and can cause disconnect with the new baby and suffering for the new mom. It can be difficult to diagnose perinatal mood disorders (PMAD) or maternal depression, but they’re very common.

“PMADs are the number one medical complication related to child bearing,” said Tracey McInnes, MSW, coordinator of the IU Health Perinatal Mood Disorder Program. “When we think about all the concerning medical conditions during pregnancy, like hypertension, preeclampsia or gestational diabetes, these physical conditions are very important. But they affect about 6% of the population, whereas about 20% of women experience PMADs.”

What PMADs look like

Perinatal mood disorders can take several forms, and they don’t always look like sadness. Women can feel anxious, disconnected, overwhelmed, irritable, obsessive or angry. While PMADs can appear very clearly in some women, other moms may suffer in silence. Women may feel confused about why they’re having these feelings, or they may feel ashamed.

Perinatal describes the period between conception through the first year after giving birth. PMAD is an umbrella term that describes several mood disorders that can affect people at any time in their lives but noticeably increase in the perinatal period.

• Postpartum depression (PPD) is the most common PMAD and often appears as feelings of sadness and crying. PPD often disrupts a woman’s sleep and appetite.
• Postpartum anxiety (PPA) often accompanies PPD and can be hard to differentiate from depression. PPA often shows up as feelings of fear, withdrawal or losing control. These moms can feel very overwhelmed and may experience shortness of breath or chest pressure.
• Obsessive compulsive disorder (OCD) creates hyper-focused, intrusive thoughts. Moms may become very fixated on cleanliness or checking the baby’s breathing so often that they themselves don’t get any sleep.
• Post-traumatic stress disorder (PTSD) is caused by a real or perceived trauma. If a woman experiences trauma during the birth of her child, which may or may not lead to time spent in the NICU, she might have negative reactions to similar noises or smells she encountered while in the NICU with her baby. This may create anxiety, panic or sleeplessness.
• Postpartum psychosis is the most concerning PMAD. These new moms may see or hear things that are not real. This type of psychosis can lead the mother to harm herself or her child and is considered an emergent mental health condition.

PMADs can intrude on important bonding time between mother and child and can create marital problems, divorce and even serious physical harm. Tracey says mothers need to know there is help, and the sooner it’s provided, the better.

“It’s important for women to know that PMAD are treatable. Through therapy, support groups and medication, we can help women eliminate these awful experiences,” Tracey said. “Early intervention is key. It’s sad when I see a mom who waited six months to reach out for help because we could’ve helped her so much sooner. These feelings are no way to live with a newborn.”

PMAD risk factors and misconceptions

Perinatal mood disorders can affect anyone, but they are more common among women with a personal or family history of depression, anxiety or other mood disorders. People with perfectionistic tendencies are more likely to have those feelings worsen after pregnancy.

Women experiencing homelessness, social isolation, past trauma or substance use disorders are also more likely to develop PMADs. Teenage mothers, older mothers and single mothers are also at greater risk. Knowing about their risk can help women better prepare for PMADs if they appear.

However, some women, like Tracey herself, don’t see it coming. There are many misconceptions about PMADs that lead some moms, family members and friends to miss or ignore the symptoms, which can range from sadness to rage.

“The very name ‘postpartum depression’ is a misconception because a lot of the cases we see happen during pregnancy and they’re not just depression,” Tracey said. “In my situation, I was completely fine during pregnancy. But as soon as my son left my body, my hormone rates plummeted, and that threw me into severe postpartum anxiety and depression. But many women suffer during pregnancy as well as the postpartum period.

A common misconception about PMADs is that these women are bad mothers, or they don’t love their babies. The truth is that these mood disorders can prevent women from properly caring for their babies and being the parent they want to be.

Another misconception is that PMADs will go away on their own, without treatment. Some families avoid treatment due to cultural or social stigmas around mental healthcare. However, moderate and severe PMADs require treatment to avoid harm to parent or baby.

PMAD treatment options

PMADs are treated using a combination of medication, therapeutic modalities and support groups.

At the IU Health Perinatal Mood Disorder Program, Tracey creates care plans and connects moms with proper support groups that will meet her needs. She also refers moms with PMADs to a psychiatrist, psychiatric nurse practitioner or therapist specifically trained in perinatal care.

Through therapy, moms work through their anxieties and identify healthy ways to cope. Effective therapies that are often used for PMADs include Eye Movement Desensitization and Reprocessing (EMDR) and cognitive behavioral therapy. By working with a psychiatric care provider, a woman’s symptoms can be assessed and treated medically.

Therapy is often combined with antidepressant medications to treat PMADs. There are selective serotonin reuptake inhibitors (SSRIs) that are safe to take while breastfeeding. Antidepressants can be very effective in the treatment of intrusive thoughts.

It’s also important for moms with PMADs to get support. There is a wide variety of postpartum support groups available, and it’s important to select one based on the mom’s specific needs. By connecting with other mothers struggling with PMADs, women can learn that they are not alone, postpartum conditions are common and there’s no reason to feel ashamed.

“The support group process was life changing for me,” Tracey said. “To know that I wasn’t the only one that felt the way I felt and to know I could go to a safe place and share my feelings of shame gave me a sense of community. I had people who understood what I was going through.”

How to approach someone you care about

During prenatal doctor visits and follow-up appointments after the baby is born, mothers should be screened for mood disorders using the Edinburgh Postnatal Depression Scale. This helps providers understand how a woman is feeling and whether additional supports are needed.

It’s important for friends and family to understand that one in five women struggle with PMADs. The new mother is not alone, and there are many effective treatments available. By helping a new mother identify the source of her struggles, recognize that she’s not alone and that help is available, supporters can help new moms find relief.

“Postpartum Support International’s motto is: ‘You’re not alone, you’re not to blame, and with help you will be well,” Tracey said. “It provides validation, reassurance and hope.”