- Postpartum depression is common—and treatable.
- Postpartum psychosis sounds similar but is different and should be treated as an emergency.
- Stigma around both conditions can get in the way of treatment.
When you’re a new mom, people expect that you will be tired, but happy.
But for one in seven new moms, that’s not how it happens, according to Jennifer Wells, MD, a specialist with Carilion Mental Health who leads Carilion's Women's Mental Health team.
Postpartum Depression
“After giving birth, women experience tremendous drops in the hormones estrogen and progesterone,” said Dr. Wells. “Those hormonal changes trigger a complex cascade of changes in your brain that affect mood and can lead to postpartum depression.”
Symptoms
According to the National Institute of Mental Health, mothers with postpartum depression may experience a variety of symptoms, including:
- Sadness
- A feeling of hopelessness
- Anxiety
- A sense of emptiness
- An overwhelmed feeling
- Moodiness
- Irritability
- Restlessness
- Anger
When you add in the lack of sleep that most mothers experience and how much energy it takes to care for a new baby, exhaustion can worsen symptoms.
Women who have a history of mood disorder are also more vulnerable to developing postpartum depression. These include:
- Depression
- Anxiety
- Post-traumatic stress disorder
“If you’ve experienced preexisting mood conditions, be sure to talk about it with your primary care doctor and psychiatrist while you’re pregnant,” said Dr. Wells. “There are often medication prescriptions or changes that can be made in anticipation of the birth that are safe in pregnancy and breastfeeding.”
More Than Baby Blues
Postpartum depression should not be confused with “baby blues,” a common condition in new mothers that lasts a few days. If feelings of sadness last for longer than three days, it is likely postpartum depression.
Left untreated, postpartum depression can last months or even years. But with treatment, it may pass in only a few weeks.
How You Can Help
It is important to know that a new mother does not have control over whether or not she will develop postpartum depression. But nonetheless, many women suffering with it often feel a sense of guilt and shame and need support from family and friends.
If someone you care about is suffering from postpartum depression, Dr. Wells suggests:
- Be an active and open listener
- Don’t be judgmental
- Offer specific help like bringing food, babysitting or doing chores
- If the new mom has not gotten help, gently suggest she follow up with a doctor
For more information on PPD, visit the National Institute of Mental Health and the U.S. National Library of Medicine.
Postpartum Psychosis
The names sound similar and they both develop after a woman delivers a baby, but postpartum psychosis is very different from postpartum depression.
Postpartum psychosis is a break from reality that causes irrational, destructive thoughts; delusional thinking and hallucinations that can potentially drive a new mother to cause harm to her partner, herself or even her baby.
After a tragic case in another state made national headlines, Carilion Clinic Obstetrics and Gynecology specialist Jaclyn Nunziato, MD, spoke with WDBJ about postpartum psychosis to raise awareness about this rare but devastating condition.
"Sometimes when the topic is so heavy it feels like it can’t be discussed, I would say that it’s even more reason for us to start discussing it,” she said. "Postpartum psychosis is a medical emergency that needs urgent and immediate attention."
Postpartum psychosis happens about once in 1,000 live births, or about 3,000 times a year in the U.S. Of those, Dr. Nunziato pointed out, only a very small percentage will end in suicide or infant death.
Symptoms
Postpartum psychosis typically occurs immediately and in the first two weeks after delivery, but it can occur through the baby's first year.
Intrusive thoughts are a key symptom, but Dr. Nunziato emphasized the difference between rational and irrational intrusive thoughts.
With the "baby blues," intrusive thinking can mean being anxious about other people holding the baby or worrying that you might drop the baby.
"These are considered intrusive thoughts," said Dr. Nunziato, "but they're very different from psychosis."
Psychosis is a break from reality in which the intrusive thoughts are both destructive and irrational. It causes hallucinations such as:
- Seeing someone who isn't there
- Hearing someone tell you to harm yourself or harm the baby
It also causes sleep disturbances that lead to insomnia.
Who Is at Risk?
Women who already have certain mental health conditions when they become pregnant are at a dramatically increased risk of developing postpartum psychosis. These include:
- Bipolar disorder
- Family history of bipolar or schizophrenia
Your risk is also increased if you have:
- A history of psychosis
- Severe anxiety
- Severe obsessive-compulsive disorder (OCD)
These conditions do not mean you will develop postpartum psychosis. As noted above, only about 3,000 women develop it each year. Even so, knowing that there is a risk makes many women with these conditions stop taking their medications out of fear for their baby.
"The most important thing is to take care of yourself so you can take better care of your baby," said Dr. Nunziato.
She recommends talking to your physician before making any changes due to pregnancy.
"The risks of these medications have been well studied," she said. " The risks of something happening to your baby with them are so much less than untreated mental health disorders."
What You Can Do
If you or someone you love experience signs of psychosis, treat it like any other mental health emergency:
- Reach out to your doctor
- Call 911
"This is a true emergency, right up there with heart attack," said Dr. Nunziato.
It is also important to push through the stigma and talk about it.
"We want people to have the conversation," she said, "and we want them to feel empowered that this is something that is treatable."
Non-Emergency Support
Non-emergency support is available for new mothers experiencing postpartum depression, postpartum psychosis or any other worries new mothers may have.
- Postpartum Virginia has a warmline staffed by other mothers: call 703-829-7152 or text 540-698-1277 (en español 757-550-4234).
- Postpartum International is another resource with information, a helpline, support groups and more: call or text "help" to 800-944-4773 (text en español 971-203-7773).
If you are experiencing thoughts of suicide or harm to yourself or your child, call your doctor or 911 or go to the nearest emergency room. You can also call 988 to reach the Suicide and Crisis Lifeline.
