Ok, so that title’s a little bit of a cheat.  But a friend recently asked us to blog about this topic, and I didn’t want to ignore her request.  Unfortunately, it’s not always possible to escape postpartum depression.  In fact, many times it’s not.  But there are things we can do to at least lessen the impact, shorten the duration, or even, at times, prevent the onset entirely.  And there are certainly some best practices in treatment.  Also, it’s very important to know that postpartum mood disorders are very treatable, and will get better, if seen by the right professionals.

First of all, what is the definition of postpartum depression?  Postpartum depression is actually just one of a cluster of perinatal mood and anxiety disorders that those of us who work with the pregnant and postpartum population see.  Postpartum depression often begins even during pregnancy, and can worsen in the postpartum period.  Symptoms are varied, but can include:

  • Irritability
  • Feelings of guilt or shame
  • Feelings of hopelessness
  •  Feeling down, crying often
  • Appetite and sleep disturbance (beyond what would be normal for having a newborn)
  • At times, difficulty bonding with baby
  • Lack of interest in things that were previously pleasurable (anhedonia)
  • Feeling like you just want to “go away” or “disappear” (not necessarily suicidal ideation, but at times, that can be a symptom as well)

(Postpartum depression is different from the Baby Blues, by the way.  Baby Blues happens to MOST of us (around 80% of new parents), and often looks like feeling “up and down” and weepy for the first week to 10 days after having a baby, usually related to hormonal changes.  But after that, symptoms should get better).

In addition to postpartum depression, I also see postpartum anxiety just as much, if not more, than postpartum depression.  Postpartum anxiety has varied symptoms, but can include:

  • Intrusive thinking (thoughts or images that pop into your head that something bad is going to happen to you or your baby, are the most common form.  I wrote a blog about this type of thinking here).
  • Constant worrying
  • Racing thoughts, often when trying to fall asleep
  • Difficulty falling asleep or appetite disturbance
  • At times, panic attacks

There are other perinatal mood disorders that I’m not addressing here, for the sake of time (or rather, space), but are certainly important and also treatable.  You can read more about those illnesses and how to get support for them here.

So now that I know what it is, how can I stop it from happening?!

Like I said, preventing postpartum depression and/or anxiety is not always possible.  But there are some proactive steps we can take.

1.       Know your risk. It’s unfair, but some of us are more at risk to develop these illnesses.  We’re more at risk if we:

  • Have a history of depression or anxiety, or postpartum depression and/or anxiety
  • Are a single parent, or lack support
  • Are very young, like an adolescent parent
  • Have a family history of depression or anxiety
  • Are in a stressful or abusive relationship
  • Have a history of miscarriage, infant loss, or infertility
  • Have a baby in the NICU
  • Had complications in pregnancy or during labor
  • Have difficulty breastfeeding (more on this here)

If you know that you’re at risk, you can proactively try to engage supports before the illness takes over.  For example, ensuring you’re doing some of the preventative things below, or even starting a medication that has been helpful for you in the past (for example, if you’ve had postpartum depression or anxiety previously) before you start to feel really bad.

2.       Sleep! Sleep.  Sleep sleep sleep.  SLEEP.

I cannot emphasize this one enough.  So often, I have a weeping, super depressed or anxious new parent in front of me who says, when I ask how much they’re sleeping in 24 hours, that they’re getting “oh, maybe 3-4 hours”.  TOTAL.  That is NOT enough.  Just because you have had a new baby does not mean that you suddenly are super human and no longer need sleep.  Of course having a baby disrupts sleep.  That’s to be expected.  If you’re breastfeeding or pumping, you’re likely getting up several times a night.  However, it’s still important to try to get at least 6 hours of sleep in a 24 hour period.  Anything less than that will seriously start to negatively affect your health- including your mood.  Some ways to get more sleep include:

  • Sleeping when baby sleeps (seriously.  Put DOWN the laundry.  It can wait.  Or, better yet, have someone else do it if you have the support!)
  • Trying to get at least one 4 hour “chunk” during the night.  If you’re nursing, this could mean trying to pump enough for one extra bottle so someone else, like a partner, can feed the baby one feeding at night. 
  • If you can’t turn your brain off, even when everyone else is asleep, than getting some help.  This might mean taking something to help you fall asleep, like hydroxyzine, which acts a lot like Benadryl and can help calm you down enough to fall asleep.

3.       Eat enough and drink water

I know, this one seems like a no-brainer.  But I can’t tell you how many times I’ve talked to a new parent who has yet to eat that day, and it’s like, 4pm.  When you become a new parent, you often start to think that your needs are last.  But in fact, they should be first.  Have you heard the airplane analogy?  When the oxygen mask falls down, who do you put it on first, yourself, or your child?  WRONG!  You put it on yourself.  Why?  Because you’re not going to be able to help your child if you’re passed out in the aisle.  Same applies to these basic needs- if your blood sugar is low, or you’re not getting enough to drink, you’re going to notice your mood is affected.  And don’t just eat anything- grab something with protein, like a granola bar.

4.       Get support.

Support can mean different things for different people.  Not everyone has access to a partner.  Or, they have one, but he/she is not that helpful.  Sometimes we have to be creative.  Reach out to people – family, a lactation consultant if you’re struggling with breastfeeding, a mama’s group, a pregnancy and/or postpartum doula, a therapist who specializes in perinatal mood and anxiety disorders, a neighbor.  People LOVE to help new parents, and often they don’t know how.  Telling them actual things they can do to help will be well received.  For example, don’t just shrug your shoulders when someone says “what can I do?”  Give them instructions!  Like, “it would be so great if you could help us set up a meal train”, or “if you could just take this crying, screaming, wiggling poop machine for a few hours so I can sleep, that would be fabulous”.    

5.       Get outside.  Get exercise if you can!

I know it’s so hard to think about getting out of the house when you have a newborn.  I’ve been there.  But getting fresh air, even just a little walk around the block, can be so helpful in clearing your head and getting the endorphins flowing.  And if you have ANY extra energy, getting out for some gentle exercise once your medical provider clears you can also be super helpful.  Something like gentle yoga, swimming, or walking can increase your serotonin levels, which helps to lower anxiety and depression.

6.       Go to your postpartum visit.  Seriously!

We new parents have this tendency to ignore our own health once our baby is fine.  This is dumb (see above airplane analogy).  Your postpartum visit is so important, because you can talk about any issues with mood you’re having.  A good OB/GYN or midwife will know about perinatal mood and anxiety disorders and be able to steer you in the right direction for help.  They’ll also be able to rule out any other underlying medical issues.  For example, pregnancy has a way of making your thyroid act all wonky (especially if you have a history of thyroid issues or your family members do), which can definitely affect mood.  So you can ask to have your TSH checked.  A low Vitamin D level could also affect your mood, so you could have that checked as well.

7.       Medication.

Medication is not ever our first response to perinatal issues.  But sometimes, it’s necessary.  For some reason, we as a culture tend to separate the brain from the body when it comes to our health, which really makes no sense at all.  If you had diabetes, or heart failure, you wouldn’t hesitate to take a medication if it was medically necessary. I won’t get into all of the details here, but there is a lot of research that shows that medications like SSRIs (such as Zoloft) can be very helpful and safe, even when pregnant or breastfeeding.  That doesn’t mean you shouldn’t question medications and do research.  Here is a wonderful site if you’d like to start.  If you’re wondering what medications to start with, it’s best to see an OB/GYN or a psychiatrist who specializes in perinatal mood and anxiety disorders and really knows what are safe vs not safe.

8.       The holistic approach.

There are so many good ways to combat perinatal mood and anxiety disorders, and the best prevention and treatment won’t be ONE thing, but many.  I find that new parents tend to feel better faster or do better at preventing the issue from starting if they adopt a comprehensive approach to treatment.  I.e., all of the things mentioned above, plus some other innovative methods that have shown some promising results.  Some examples would be:

  • Doulas- I know I’ve already mentioned them, but having a birth doula and/or a postpartum doula has been proven to help with so many things, including lowering the risk of invasive birth procedures, birth trauma, and perinatal mood and anxiety disorders. 
  • Placenta encapsulation- Although there hasn’t been a ton of clinical research on this yet, I have treated many a new parent who swears by this. 
  •  Acupuncture – there is some great research out there demonstrating that acupuncture can be helpful in lowering anxiety and/or depression symptoms.
  • Supplements- obviously, always talk to your health professional before you start taking a supplement.  But sometimes supplements like Vitamin D or B complex vitamins can be super helpful in lowering symptoms of depression or anxiety.

This list is not exhaustive.  Let us know in the comments below what helped YOU prevent or, at least, lower the intensity of your postpartum issues!  And if you need any help getting connecting to some great professionals in the area, feel free to reach out to me!