Beyond Postpartum Depression

A few months after my daughter Alice was born I sat in a rocking chair at four in the morning, nursing her and crying for no clear reason — for probably the fifth time in as many hours. It had become my go-to state; a big, blank sadness punctuated by lightning flashes of intense, all-consuming anxiety.

“I’m just tired,” I’d say in the beginning when friends or family expressed concern. “I’m a new mom. You know how that goes!”

The next month it was the same. “Just hormones!” I sobbed at my husband. “Just tired… Just adjusting… It’ll get better when she starts sleeping more. When things feel normal. When I can fit into my clothes…”

But months passed and it didn’t get better. Finally I realized I needed to get some help.

Before it became clear that my 4am crying jags were more than “just hormones,” I’d had a vague image of postpartum depression gleaned from cursory internet searches and the pamphlets they’d handed out at the hospital. It mostly featured a miserable new mother, struggling to connect to her baby. That wasn’t me, I rationalized. Sure, I was sad, but I felt totally connected to my baby. Too connected, even. So connected that I spent hours obsessing over every bad thing that could possibly happen to her, imagining increasingly awful and unlikely scenarios. That branch could fall and crush her. How could I live if she died? What if someone takes her? What if she suffocates in her sleep? What if, what if, what if…

But that was normal, I figured. Wasn’t worrying about your child just what moms did?

Not quite.

Most women are familiar with postpartum depression, but moms can also struggle with postpartum anxiety, OCD and psychosis. That’s why the older term “postpartum depression” is giving way to a new, broader one: “perinatal mood and anxiety disorders,” or PMADs.

“I like to say PMADs are the new postpartum depression,” says Catherine Birndorf, MD, founder and medical director of The Motherhood Center in New York City, which specializes in perinatal mental health. “The problem is that so many moms hear ‘postpartum depression’ and think, ‘but I’m not depressed! I’m anxious, I can’t sleep, I don’t feel like myself,’ but none of those necessarily sound like depression, so they don’t think to seek treatment.”

Help is out there, and it works, but finding the right kind of treatment means knowing what to look for — especially when your symptoms don’t fit the stereotypical image of postpartum depression.

While the terms “perinatal” and “postpartum” refer to the time right after giving birth, the reality is that many moms find themselves struggling with these mental health issues long after the baby is born. “Symptoms occur at different times in life,” says Dr. Birndorf, “I know moms with teenagers who are saying, ‘I feel like I’m still dealing with postpartum issues!’”

Moms who found ways to cope with early postpartum struggles often find themselves unable to manage when faced with new challenges, like the birth of another child. “The system gets stressed,” says Dr. Birndorf. “When you’re already operating at the edge of your capacity, there’s no room for new stressors. It doesn’t take much to take you down.”

This is especially true for mothers of children who are experiencing difficulties of their own. Worrying about a kid who’s struggling in school, caring for an anxious child, or white knuckling through another meltdown at the grocery store can be enough to knock a struggling mom right back into the jaws of depression or anxiety.

The upside of this, says Dr. Birndorf, is that when mothers seek help for their children they often have an “Ah-ha!” moment about their own mental health. “When parents have to slow down and look at what’s going on with their kid it can be a moment to stop and consider what’s going on with themselves.”

Since some anxiety is par for the course when it comes to having a child, many new mothers assume, like I did, that their worries are just part of being a parent. “A lot of mothers experience intense, terrible anxiety,” says Dr. Birndorf, “but don’t realize it’s a postpartum symptom.” Signs of a perinatal anxiety disorder include:

• Persistent, intense anxiety that is out of proportion to your actual experience. For example, fearing that a healthy baby might have cancer. Or a general sense that something “terrible” could happen, when things seem to be going fine
• Insomnia
• Intense, frightening images of harm coming to your child, or of you harming your child, that seem to come out of nowhere
• Feelings of hopelessness, worthlessness and dread
• Fears or worries that impact your ability to function, making even the most simple tasks, like leaving the house or driving from one place to another, seem dangerous and insurmountable

For some mothers, these thoughts become intrusive, obsessive and controlling, and may be a sign of a separate condition called postpartum obsessive-compulsive disorder (OCD).

Likewise, it can be hard to figure out if what you’re feeling is postpartum depression or just the growing pains of being a parent. Especially when you’re incredibly exhausted and living off whatever you can grab in the five minutes before the baby wakes up. Many women experience a period of mood swings, sadness or irritability known as “baby blues” after giving birth, but for most the symptoms fade after a few weeks. If they persist, or seem to be getting worse, not better, it might be time to talk to your doctor. Signs of postpartum depression include:

• Feelings of worthlessness, hopelessness or numbness
• Mood swings
• Crying all the time or bursting into tears for little (or no) reason
• Loss of appetite or emotional eating
• Forget sleeping when the baby sleeps, you’re not sleeping at all. Or, conversely, you do nothing but sleep
• Lack of resilience. Feeling totally overwhelmed by even the simplest of tasks
• Feelings of rage, lashing out at friends, family or your baby
• Feeling disconnected from your baby, or so intensely, upsettingly connected that you feel unable to cope
• Worrying that “nothing will ever be the same again”

It is also possible to have both anxiety and depression. In fact, anxiety that goes untreated often results in depression as well.

Parents often overlook their own feelings and needs in favor of taking care of their children’s  — something that, however well meant, can cause a negative ripple effect on the whole family’s mental health. “There’s this pervasive myth of the supermom, who’s always caring for everyone but herself,” Dr. Birndorf says. “But when the supermom is struggling, pushing through often does more harm than good. If mom and dad are not well, it’s very hard for the child to be well.”

Kids look to parents for cues on how to behave, and when you’re a parent who’s struggling, you’re doing it in front of an audience. Studies have shown that children of depressed or anxious parents are more likely to have behavioral problems, learning issues and mental health struggles of their own. That’s why it’s important for parents to get help for themselves, and model resilience to teach children how to manage difficult situations in a healthy way.

Making time to practice self-care is important. Self-care can be anything that allows you time to step away from stressors and have a moment for yourself. Some examples could be:

• Taking a bath when your child is sleeping, or watching a favorite show after everyone has gone to bed
• Going out to dinner
• Journaling
• Taking an exercise class
• Meditating for five minutes or using a meditation app
• Taking a quiet walk outside

Self-care doesn’t have to be fancy, expensive or time consuming. “Small interventions can be really helpful,” says Dr. Birndorf.

It’s also important to stop pretending to be okay when you’re not. Reach out to supportive family or friends. “Tell people you’re struggling and, most importantly let them know how they can help you,” says Dr. Brindorf. Giving specific tasks will make it easier for people to help in ways you actually need. For example, taking your child to an appointment, babysitting while you and your partner go on a date, or just checking in with you once a week to see how you’re doing.

Joining online communities or Facebook groups that focus on parenting or postpartum mental health is another great way to find support and connect with other parents. But make sure the groups or pages you’re engaging with are calming your anxieties, not increasing them. “Online groups can be helpful,” says Dr. Birndorf, “but remember that people on the web can sound as authoritative as your doctor, and be totally, totally wrong.”

Connecting with other moms in person can help alleviate a sense of isolation, and joining a PMADs support group in your area can be a huge help, says Dr. Birndorf. “Just talking to other people who understand what you’re going through often takes a big weight off.”

Cognitive behavioral therapy (CBT) has proven very effective in treating perinatal disorders. CBT teaches people that their thoughts, feelings and behaviors are all interconnected, so changing one of these points can change all three. Clinicians and patients work together to meet certain goals, like catching unhelpful thought patterns and improving resilience.

Some therapists specialize in PMADS. But, says Dr. Birndorf, a specialty isn’t everything. “Getting help when you need it is the point. If you’re struggling, finding a therapist who you feel comfortable developing a relationship with and who understands your needs is more important than finding a specialist.”

Anti-depressant or anti-anxiety medications can also be an important part of the equation. Women who are concerned about taking medication while breastfeeding should talk to their providers, says Dr. Brindorf. “It’s absolutely possible,” she says, “you just have to work with someone who can help you find the right solution.”

I finally took the leap and found a therapist who understands where I’m coming from. I’ve started making friends with other parents, asking for help when I need it, and stopped insisting I’m fine when I’m not. I have bright days and bad ones, but I no longer feel isolated or afraid. I see my daughter watching my face, and lines from Theodore Rotheke’s poem “The Waking” flash through my mind: I learn by going where I need to go.

“We’ll figure it out together,” I tell her, smiling.