When is it more than the baby blues?

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Recognizing the symptoms of perinatal and postpartum depression

Pregnancy and childbirth are portrayed as some of the most magical moments in a woman’s life. But what if those magic moments don’t turn out as planned? Amid the sleep deprivation and fatigue, how can you tell if you have something more than the “baby blues?”

Approximately 14 percent of women, or 1 in 7, experience significant depression following childbirth, according to the Centers for Disease Control and Prevention and the American Psychological Association.

Symptoms can start anytime during pregnancy or up to a year after a woman gives birth. According to the National Institute of Mental Health, symptoms can include:

  • Feeling sad, hopeless, empty or overwhelmed.
  • Crying more often than usual or for no apparent reason.
  • Worrying or feeling overly anxious.
  • Feeling moody, irritable or restless.
  • Oversleeping or being unable to sleep, even when the baby is sleeping.
  • Having trouble concentrating, remembering details and making decisions.
  • Experiencing anger or rage.
  • Losing interest in activities that are usually enjoyable.
  • Suffering from physical aches and pains, including frequent headaches, stomach problems and muscle pain.
  • Eating too little or too much.
  • Withdrawing from or avoiding friends and family.
  • Having trouble bonding or forming an emotional attachment with the baby.
  • Persistently doubting the ability to care for your baby.
  • Thoughts about harming yourself, the baby or others.

“When I’m talking to patients who are worried they may have perinatal or postpartum depression (PPD), I try to simplify the medical criteria for it into a few basic things,” said Dr. Heather Graham of Novant Health Rankin OB/GYN in Charlotte, North Carolina. “Are they doing the basic functions they need to every day? Eating, sleeping, exercising and playing – all things that are definitely more difficult for a new mom to do.”

That means you should be eating – even if it’s just the few minutes you have while your baby is sleeping. “Poor appetite or overeating can be a sign of depression,” Graham said.

You should be able to sleep when your baby sleeps, according to Graham. “Every new mom is sleep deprived, but if you’re riddled with anxiety and worry and are unable to sleep, that can be a sign,” she said.

And when it comes to exercise and play, Graham asks new moms if they’re enjoying their baby and the things that matter to them in their lives. “Most moms’ lives are radically changed when their baby is born,” she said. “Moms are already largely at risk for postpartum depression because they’re bogged down in the day-to-day of taking care of their baby and aren’t necessarily taking care of themselves.”

“More bad days than good”

Formal medical criteria from the American Psychiatric Association for perinatal or postpartum depression includes a depressed mood for two weeks or longer, as well as symptoms of guilt, low energy, sleep and appetite disturbances, difficulty concentrating, lack of enjoyment and fatigue, among others, Graham said. “Suicidal or homicidal thoughts are obvious red flags that require immediate intervention,” she added.

But how to find the fine line between normal “baby blues” (mood swings and weepiness during the first two to three weeks after birth that affect about 80 percent of women) and something more serious?

“Postpartum baby blues typically lasts the first couple of weeks and can largely be attributed to fatigue. You may cry at the drop of a hat from exhaustion,” Graham said. “Postpartum depression is more a day-to-day problem that does not resolve quickly.”

That advice resonated with new mom, Carrie Lock. “I was told to pay attention to whether I was having more bad days than good. And that it doesn’t have to be that way,” she said. “That really resonated with me. It’s hard because your hormones are so crazy and sleep deprivation makes everything so much harder. It’s important to know that you shouldn’t worry if you’re still scared or anxious after the baby’s born and it’s not purely the magical moment you’re expecting.”

Causes and risk factors

There is no definitive cause of perinatal or postpartum depression, though women who have a personal or family history of depression, anxiety or PPD are at a much higher risk of experiencing it, Graham said. “If women discontinue their depression medication during their pregnancy, they have up to a 68 percent chance of a recurrence of depression during pregnancy or postpartum,” she said.

The physiological changes that women experience during and after pregnancy also can contribute. “The fluctuation in hormones combined with extreme sleep deprivation, difficulty breast-feeding or a colicky baby can be the perfect storm for some women,” Graham said.

Other women who may be at a higher risk for perinatal or postpartum depression include women who:

  • Experience premenstrual dysphoric disorder (PMDD or PMS).
  • Have inadequate support in caring for the baby.
  • Have financial or marital stress.
  • Experience pregnancy, birth or breast-feeding complications.
  • Have experienced a recent major life events, such as a loss, house move or job loss.
  • Are mothers of multiples.
  • Have infants in the Neonatal Intensive Care Unit (NICU).
  • Have undergone fertility treatments.
  • Have a thyroid imbalance.
  • Have any form of diabetes (type 1, type 2 or gestational).

Overcoming the stigma, reaching out

Graham said she still sees a “huge stigma” related to depression. “People are still very afraid of bringing it up,” she said. “And I think that’s why so many people also will stop their depression medications during pregnancy because they think it is something they can control and something that makes them weak. When, in fact, stopping the medication can cause a lot more harm than good.”

Graham reiterated just how common depression during pregnancy is. “One in seven women are diagnosed with depression at some point during their pregnancy. That is a huge number,” Graham said. “People are aware of what it is but may not be aware of how common it is and how it can be treated effectively.”

Treatment can include counseling or antidepressant medications or both in combination, Graham said.

More than anything, Graham said, it’s important to tell someone how you feel. “Tell your family. Tell your OB-GYN. Tell your primary care provider, if you prefer. But women need to tell someone if they think they’re experiencing perinatal or postpartum depression. Reaching out for help is huge. You aren’t alone in this.”

Novant Health offers information about a postpartum depression risk assessment online along with additional resources for new mothers.

If you have thoughts of harming yourself, your baby or others, seek medical attention immediately.

For more information about maternity services offered by Novant Health, call toll-free 1-855-251-8808.

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