Postpartum Depression

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Postpartum Depression

Brooke Shields became a superstar model and actress at a young age. Her career started as a baby, in Ivory Soap ads. She starred in the movie Pretty Baby at age 12. She was 14 years old when she appeared in provocative ads for Calvin Klein jeans, and 15 when she starred in The Blue Lagoon. Her most important and courageous role, however, was her public disclosure in 2005 of her struggles with postpartum depression (PPD) and thoughts of suicide. By raising public awareness of this serious syndrome, she leveraged her celebrity status towards reducing stigma and encouraging people to get help.  (In addition to interviews and articles, she wrote a memoir titled Down Came the Rain: My Journey Through Postpartum Depression.)

Postpartum depression is common (up to 15% of new mothers), can be life-threatening, can interfere with parent-child bonding, and is treatable. A more accurate name might be “peripartum depression,” as the depressive symptoms can begin during pregnancy.

Differentiating postpartum depression from the even more common “baby blues” is key. Baby blues affect many new mothers and last from 2-3 days up to 2 weeks. Women can experience anxiety, insomnia, moodiness, tearfulness, irritability, sadness, impaired concentration, and changes in appetite. This is short-lived and resolves on its own.

Postpartum depression, however, is more severe and longer lasting. It can go on for months (up to a year) if untreated and can lead to suicidal thoughts, and sometimes even thoughts of harming the baby. There may also be significant negative effects on mother-infant bonding, the ability to care for the baby, and on basic self-care. Also, the relationship with one’s partner may be impacted.

Symptoms of postpartum depression can include: sadness, anxiety, fatigue, loss of interest in activities, crying, withdrawing from loved ones, foggy brain, feelings of worthlessness or guilt, lack of interest in your baby, trouble caring for your baby, suicidal thoughts, and sometimes thoughts of harming your child.

Risk factors for developing PPD include: prior depression, family history of depression, feeling ambivalent about the pregnancy, pregnancy complications, being a young parent or a single parent, financial stress, limited social support, and relationship stress.

 Since the depression is treatable, and treatment is potentially life-saving, it is crucial to talk with your OB/GYN, primary care physician, a psychiatrist, or seek help from someone else especially for: symptoms persisting for longer than two weeks, worsening symptoms, thoughts of harming oneself or one’s baby, thoughts of suicide, difficulty taking care of the baby/self, and/or difficulty performing regular daily activities.

Postpartum psychosis, a related but much less common syndrome is a mental health emergency. Seek care immediately. The onset can be within one week of delivery. It is rare but severe and requires immediate treatment due to significant risk of harm and death. Symptoms can include paranoid thoughts, confusion, hallucinations or delusions (false beliefs), insomnia, agitation, hyperactivity/rapid speech, and feelings of hopelessness and shame.  

Interestingly, postpartum depression can also occur in the other parent, with similar symptoms (depressed mood, fatigue, changes in appetite and sleep, anxiety, feeling overwhelmed.)  

Since Brooke Shields’ disclosure, many other celebrities who have openly discussed their experiences with postpartum depression, including Serena Williams, Reese Witherspoon, Alanis Morissette, Gwyneth Paltrow and Adele. Still, many myths about pregnancy and new parenthood remain entrenched in our culture and can act as barriers to seeking help. Some myths: that new motherhood “will be the happiest time of your life” and is “totally fulfilling;” bonding with your baby and breastfeeding always come “naturally;” and that new parents must be selfless at all times. Therefore, struggling parents often feel guilty and defective if they experience negative feelings such as sadness, anger, resentment, and the wish to escape at times.

Awareness about postpartum depression is growing, with a new category of medications approved specifically for this illness (in addition to the traditional antidepressants). Brexanolone (Zulresso) was the first medication in this category of neuroactive steroids for PPD, was approved in 2019. It was a breakthrough in terms of effectiveness, but difficult to use; it requires a 60-hour IV infusion at a healthcare facility. Now, in August 2023, the FDA approved Zuranolone (Zurzuvae), a medication with a similar mechanism of action but in pill form, the first pill ever approved for PPD.

There are also many non-medication approaches, including psychotherapy, lifestyle changes and support.  Family and community support can include help with childcare and household chores, financial support, and emotional support. For the depressed mother: avoid isolation, reach out to people and talk about how you are feeling, elicit help so you can get enough rest and sleep, add in some exercise (such as walks), and set realistic expectations for yourself. And talk with your OB/GYN or primary care physician.

In many cases, PPD is first recognized by a family member or friend. A new mother may not recognize what is occurring and/or may feel too ashamed to seek help. Please reach out if you suspect that someone you know may be struggling with peripartum depression (or psychosis).

Gwyneth Paltrow:

“I felt like a zombie. I couldn’t access my heart. I couldn’t access my emotions. I couldn’t connect. It was terrible. It was the exact opposite of what had happened when Apple was born. With her, I was on cloud nine. I couldn’t believe it wasn’t the same [after Moses was born]. I just thought it meant I was a terrible mother and a terrible person. … I think it was the fear of loving a little boy as much as I loved my dad and more. … About four months into it, Chris [Martin] came to me and said, ‘Something’s wrong. Something’s wrong.’ I kept saying, ‘No, no, I’m fine.’ But Chris identified it, and that sort of burst the bubble. … The hardest part for me was acknowledging the problem. I thought postpartum depression meant you were sobbing every single day and incapable of looking after a child. But there are different shades of it and depths of it, which is why I think it’s so important for women to talk about. It was a trying time. I felt like a failure.” 

 Good Housekeeping, January 2011

If you or a loved one are having thoughts of suicide (or harming others):

  • Call or text 988 to reach the 988 Suicide and Crisis Lifeline.
  • Call 911.
  • Reach out to a healthcare provider. 
  • Tell a loved one or close friend. 

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