Raising Awareness: What is Postpartum Depression?

Postpartum depression (PPD) is a mood disorder that affects nearly 15% (more than 3,000,000 in the US alone each year) of women after childbirth. This percentage is even higher for women living in poverty, teen mothers, and parents with a baby in the NICU, and doubles for women with a prior history of PPD.

PPD is a serious mental illness that involves the brain and affects a woman’s behavior and physical health. Symptoms include feelings of extreme sadness, anxiety, and exhaustion that may make it difficult for them to complete day-to-day tasks to care for herself or others.

“Postpartum depression isn’t a character flaw or a weakness. Sometimes it’s simply a complication of giving birth.” MayoClinic.org

Some women don’t tell anyone about their symptoms due to feelings of embarrassment, shame, or guilt about feeling depressed when they are supposed to be happy. They may also worry they will be seen as bad mothers.

Part of the reason I started this blog was to bring awareness to important issues like postpartum depression to other new or young mothers like myself. I want to join my voice along with other affected mothers to raise awareness that postpartum depression is a real disorder that needs to be recognized, treated, and discussed. The stigma that surrounds mental illness and postpartum depression need to be ameliorated and instead be replaced with acceptance, understanding, and support. Increased awareness can give way to increased access to services specifically developed to help women following childbirth and the development of even more effective treatments.

September is suicide awareness month, and unfortunately too many women have been lost to postpartum depression, including a family friend. If proper education and services are available and the stigma to admit to your symptoms and seek help disappears, we can make a difference in preventing these unnecessary deaths.

I know I personally was worried that talking about my symptoms would cause Child Protective Services to be contacted because I was an unfit mother and/or the living conditions were considered unsafe for my children.

Symptoms

Postpartum depression can begin anytime within the first year after childbirth, but most often occurs within the first 3 months after delivery. Research has shown that although depression generally decreases over time, depression remains a chronic problem for anywhere from 30-50% of women.

In community- based studies, 30% of mothers diagnosed with PPD were still depressed up to 3 years after delivery.

The most common symptoms of postpartum depression include:

Feelings of sadness, hopelessness, emptiness, guilt, rage, or anxiety
Feeling moody, irritable, angry, overwhelmed, or restless
Oversleeping or insomnia
Severe mood swings
Excessive crying
Difficulty concentrating, remembering details, and making decisions
Physical aches and pains including headaches, stomach problems, and muscle pain
Appetite changes
Loosing interest in activities that were once enjoyable
Withdrawal from family and friends
Difficulty bonding with baby
Persistently doubting her ability to care for her baby
Thoughts of death or suicide
Thinking about harming herself or her baby
Fear to be alone with her baby

Causes

There is no known cause for postpartum depression, but likely results from a combination of physical and emotional factors. Postpartum depression is not the result of something a mother does or does not do.

Hormonal changes may trigger symptoms of postpartum depression. Estrogen and progesterone are the primary pregnancy hormones. A woman will produce more estrogen during one pregnancy than throughout her entire life when not pregnant. The rapid increase in estrogen levels during the first trimester may be the culprit for some of the nausea associated with pregnancy. Estrogen levels increase steadily during pregnancy and reach their peak in the third trimester. Progesterone levels are also extraordinarily high during pregnancy.

Estrogen is a female hormone that is mainly produced by the ovaries. It serves many purposes including helping to regulate the menstrual cycle, preserving bone density, and increasing uterine growth. Estrogen levels vary from day-to-day during different cycles in the menstrual period as well as during normal stages of female development. Estrogen levels rise during puberty and a healthy pregnancy and fall during menopause. Estrogen plays an essential role throughout the menstrual cycle. When estrogen levels are low, resulting symptoms can include fatigue, hot flashes, night sweats, vaginal dryness, difficulty concentrating, feeling depleted and exhausted.

Estrogen Reference Ranges

Phase or Trimester	Mean Age, Years	Reference Range
	7.1	undetectable- 20 pg/mL
	10.5	undetectable- 24 pg/mL
	11.6	undetectable- 60 pg/mL
	12.3	15-85 pg/mL
	14.5	15-350 pg/mL
Follicular phase		30-100 pg/mL
Ovulation		100-400 pg/mL
Luteal phase		60-150 pg/mL
Pregnancy First Trimester		188-2497 pg/mL
Pregnancy Second Trimester		1278-7192 pg/mL
Pregnancy Third Trimester		6137-3460 pg/mL

Progesterone Reference Ranges

Phase	Age, years	Reference Range
	5-9	0.6 ng/mL
	10-13	10.2 ng/mL
	14-17	11.9 ng/mL
Follicular		<0.2 ng/mL
Luteal		3-20 ng/mL
Pregnancy First Trimester		8-48 ng/mL
Pregnancy Third Trimester		99-342 ng/mL

After childbirth, the levels of the hormones estrogen and progesterone drop quickly. Changes in estrogen and progesterone levels also influence serotonin levels. Low levels of serotonin are linked to feelings of sadness and irritability, in addition to trouble sleeping and unusual food cravings. This drop leads to chemical changes in the brain that may trigger mood swings.

Additionally, many mothers are unable to get adequate sleep to fully recover from giving birth. Constant sleep deprivation can lead to physical discomfort and exhaustion, which can contribute to the symptoms of postpartum depression. Sleep deprivation alone can noticeably affect performance, ability to think clearly, react quickly, and form memories. Sleep deprivation affects mood and leads to irritability and increases anxiety. Chronic lack of sleep causes your stress hormone cortisol levels to soar. Additionally, not getting enough good quality sleep, you put stress on your adrenals, which leads to lowered serotonin. Serotonin is a natural mood stabilizer that helps with sleeping, eating, and digesting. It also helps reduce depression, regulate anxiety, heal wounds, stimulate nausea, and maintain bone health.

Many non-hormonal factors may also contribute as well:

Changes in body may make you feel less attractive
Changes in work and social relationships
Struggle with your sense of identity
Having less time and freedom for yourself may make you feel that you’ve lost control over your life
Lack of sleep
Worries about your ability to be a good mother

Risk Factors

Although there is no known single cause for postpartum depression, there are several risk factors that put some women at a greater risk for developing postpartum depression.

Under age 20
Depression during or after a previous pregnancy
History of depression, bipolar disorder, or an anxiety disorder
Family history of depression or other mental illness
A stressful life event during pregnancy or shortly after giving birth
- Job loss
- Death of a loved one
- Domestic violence
- Personal illness
Medical complications during childbirth
- Premature delivery
- A baby with medical problems (NICU numbers)
Mixed feelings about the pregnancy
Difficulty breastfeeding
Having multiple births- twins, triplets, etc.
A lack of strong emotional support from her partner, family, or friends
History of or current use of alcohol or other drug abuse problems

Treatment

If you experience any symptoms of postpartum depression that don’t fade after 2 weeks or are getting worse, call your doctor and schedule an appointment. There are effective treatments for postpartum depression, including:

Counseling– talking one-on-one with a mental health professional
- Cognitive Behavioral Therapy- involves discussing feelings and thoughts so that the therapist can help to assess where thought patterns are creating depression and anxiety. Provides coping skills and self-help tools to control and manage symptoms
- Interpersonal Therapy- aimed at relieving symptoms by acknowledging the causes and contributing factors of PPD
- Eye Movement Desensitization and Reprocessing- addresses traumatic experiences involved in PPD using brain stimulation techniques to alleviate emotional attachment to the traumatic memories
- Group Therapy- help women to better understand PPD by immersing them in a controlled environment with others experiencing similar journeys
- Couples Counseling- a concerning aspect of suffering from postpartum depression is the toll it can take on marriages and relationships. The goal of couples therapy is to open up lines of communication while providing a safe place for each person to be heard.
Medication– antidepressant medications that act on chemicals in the brain to regulate mood.
Lifestyle and home remedies-
- Physical activity, adequate rest, eat healthy foods, and avoid alcohol
- Vitamins- take supplements that include omega-3s and riboflavin (B2) and increase foods such as flax seed, chia seeds, salmon, sardines, and other oily fish.
- Herbal supplements- St. John’s Wort
- Set realistic expectations and make simple goals
- Make time for yourself to go out, visit friends, or spend time alone with your partner
- Avoid isolation
- Ask for help from family and friends

Other helpful options and tips include:

Support groups
Good social support from family, friends, and coworkers
Call a suicide hotline
- National Suicide Prevention Lifeline 1-800-273-8255 or www.suicidepreventionlifeline.org/chat

The progression of postpartum depression is different for every woman, but usually women feel their most intense symptoms initially, followed by a gradual recovery.

As my counselor told me, “The path to recovery isn’t a straight one.”

Many women who receive medical treatment, continue to experience chronic symptoms of postpartum depression for more than 1 year after childbirth.

There is no normal way to experience postpartum depression when it comes to a timeline. Postpartumdepression.org

Ramifications

If left untreated, postpartum depression can last for months or years and can affect:

The mother’s health making it harder to manage other illnesses such as diabetes or heart disease
The mother’s ability to connect with and care for her baby
Increases a woman’s risk of future episodes of major depression
The risk of depression in the baby’s father may also increase
Children with untreated mothers are more likely to have
Prenatal- inadequate prenatal care, poor nutrition, increases risk for preterm birth, low-birth weight, pre-eclampsia, and miscarriage.
Infant- anger and protective style of coping, passivity, withdrawal, self-regulatoryand behavioral problems, such as sleeping and eating difficulties, excessive crying, and delays in language development

However, if properly identified and treated, medicine and counseling can often successfully reduce or eliminate symptoms.

Sources:

BabyMed. Estrogen (Estradiol) Levels During Pregnancy.

Healthfully. Range of Normal Estrogen Levels.

Healthline. What Bodily Changes Can You Expect During Pregnancy? and How to Deal with Premenstrual Mood Swings. and Serotonin: What you need to Know. and Are There Natural Remedies for Postpartum Depression?

MedlinePlus. Postpartum depression.

MayoClinic.org Postpartum depression.

Medscape. Estradiol.

Mindbodygreen.com 3 Types of Mood Swings (Thanks, Hormones) + Exactly How to Snap Out of it.

National Institute of Mental Health. Postpartum Depression Facts. And How is the body affected by sleep deprivation?

Perinatology.com Normal Reference Ranges and Laboratory Values in Pregnancy.

PostpartumDepression.org Postpartum Depression Timeline.