September 5, 2023

How Therapy Can Help with Postpartum Depression and When to Seek Help

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Nick Forand, PhD, ABPP

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Having a baby is oftentimes thought of as a joyous event worth celebrating. Unfortunately, new moms struggling with postpartum depression (or peripartum depression), a mental health condition that exists under the umbrella of a variety of perinatal mood and anxiety disorders, may feel like joy and celebration are distant memories of the past.

An estimated 1 in 5 women in the U.S. experience symptoms of depression that start during pregnancy up to a year after giving birth, and while it can impact both mothers and fathers, it is most common in mothers. It’s important to know the signs of postpartum depression, as it’s possible to recover through the right treatment.

If you’re looking for postpartum depression help, therapy with the support of a postpartum therapist who’s right for you could be an effective treatment.

What are the signs and symptoms of postpartum depression?

The exact set of postpartum depression symptoms experienced can vary from one person to the next. The most common symptoms include:

Prolonged feelings of sadness
Mood swings
Emotional numbness
Hopelessness about the present and future
Indifference
Irritability or increased anger
Anxiety, excessive worry, or feelings of impending doom in the absence of a threat
Panic attacks
An inability to function in life
Sleeping too much or difficulty sleeping (insomnia)
Increased or decreased appetite
Difficulty concentrating, brain fog, and difficulty making decisions
An inability to bond with or show interest in your baby
Shame or guilt over being a ‘bad parent’
Negative thought patterns
Fear or anxiety surrounding the well-being of your baby
Thoughts of hurting your baby or self
Recurrent suicidal thoughts
Excessive crying
Lack of energy and motivation
Loss of interest in things once enjoyed
Increased anxious fidgeting or body movements
Moving much slower than normal
Social withdrawal, self-isolation
Self-harm
Escapism through substances or other addictions

How do symptoms of postpartum depression start?

The symptoms of postpartum depression may start small and grow over time, or come on strong all at once. It’s important to be aware of the signs and any increased risks and to monitor your moods, thoughts, and behaviors during and after pregnancy. Symptoms of postpartum depression can start any time during pregnancy up to one year after childbirth.

There are also several risk factors for developing postpartum depression. Women have an increased risk of developing postpartum depression if there is a personal or family history of depression or other mood disorders, a history of depression following hormonal birth control use, stressful life events outside of the pregnancy, trauma, or a lack of social support from family and friends. Being a young mother under the age of 20 is also a risk factor.

Research suggests that the fluctuations in hormone levels during and after pregnancy may contribute to symptoms of postpartum depression as well.

Additionally, women of color can experience postpartum depression differently than white women. According to research, birth and postpartum customs, as well as gender roles, from your native culture are important in shaping the way postpartum depression is viewed. Many women from collectivistic cultures, for example, believe in suffering and sacrificing for their children and rely heavily on their families for emotional support. They may fear judgment from seeking treatment for depression and may only be open to it if their symptoms are severe.

How long do postpartum symptoms usually last?

The duration of symptoms can vary, depending on their severity and whether or not you seek treatment for depression. The symptoms must persist for at least two weeks to be considered depression, and can be long-term if left untreated.

Because of this, intervention is a crucial part of the recovery process. Unfortunately, a lot of women don’t seek out postpartum depression treatments for one reason or another — some may not be aware they are experiencing a serious condition and believe that it’s a normal part of parenthood, while others may find it difficult to ask for help or support until their problems become severe.

Are there any conditions related to postpartum depression?

There are several conditions that may be present alongside postpartum depression, or look similar. With the help of a therapist trained in perinatal mental health disorders, you can properly identify what’s going on with you and work together to feel better.

Postpartum anxiety is common for 16-17% of women during pregnancy or after giving birth. It’s also common to have postpartum anxiety alongside depression. One study found that nearly two-thirds of women with postpartum depression also experienced anxiety symptoms.

"Baby blues" presents itself in a similar manner as depression, however the symptoms are less severe or are short-term, lasting less than two weeks.

Postpartum bipolar disorder may look like postpartum depression, but it also involves periods of elevated highs or irritability called mania and hypomania (a less severe form of mania). These manic states involve sleeping less, elevated energy levels and moods, rapid speech and racing thoughts, paranoid or delusional thinking, compulsive or risky behaviors, irritability, and sometimes hearing or seeing things that others cannot hear or see.

Postpartum obsessive-compulsive disorder (OCD) involves obsessive, intrusive thoughts or fears about hurting your baby, or something negative happening to your baby. This can include horror about the obsessive thoughts, hypervigilance in protecting your baby, or fear of being left alone with your baby.
Postpartum psychosis* is incredibly rare, but quite serious. It occurs in one or two out of every 1,000 births. This condition involves audio or visual hallucinations, agitation, excessive energy levels, and paranoid or delusional thinking. Those who have a diagnosis of bipolar disorder have a higher risk of developing postpartum psychosis.

How does postpartum depression affect your relationships?

Postpartum depression can take a toll on your relationships. While it can make bonding with your baby difficult, it can also put strain on personal relationships with partners, family, and friends. For those who are partnered, postpartum depression can cause feelings of being unsupported, neglected, and burdened by their partner. The symptoms of exhaustion that come with this condition can add extra weight to these feelings as well, which can cause impaired intimacy and a tendency for the person struggling to self-isolate and withdraw from family and friends.

How can therapy help with postpartum depression?

Seeking help requires you to be vulnerable, and that can be quite difficult and scary. It can sometimes feel easier to suffer in silence and try to be strong, not burdening anyone. Those experiencing severe symptoms of postpartum depression may feel guilt and shame about seeking help, feel unworthy, or fear they will be judged or punished for being ‘bad parents.’ Believing the negative thoughts that oftentimes come with depression can most certainly hold someone back from seeking help, but surrendering to the fact that you need support is one of the bravest things a person can do.

Therapy can help treat the root causes of postpartum depression symptoms through a combination of evidence-based practices, such as interpersonal therapy (IPT) or cognitive-behavioral therapy (CBT), which are designed to help you heal while challenging negative thought patterns, improving your relationships, boosting self-esteem, implementing healthy behaviors into your lifestyle, and giving you a sounding board filled with unconditional, nonjudgmental support. A licensed postpartum therapist will help you determine the best course of treatment while equipping you with the tools you need to manage difficult symptoms, situations, and emotions that arise throughout day-to-day life.

When is it time to seek therapy?

In general, if a mother has a history of mental health disorders, it’s wise to establish care with a therapist as early as possible — even starting at conception — in case postpartum depression arises.

But depression is something that no one is immune to. It can strike anyone at any point in life, and it may have hit you unexpectedly after having a baby. If you’re experiencing any of the signs of postpartum depression or related disorders that have lasted longer than two weeks or are getting in the way of your daily life, the sooner you seek therapy, the better.

You do not have to carry the burden of postpartum depression in silence or alone — help is available and recovery is possible.

Learn more about how we can connect you with the right therapist for you to recover from postpartum depression or related conditions.

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