What I wish someone had told me about Postpartum Depression

It was six weeks after Annika was born, on a Friday, that it hit me.  Annika was having another one of her “colic” fits of uncontrollable crying.  (The crying that is completely unsoothable, regardless of how many of Dr. Karp’s “S’s” I try.)  Annika’s uncontrollable crying lasted about 45 minutes.  My uncontrollable crying lasted 3 hours.

It sounds stupid to say that I didn’t know I had postpartum depression, but I didn’t.  I thought, it’s just sleep deprivation from never getting more than 2 hours at a time all night long.  It’s social isolation, from never going anywhere since Annika would scream in her carseat. It’s just sadness from having a kid who is obviously hurting, and there is nothing I can do about it.  (Don’t worry, everyone said.  It’s just colic, she’ll grow out of it.  So 3.5 months later we finally got a diagnosis of silent reflux. In the meantime we suffered and she suffered, while we heard every piece of parenting “advice” from well meaning friends and strangers with babies obviously “easier” than our own.)

Somehow I didn’t put the pieces together until I saw one of those little mini quizzes on babycenter.com.  “You might have postpartum depression if…” I answered “yes” to every single one of the questions.

And then I got scared.

What if I can’t provide for my daughter?  What if I hurt her? (I ask myself, as I cling to her, wearing her and soothing her and nursing her and caressing her all day long and all night.) “Babies with mothers who have PPD are more at risk for _______” they say.  Oh dear Lord, another thing I need to worry about now.

Thank God for my midwife (a naturopathic doctor, too).  Jason begged me to bring it up at my 2 month visit with her.  (Actually, I think he brought it up.)  And thank God for the passage of time.  Once we learned it was reflux and treated it, Annika slept better and cried remarkably less.  Then she learned to sit up, we moved to a place where it is sunny (sorry Seattle), and I finished my stressful board exams.  It feels like ages ago since I sat there in our tiny one-bedroom apartment sobbing for hours.

It was a horrible experience, but now, on the other side of things I am glad I went through it.  My heart for postpartum Moms has swelled.  I understand what it is like to have a sick kid, and how awful and scary and out of control it feels.  I know what to look for in colicky babies and when to not call it “colic!”  And I definitely know how to identify and treat Moms with PPD.

So, from a Mom and a doctor who went through postpartum depression herself, here is what I wish someone had told me:

1. It’s not your fault.  Let me repeat: it is not your fault! You did not do anything wrong to get postpartum depression.  It is not your body failing you.  It is not because of any wrong choice you made in pregnancy.  It is not because you aren’t strong enough, or healthy enough, or smart enough or wealthy enough.

Let me explain.  During pregnancy progesterone levels remain high and then precipitously drop after childbirth.  Though we typically think of progesterone as a reproductive hormone, in actuality it has effects in multiple places, particularly the brain. Progesterone is converted to allopregnanolone (or 3α,5α-tetrahydroprogesterone) in the central nervous system and strongly acts on GABA receptors.  Just to give you an idea of what GABA receptors do – alcohol, valium and other sedatives act on these receptors, which is why most people feel generally relaxed and happy on GABA-acting drugs.  So basically your brain is going through a valium-like withdrawal after pregnancy.

If that weren’t enough, the process of pregnancy also depletes many of our nutrients we need to maintain good brain chemistry.  Pregnancy depletes B vitamins necessary to make neurotransmitters like serotonin and norepinephrine.  It also depletes minerals like magnesium, which makes people feel relaxed.  Many women are also low in essential fatty acids like DHA and EPA (Omega-3’s) after childbirth.  Studies have shown that women who are deficient in omega 3’s are more likely to have postpartum depression. There are so many physiological reasons why women get postpartum depression.

2. You are a good Mom. You are the best Mom for your baby.  Having postpartum depression is tough.  It makes it hard to get anything accomplished during the day – laundry goes by the wayside, meals are straight from the freezer, and there are baby supplies scattered all over the house.  But that doesn’t make you a bad Mom.  Your baby still relies on you to get its needs met – in this early stage that basically means food, shelter, clothes and safety.  If you can still accomplish these basics then you are doing a great job.  At this point you know your child better than anyone else in the world.  You know the ins and outs of your child and what they need and when.  Trust your instincts and don’t let anyone tell you to do things differently if it doesn’t feel right.

3. Get help. Get help in any way that you can.  Visit your doctor.  If he/she isn’t concerned, then find a new one who is.  Find a doctor who is willing to do bloodwork and find and treat the underlying cause of your depression.  (Every Mom with PPD should be tested for thyroid function, anemia and vitamin D at the minimum!)  Find a doctor who will support you in any decision you make.

Talk your heart out to counselors or good friends.  (I remember the best people to cry out to were other Moms who had “been-there-done-that.”  It never got old to hear them say “It gets better.”) Vent your frustrations to someone who has the energy to listen heartfully (skip your spouse – they are going through enough themselves).

Find a Mom’s support group, a breastfeeding support group, church group, play group, or depression support group.  Being around a group of Moms who have babies the same age as yours can be very helpful – you’ll be surprised at the number of times other Moms are feeling the exact same way that you are.

Get help around the house.  Find friends (or friends-of-friends) who may be willing to do a little housework or cook a meal or two.  It can make a big difference.

4. Your safety is your top priority.  Don’t feel guilty for needing some assistance, whether it be housework, vitamins, herbs, counseling or medication.  Do what you need to do to stay safe.

When I went to my midwife Jason begged her to give me a prescription for an antidepressant.  Not to take, but to have just in case.  I never needed it, thankfully, but it was nice to know that if things got really bad I could have some pharmaceutical support.  I know in the natural childbirth community there can be some guilt attached to using any type of drug.  In my practice I’ve had wonderful success treating postpartum depression naturally.  The vast majority of women I see will not need any pharmaceutical, but I will never hesitate to recommend an anti-depressant for someone who really needs it.   If you need it to stay safe: take it!  (Don’t worry, I have a great program for getting patients off their anti-depressants when the time comes – you won’t need them for a lifetime.)

One woman on babycenter.com in my birth club group relayed her story of how she ended up in E.R. for postpartum depression.  She was scared for her safety and her child’s safety and so she went.  She told everyone in our group what a positive experience she had, and that she felt unbelievably cared for and supported, not judged or talked down to like she thought she would.  If you need emergency support, don’t hesitate to call 911 or go to your local emergency room.  Or call the national postpartum depression hotline: 1.800.944.4PPD.  They will NOT take your baby away from you for getting help!

I hope this helps.  Here are some more resources:

A brief quiz on PPD.
Babycenter.com’s advice on postpartum depression and anxiety.
Babycenter.com’s community group: all mom’s who are dealing with postpartum depression and anxiety.

Don’t forget that PPD can come in all shapes and sizes – some women may have anxiety, OCD or other mood disorders not limited to depression.  If  you want my help I am happy to do so – you can call (406) 552-5041.  Even if you just need a few minutes to talk to another Mom who is been there before…

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