Postpartum Depression: When Running Isn’t Enough

Brooke Shields went public with her PPD about the same time I was suffering, which was surprisingly comforting to me.

I don't mean to take the ho-ho-ho out of the holidays with this post, but postpartum depression, a very important topic, has come up randomly in a couple of my conversations in the past week. So I, who got hit with it pretty intensely after having Ben, thing #2, wanted to give it some airtime.

I turned to Mary Jackson Lee, LCSW, a psychotherapist in Wheaton, Illinois, who specializes in helping mothers. Lee, the mother of a girl in second grade, has run the Chicago Marathon twice and will be running NYC in 2011. "My favorite time of the week is running with my pack: we meet year-round, 6:30 on Sundays," she says, "All but one of us are moms, and we have similar problems and stories. I'm so grateful for them."

A similar, been-there-and-here-to-testify theme shows up in her clinical work. "Being an objective sounding board for mothers is incredibly fulfilling. A patient comes in, thinking she's crazy and an awful mother," she says, "I tell her, 'I heard a similar story 3 hours ago. You are not alone.'"

Mary and I had a great conversation; she's a woman who gets it. ("We need a magazine showing women in really bad sweatpants," she says, "The real stuff. Not stories that get neatly wrapped up in two pages.") Here are some highlights. I hope that it, if necessary, prompts a helpful conversation, or that you can send it to a friend or a sister who might need a gentle, loving nudge.

D: How prevalent is postpartum depression (PPD)?

M: About 10 to 20% of women develop it. That feels like a low number because new moms might be afraid to ask for help; there’s definitely still a stigma around it, which is frustrating because it's so treatable. We surrounded by pictures of glowing moms wearing cute capris with smiling babies, and it’s hard to admit that you don’t feel that way. The mom thinks, “How can I have this beautiful baby and feel this horrible?”

D: Is anybody at risk for PPD?

M: There are clear risk factors: previous episodes of depression, a major life change that coincides with having the baby, like a move, a job loss or significant marital stress. In addition, although a history of severe PMS hasn’t been totally nailed to the wall yet scientifically, a correlation has been established.

Lack of sleep can put you at a higher risk. Getting a few of broken hours a night seems to be the norm, so lots of moms just brush away that aspect of a new baby. But I remind them sleep deprivation is actually a method of torture, so don’t minimize it. That said, there are plenty of moms without these risk factors who develop PPD, so it's important to realize it can hit nearly anybody.

Also, don’t think that PPD shows up within 6 weeks or so of having a new baby. It can occur up to a year after the birth of a child, and adoptive mothers can develop it too. Again, many moms just think the awful way they're feeling is due to their hormones being out of whack, but clearly, if adoptive moms are susceptible, that's not the case.

Finally, if you’ve had it before, you’re up to 30% more likely to get it with a future child. But I know a woman who had five kids and only had PPD with her 5th. It’s unpredictable, so you have to be vigilant about it.

D: So how do you know when it’s PPD?

M: PPD is shares many of the same symptoms as the baby blues: mood swings, tearful, tired, irritable. But comparing the baby blues, which go away on their own after a few days, and PPD, which can linger for months and doesn't go away without treatment, is like comparing a paper cut to a gashing would that requires stitches. A mom suffering from PPD doesn’t have any joy in her life. It’s unsettling to see a mom with PPD look at her baby: when it cries, she may just glance down and not really be interested in quieting it.

When the symptoms are severe, a mom lies down to rest and she can’t quiet her mind: she’s feeling guilty and sad and obsessing over what she should be and do. Or, if she can sleep, she wakes up and feels no sense of restoration. The degree of severity can rachet up to wanting to harm yourself or the baby; that’s obviously a huge issue and those feelings won’t go away on their own.

Some of my patients say they want to harm themselves--they have a plan, are intent and are at true risk--but some have more of a passive suicidality. They don’t want to be gone forever. They just need a break. So they say things like they wish they want to run away forever, or that they could break their leg and have people just wait on them. That’s PPD.  And that’s when it’s time to ask for help from friends, family and your doctor.

D: So hard to ask for help, though: to admit that things aren’t as good as you expect them to be.

M: I get that, but I also say, put yourself in a good friend’s shoes. If she were suffering, wouldn’t you reach out to help her? Wouldn’t you be angry if she didn’t tell you how much she was hurting? Why won’t you give her that opportunity?

It takes a village is a cliché for a reason. Have a friend gather an army of people who can help with cleaning, cooking, babysitting, whatever you need. Too many moms are told--or think--that what they're going through is normal, but PPD isn't normal. It's not the time to suck it up and just soldier through; it speaks to the stigma of PPD that a woman is comfortable getting help if she has a broken leg, but not if she's mentally suffering.

One tricky group is nursing mothers. Many women are against taking meds for depression, but a nursing mom may be extra resistant. She doesn't want to give up nursing, and but also doesn’t want to risk the medication being transmitted through the milk, so she thinks she's stuck. There are options—Zoloft is one—and more importantly, I tell them, you can’t nurse the baby if you hurt yourself. It sounds crude, but it’s the truth. I like to remind moms there's a reason why we are told to put our oxygen mask on first when flying; if we pass out, nobody will be there to help the baby.

D: So how does running or exercise help with PPD?
M: I share with my patients that I’m a distance runner. I didn’t start running until my daughter was about 2.5 years old, and I tell them, I was literally and figuratively running away from the house. I wasn’t seeing patients then, and I needed something for myself. I can’t rave enough about it.

Before I tell a patient to lace up, though, I tell her to rest, rest, and rest to recover from PPD. Then rest some more. Once she's feeling stable, running  or any type of regular cardio is a wonderful way to manage day-to-day motherhood stress.

Physically, exercise releases neurotransmitters like endorphins that lift you up, and decreases the immune system chemicals that deepen depression. Also, scientists are seeing a correlation between an increase in body temperature and an overall sense of calm in the body.

I had one patient recently who had mild to moderate depression. She used to be a runner, but stopped when she had her child. Talk therapy was helping, but she needed a little something more. She figured out a schedule so she could run again, and she’s doing so much better. She’s now o.k. with the bad days, the temper tantrums, the feelings that she's not perfect. That’s the thing: the bad days never go away. Our goal is to get better with the bad days, and exercise can help you get there.

D: What advice would you have for a pregnant woman?

M: Think about preparing for PPD before you have the child. (Actually, be aware that depressive symptoms can start in pregnancy.) Get your army in place now, before the baby is due. We spend so much time preparing for the birth, but tend to neglect thinking about the weeks and months after the child arrives; my doula talked to me about it, but I mentally glossed over it. That’s like thinking all about the wedding but forgetting the years of marriage that will follow: the wrong focus.

36 responses to “Postpartum Depression: When Running Isn’t Enough

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  2. Thank you to all of you brave women for bringing this up. I also had PPD after my first was born, but thankfully not after my second – although I dreaded it and tried to be more prepared just in case. I felt all of the shame, isolation, fear, anxiety and panic others here have posted. Even though I was the birth mother, I felt some things adoptive mothers may feel, such as that I was a fraud mother, not good enough, shouldn’t have become a mother, etc….even though I had wanted, planned for and did love my son very much. I do think the sleep deprivation and the social isolation (I really don’t think as a species that new mothers are meant to be alone in a house 24/7 with a newborn…we are meant to have grandparents, aunts, other new mothers around us…)were huge contributing factors. Also stress about having only 6 weeks of maternity leave. Unfortunately, I did not get external help…I struggled for a good two years, with incremental improvements as Monica posted, getting significantly better when my son was 18 months, then 2, then just about fully-functioning when he was three and I got pregnant with my second. The Brooke Shields book came out sometime in that time period and was helpful in tangibly describing what I had felt, although she got help very early. Recently, I read a book that came out much later than my births but I think would be very helpful to someone experiencing PPD right now: Heather Armstrong’s book: It Sucked and Then I Cried. I hadn’t made the connection before, but I did join a fitness group called Moms in Motion after my second and began training to run a simple 5K. It helped so much – feeling control over my body, setting a goal, and also the social component of talking with other moms. Also, it helped me realize that my kids WOULD survive without me for an hour on a Saturday and that the whole family benefited more from a sane, centered, happy mom that was occasionally absent rather than a mom that was always with them (when not working), but was depressed and miserable (I had been too anxious and guilty about working to leave them for anything other than work before). For those experiencing PPD right now: know that it WILL get better, and that having PPD does NOT mean that you are a bad mom. I look at my kids whom I love so much (now 10 and 6) and our family now and have tremendous gratitude for each of them and for how far we’ve come together.

  3. I had ppd after my third baby was born. The first 6 months were normal. Challenging. Not much sleep. But I was coping okay. Then I started dealing with severe sleep deprivation. There would be many nights I didn’t sleep at all. It was horrible. When I think of the empty ghost, that was me, I have this strong sense of protection and compassion and love that mama. Now, feeling so much better, I can’t even comprehend how horrible those many months felt. I tried to deal with the insomnia, but nothing was working. I was so desperate. Anti depressants were the next step. I stopped nursing to go on the meds, which broke my heart. I love nursing my babies. I had tons of shame about being medicated. I didn’t know why my usual coping strategies, exercise, social interaction, ‘me’ time, weren’t working. I thought I was an exceptionally strong in the mental health department. I worked out for 40 minutes every single day. But what I was going through, there was no way out of (or so I thought, I was afraid this was my new life and it would never end). I used to imagine 6 impossible things each day (like the queen told Alice), like sleeping more than 2 hours a night, not being anxious, living with hope. It took more than a year, more like three, of small, gradual, improvements. My son is 4.5 now and I’m slowly weaning off my meds. I’m on 1/2 of the lowest dose possible and plan to go all the way off in spring (when I start training for my first 1/2 marathon!!!!). I’m totally off my sleeping pills. But more than that, I’m a much softer, kinder, more compassionate, more grateful person having gone through ppd. I understand myself better. I like myself better. I’m unbelievably proud of how I worked to ‘kick’ it and how I wanted to soak every last bit of meaning and learning out of it, so it wouldn’t have happened to me in vain.

    I took my first ‘learn to run’ clinic when I was pregnant with my son. Now, as I say goodbye to the last little remnant of ppd (my meds), I’m taking on my first ever 1/2 marathon. When I go out for a run (in the cold, snowy, -15 degrees Celsius) I feel the ‘yuck’ and the anxiety of the day leaving my body and mind. I come home full of love for my life. Full of gratitude that I CAN run.

    maidenmonica(at)gmail(dot)com . . . for anyone who find themselves in a similar place.

  4. I was borderline PPD with both of my boys. And is is SO TRUE that this is a topic rarely discussed among moms. I heard the horror stories of labor, water breaking at inoportune times, and the pain of contractions… but no one warned me about “Baby Blues” or PPD. So much so, that I truly thought that I must be the most awful person in the world to NOT be enjoying those first few months of my sons’ lives. It wasn’t until I started sharing with a few close friends that I realized that I was not alone in this feeling. I just picked up running this past January, three months after having my second son (using Couch to 5K…and if I can do it, ANYONE can!), and along with losing a bunch of weight, I have felt so much better. So i am hopeful that this new lifestyle of running will help me out if we go for a third… or fourth. But not until I complete my first 1/2 in March…. if my knees will hold out, that is! 🙂

    1. Mary,
      I am glad that you mention the fact that moms don’t talk about it with each other. I often have a hard time getting my clients with PPD to admit to their proclaimed “best” friend that they are experiencing these symptoms. Validation goes a long way in making women feel more comfortable with getting help even if it is just a sounding board when a nap gets skipped or an ear infection returns. Once women do experience PPD, ask for help, and get better they are the strongest advocates for other women, they recognize the symptoms in other moms who are isolating and are often sought out by other moms as a safe contact. Keep talking ladies!

  5. Such a great post and important subject to discuss. And I think this is a very apt time to discuss it (since the holidays are also prime-time for depression in those that are predisposed to it). I was hit hard after #2 as well and for some reason didn’t run.. I look back now and wonder why the hell didn’t I run but I was so paralyzed by everything and wanted to slap anyone who suggested I might feel better if I just got a little exercise. Eventually when all else failed I did start running again and its made the biggest difference.

    1. Hey Maggie–Yeah, Mary actually mentioned that January is her biggest month for new clients, but there wasn’t an easy way to slide that in there. Glad you’re coming out of the dark (and totally hear you on that slapping thing).

  6. PPD was just another misdiagnosis for me in a lifetime of health troubles…After the birth of my second child, I ended up on Zoloft for about 9 months but with all the other issues I was having, I knew there had to be something more. I then turned to accupunture and discovered I was lactose intollerant. My accupuncturist recommended that I go see a GI doctor. Turned out that I was a lifelong sufferer of Celiac’s Disease. My GI troubles were misdiagnosed as colitis, then IBS. My skin issues were misdiagnosed as eczema. Had a miscarriage between the births of my son and daugther. Had my gall bladder removed when it was not functioning. Started taking synthroid when I was diagnosed with hypothyroidism. In April of 2009, at the age of 44, I was finally diagnosed with Celiac’s Disease. When I went gluten free, the fog finally lifted. My brain felt lighter. And I was about to run my 2nd half marathon. Now, at age 46, I just ran my first marathon and I am the healthiest I’ve ever been.

  7. “So they say things like they wish they want to run away forever, or that they could break their leg and have people just wait on them. That’s PPD. And that’s when it’s time to ask for help from friends, family and your doctor.”

    Wow, I was surprised hear this. There are lots of things that people say in passing that don’t actually warrent the diagnosis of a disease. I went to the doctor three years ago to see if I could get some tests done to see why I was so tired. The doctor’s first response is to suggest it might be depression and she then suggests Zoloft or Prozac. I was blown away. I hadn’t even been in her office 60 seconds before she offered to throw a pill at me to get me to go away. ( I said I ‘d like a second opinion- maybe to explore other options and she told me to come back if I felt worse and that was that!)
    Sometimes you just need someone to listen to you. I later found running and blogging and that has helped alot. Would I take drugs if I needed to? Maybe, but I need to know and I think there are other women out there with cases of depression who just want to be heard first. Medication is okay if you need it, but not in place of actual discussions about what is wrong. You can’t fix what you don’t know is broken.

  8. I love that she says, “don’t think that PPD shows up within 6 weeks or so of having a new baby”. I had PPD show up when Spud was pretty much 1 on the dot. It took me a good while, though, before I actually acknowledged it to myself. When you sit in front of the computer crying and tell your husband that the description of PPD is you, you know something needs to be done. My GP (who I’ve had since I was born) was really receptive about me coming in saying that Dr. Google told me that I probably had PPD. Thankfully it wasn’t severe – I never had to go on prescription drugs – but getting some decent vitamins into me, eating better, getting more sleep and exercising really helped.

  9. Thanks for this post! I have a 5 month old and some of the lingering effects of childbirth are making running unpleasant & difficult. It’s my favorite coping skill, and my body and mind miss it so much. I’ve been beginning to wonder if I have PPD or SAD or am just tired – thanks for giving some perspective on this, and helping remind me that it’s temporary!

    1. Hey Sarah; A run at this point, so soon after birth, shouldn’t leave you with an unpleasant taste in your mouth. Make it a run/walk or fast walk or whatever feels good, and end it while you still feel strong and happy. You need to keep your energy up to deal with your life, and running should be an outlet for happiness, not dread.

  10. This post was so relevant to me right now and I thank you so much for writing it. My son is just 5 weeks old and I am currently being treated for Post-Partum Depression. I am so glad that I sought help right away and that I was so honest about how I was feeling because the depression was really taking away from my ability to bond with my newborn. Now that I have been cleared to exercise again, I’ve started to add running back into my life and I’m really looking forward to the positive impact it will have.

    1. Hi Courtney: So sorry you’re under the spell right now, but so glad you were able to recognize what you were feeling wasn’t normal, and got some help. Sending you more positive, healing vibes.

  11. Thank you, thank you, thank you for posting Dimity!! And thank you to the women posting so far for sharing their stories.

    I’m a perinatal psychiatrist — treating depression in pregnancy and postpartum is what I do each day that I go to work. So many of the women I treat feel so alone — the more women who speak out, the better for all of us!

    Having a baby is never easy and finding ways to feel better can be difficult on so many levels when you’re depressed…especially if one is understandably reluctant to take medication due to pregnancy or breastfeeding. Exercise can be part of the solution. I find it so gratifying to help women through medication, psychotherapy and/or helping them find effective alternatives like exercise.

    This is a well-timed post as I was just reviewing this literature for my Grand Rounds presentation tomorrow on “Exercise and Depression” (anyone in Iowa City is welcome!), with perinatal women being, of course, my special population of interest. Running (and other aerobic exercise) increases activity of serotonin and norepinephrine (the chemicals that antidepressants work on) in parts of the brain affected by depression. There are a number of studies supporting the benefits to mood for perinatal women. Google and read ladies! (Downs et al. 2008, Ersek et al. 2009, Haas et al. 2005, Strom et al. 2009, Daley et al. 2007, Dritsa et al. 2009, Poudevigne & O’Connor 2006, Polman et al. 2007, Koltyn & Schultes1997, Armstrong & Edwards 2004, Heh et al. 2008)

    One thing of particular interest is that sometimes it is difficult to tease apart the benefits of groups from the exercise itself. I think studies have now made headway in addressing this. (Yes! Exercise alone of adequate intensity helps!) However, social support is huge. We haven’t yet realized (and researched) the full potential of blogging, Facebook and other forms of social networking, but I have no doubt that RLAM is helping more mom’s with their mental health than can be realized through encouraging running and other exercise, as well as social support! Great work Dimity and Sara — you reach more women in a day than I can!

  12. thank you for this post. I had it. TWICE. Now I am ok talking about it but it took a while. I am an imigrant and all my family is in Canada and I was very alone. Husband went back to work on day 6….yeah…not good. PPD hit me like a truck. At first I had no clue what was wrong. I reached out to NOBODY. It was a dark lonely place to be. Took several months get out of it. When I got pregnant with #2…I was so scared to get it again. This time I prepared for it. I had my mom come down here to help me. PPD hit again but not as hard that time. It makes me sad that this subject is still taboo and not discussed enough. Women are ashamed to say they had it, I know I was. Looking back I don’t understand myself then but I guess that is part of depression right. PPD is a dark part of motherhood but it is one and if someone who has it is reading this blog today well know this : YOU ARE NOT THE ONLY ONE AND YOU ARE NOT ALONE, IT IS OK TO ASK FOR HELP. One of the problem is the lack of education for the spouses who cannot recognize what is going on with their wives and they just wait for “it” to pass. sorry this is so long….subject hitting close to home today. I really think running would have saved me…but I did not know that then.

    1. Hi Caroline: so glad you found running. Better late than never. 🙂 I was totally alone–just moved when Ben was 2 weeks old–so I can relate to your first case. No shame ever in talking about it: if nothing else, it makes people feel like they’re not alone.

  13. Thanks so much for posting about this, Dimity. An extra thanks for mentioning the adoptive parent. I was a wreck after we brought home our 5 month old from Korea. He was up 5-8 times a night for almost two years. I can scarcely remember that first year and more than once I remember literally banging my head against the wall, falling in a heap on the kitchen floor crying in the middle of the day, and having a sense of dread for the morning to come and having to face another day coping with my anger and depression. AND, feeling horrible about not being overjoyed at finally having children. Everyone kept saying, “wow, after 5 years, you finally have a child home, how fantastic for you.” Of course, not having birthed him, I felt insane about being depressed which added to the problem. I finally started researching PPD in adoptive parents and found others (including other adoptive moms I finally talked to about it) who had suffered with it. Running saved me. I started training for my first marathon about a year after he came home and I think it kept me from going over the deep end.

    1. It surprised me a little bit when she said it, but then I see how it makes total sense–and maybe even more sense than for somebody who carried a baby. She literally feels the weight of how her life will change; adoptive mothers may not have that visceral experience. I can’t imagine getting up 5-8 times a night for 2 years: talk about sleep deprivation. Glad you came through on the other side, a marathon under your shoes; your son is so lucky to have you. 🙂

  14. Great post! Definitely think running has helped me mentally bounce back after having my two kids. You give so much to your kids, you need the ‘me’ time to rebalance.

  15. I fought depression for years and had post partum depression with my first child.
    I started running when she was about 6 months old- mainly to get out of the house for a few minutes each day. I soon began to feel better and better . Its not that I dont ever feel depressed but it is much more manageable and I know if I need a little pick-me- up, I can get out there and run. My daughter is now 30 months old and I have a 2 month old.
    I ran all the way up to the day I delivered my second child and started running 2 weeks post partum. I haven’t had any post partum depression with this baby and I do truly believe it is due to all those miles!

  16. Wow, this brought me to tears. Remembering how it was after I had my twin boys. I had a daughter already, and felt fine after her, so I thought it was just the fact that now it was two babies instead of one. They were extremely colicky,and their dr. wasn’t any help until they were 9 months old. I was nursing them, so I was up a lot at night,that was the easiest and quickest way to get back to sleep! I was exhausted all the time, and my husband kept telling me that I was depressed but I wouldn’t believe it. I didn’t have any friends that understand, I was very young, so I felt really alone. And I couldn’t really go places because I had two screaming babies, and an 18 month old. It was just a tough time all around. Finally one day I just said, I am going to the dr, and they started me on Zoloft, which I was somewhat ashamed that I had to be on. We think that as moms, we have to be “Supermom” or we fail our kids. So not the case. I totally understand the feeling of just needed a break, maybe I would get hurt sometime just to be able to sleep a bit. The Zoloft did help, but a little bit later I did start running. I would tell myself that it was perfect, I could run away for a bit, then once I felt better, run back to my kids! My twins are 5yrs now, so things are better, but looking back and reminding myself how it was that first year, is very emotional. I hope that your article will reach a mom in need and she will seek the help that is needed!

    1. Catrina — thanks for sharing your story. Sertraline (Zoloft) is one of the most commonly prescribed antidepressants for postpartum depression and really can help many women, difficult as it can be to acknowledge needing to take it. You are also right — sometimes it isn’t all that is needed. Adding in running may have just been that extra part for you– physical activity and “me time”. (Research supports use of exercise when the antidepressant doesn’t quite do everything.) Your twins are very lucky you have taken such good care of yourself.

      (And if you think your post is long…check mine out! We all have our passions. :))

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