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.