Frequently Asked Questions about Postpartum Depression and Other Perinatal Mood Disorders

I have always felt like I have my life together. Why, now, am I having such a hard time?
Due to sudden drops in hormone levels after giving birth that affect a Mom’s neurochemistry (chemicals in the brain responsible for emotional balance), many women will become less resilient to stress. A woman who has typically been able to think clearly during times of transition or who feels that she has usually been able to multitask may suddenly feel that she can not manage her life once a baby comes. Sleep deprivation and nutrient depletion also contribute to this new sense of emotional vulnerability. Women who have a prior history of depression and anxiety often have “relapses” in the postpartum period- especially if they have not been receiving treatment during pregnancy. Along with these physical risk factors, having a new baby brings identity shifts, new issues in marriages and partnerships, resurfacing of family of origin issues, a sudden loss of control, and a deep need for community. Many women have a difficult time negotiating all of these changes.
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When you say “many women”, what exactly to you mean? It seems like everyone can do this mothering thing but me!
20% new mothers (that’s 1 in 5) if not more will struggle with a Postpartum Mood Disorder in the first 12 months after having a baby. That’s a lot of women. As I say to the moms in my office, the women who look like they have it all together are probably the ones with appointments in my office later that day. Most women struggle at some point and many, many women work hard to cover their challenges up.
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What are the most common symptoms of PPD and other Postpartum Mood Disorders?

While many women may feel depressed after having a baby, the most common symptoms that women will feel are anxiety and overwhelm. Too many women don’t reach out for help because they assume that since they aren’t depressed, they must not have PPD. Other symptoms of PPD and other Perinatal Mood Disorders include:
- feelings of helplessness and/ or hopelessness
- difficulty in making decisions
- changes in sleeping and/ or eating patterns
- isolation and withdrawal from community and loved ones
- frequent feelings of “I can’t do this”
- not feeling like yourself
- intrusive thoughts, images, fears of harm coming to your baby that you can not stop and that you know are wrong
- irritability, impatience, rage
- difficulty concentrating
- difficulty attaching and bonding to your baby
- In the most serious cases, seeing, hearing, or feeling things that are not really there and/ or beliefs that are not based in reality

Woman may experience all of these symptoms or only a few.

Postpartum Depression is just one of the many Postpartum Mood Disorders. Other categories include: Postpartum Anxiety, Postpartum Panic Disorder, Postpartum OCD, Postpartum PTSD, and Postpartum Psychosis (affecting .1-.2% new moms many of who have a prior history of Bipolar Disorder)

Every single postpartum mood disorder, including postpartum psychosis, is treatable and women who seek help and follow treatment recommendations do get better.
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I talked to my doctor about some of my symptoms and she said that I couldn’t have PPD because my baby is 9 months old. Is this true?
No. Postpartum Mood Disorders can surface any time in the first 12 months after giving birth. For women who do not seek help early, symptoms can last much longer.
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I am suffering but I really don’t want to take medication. Is this okay?

Many pregnant and breast feeding moms do not want to take medication for fear of the risks that might come to their baby. While taking medication during these times may not be risk-free, we do know that there are many anti-depressant and anti-anxiety medications that are known to be safe to take while pregnant or breast feeding. In fact, we know that the risks to a developing baby from untreated postpartum mood disorders outweigh the potential risks from these medications.
With that said…. not all women who are suffering with depression or anxiety need to be on medication to get better. Psychotherapy along with other complimentary supports such as acupuncture, nutritional counseling, exercise, yoga and meditation, and relaxation strategies have been hugely helpful for many women. It is important that you talk openly with your doctor or therapist so that you can make the right decision for you around whether or not to take medication.
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How long will it take to get better?
I wish there was a single answer for this one- it comes up all the time. This really depends on how long you have been suffering and how quickly you get help, what your symptoms are, what kind of support you are receiving outside of therapy, and what your individual goals are. Usually, I see moms in my office for anywhere from 8 weeks- 6 months. Some decide that they would like to stay longer and many women choose to return if and when they become pregnant again.
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What if I decide to just get through this on my own. Will I get better over time?

Probably not. While time may make things easier (your baby gets older, you begin to get a hang of things etc), usually a mom’s symptoms will actually get worse without support. We live in a society where we assume that we should be able to get through things on our own, and this is a real disservice to us and our families. There is absolutely no need to just push through this challenging time. The sooner you get help, the sooner you will feel like yourself again.

What will the therapy be like?

In the beginning, I will take a thorough assessment so that we can determine what factors might be playing a role in your postpartum mood disorder. This assessment will look at your personal and family physical, psychological, and social history. After we determine what might be getting in the way of you feeling your best and being able to enjoy these early weeks and months, we will begin to set goals and make a plan for the work ahead. This may involve coming up with very practical strategies for your physical, psychological, and social health. It may also involve looking at old patterns within your family, a trauma history in your past if it exists, and/or resurfacing issues to determine the ways that your past might be interfering with your ability to be in the present. We will probably spend time discussing what kind of mother you would like to be outside of the “shoulds” that are placed on us by others and society. We might discuss the ways that your sense of self has shifted since having a baby and focus on ways for you to feel good about who you are in this new role- both as a mother and as a woman. While it is my job to help connect the dots and suggest ways that you might begin to feel better, it is your job to determine what resonates and what feels right to you in your journey towards health. And I will help you to figure this out. I firmly believe that each woman that walks into my office is her own expert and that she knows best what she needs to get well. Without rushing the process, my goal to to work with you so that you feel your best and therefor do not need to continue coming to therapy as soon as possible.
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I don’t have childcare. Can I bring my baby?
Absolutely. I have a changing table, infant swing, toys, and blankets available if you would like to use them. Many, many women have nursed, bottle fed, changed diapers, bounced their babies, and soothed their babies in my office. You are welcome to take care of your little one in any way that is appropriate.
Once your baby becomes a bit older, we want to consider whether or not having him/her with you is a distraction for you and your work. Sometimes, having a specified time away from your baby- just for you- can be healing in itself.

Can I bring my husband/partner?

Yes- and in fact, I encourage it at least in the beginning. It is almost always helpful to have him/her on board so that he/she can learn how best to support you through this process.

If I talk to you about how I am feeling, will you think that I am an unfit mother and take my baby away?
No. Quite the contrary, actually. Having a postpartum mood disorder is never a reason for someone to take your baby away and the moms that come in for support are there for the well being of both themselves and their families. This is one of the many myths of PPD.
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