Women's Health

Finding Support When Perinatal Depression Strikes

I was a reluctant mom; the carrier of an unplanned pregnancy that, for the most part, I took head down. Even before I had the baby, I was familiar with the possibility of facing some form of postpartum symptoms from the sheet handed out to me at the doctor’s office: lack of interest in your child, thoughts of sadness or, worse, harming yourself or the baby.

My symptoms crept up slowly after I gave birth. I didn’t want to hurt my son, but I had unimaginable thoughts that left me questioning how my mind could architect such scenarios. I had anxiety and panic attacks for the first time, and I could never sleep when he slept. Breastfeeding turned into a monster of exhaustion, humility and a challenge to my self-identity. I became obsessive over weaning him from breastfeeding and picking a formula. A labor that was all too hard and all too real from a decision to turn off my epidural had left me grappling with the experience. And I was mad. Raging mad.

I cast it off as being a new mom.

Three months in, a simple moment was my cue that this wasn’t going the way it was supposed to. Since my son was born, he had this uncanny trait of looking right into you. Seeing you. On this particular day we were in his nursery room, and I caught a glance from him as he laid nestled in his Rock ’n Play, quietly staring back at me. Where another mom may have been urged to interact and play with him, I sat paralyzed. The only urge I had was to walk out the door and drive somewhere far. I knew my son needed better. I knew I could be better. But I wasn’t going to be able to do it alone. I gave it the only label I knew — postpartum depression (PPD) — and turned to my computer to begin the search for help.

According to Jo Kim, PhD, director of the Perinatal Depression Program at NorthShore University HealthSystem, PPD is defined as a major depressive episode that occurs either during pregnancy or up to one year postpartum. Literature has commonly cited that 1 in 10 women experience PPD, but that prevalence has since increased to 15 percent according to a 2013 studyfrom the University of Iowa Department of Psychology published in the Annual Review of Clinical Psychology. The study also cites that 40 to 80 percent of women will experience the baby blues, a milder form of depression that can last for several days to a few weeks after birth and may be caused by hormonal changes, disrupted sleep patterns and fatigue.

“Symptoms of the baby blues are typically transient, short-lived episodes of altered mood that resolve quickly and the new mom feels like her usual self in between, and time-limited, resolving or at least improving by about two weeks postpartum,” Kim says. “If a new mom is feeling sad, down, anxious or irritable more often than not, and if she’s been feeling this way for more than two weeks without any sign of things improving, she is more likely experiencing PPD or another related condition.”

The term postpartum depression has been a catch-all for the variety of mood disorders that can present during and after pregnancy, but it has since been expanded to the more current phrase — perinatal mood and anxiety disorders — to reflect all stages of a woman’s experience. This can include prenatal depression (depression occurring during pregnancy), postpartum blues (more commonly called the baby blues), postpartum depression and anxiety, postpartum post-traumatic stress disorder (PTSD) and even the rare postpartum psychosis.

“For many women, anxiety is a main piece of the picture,” Kim says. “Anxiety hasn’t been recognized as much in the medical community, but women can struggle in all different ways.” Kim notes that many women can also experience a new onset of obsessive-compulsive disorder as a part of the postpartum period.

Factors such as a personal or family history of depression, inadequate social support, a high degree of life stress or having a baby with health issues can put a woman at increased risk. Women with premenstrual dysphoric disorder — a severe form of premenstrual syndrome (PMS) — or women with a thyroid imbalance or any form of diabetes may also be at an increased risk, according to Postpartum Support International(PSI).

As for the likelihood of getting PPD, Kim says that even women who didn’t experience perinatal mood and anxiety disorders with one child may experience it with another. About 10 to 20 percent of women experience PPD, and the number increases to 25 to 35 percent for women who have had it before. Kim has not seen any association with age, but says researchers see higher risks of PPD in teen parents.

While there is no one known medical cause, Kim points to two theoretical models that may begin to explain it: the stress sensitivity model and the hormonal sensitivity model. The stress sensitivity model includes genetic research into two variants of a stress sensitivity gene informally known as the “cactus” allele and the “orchid” allele. It suggests that a subset of women may be more vulnerable to depression when under heightened stress: those with the “cactus” allele are naturally more resistant to stress and its impact on their mood, while those who have the “orchid” allele are more vulnerable.

The hormonal sensitivity model, on the other hand, suggests that a subset of women may be more vulnerable to depression during times of intense hormonal changes, like the kind found in the perinatal period. Kim says this may explain why women who have a history of PMS or premenstrual dysphoric disorder seem to have a higher risk for PPD.

The models are not mutually exclusive. “It is possible for a woman to be vulnerable from both stress and hormonal perspectives,” Kim says.

The good news is that those who get help will typically recover. The current gold standard for PPD treatment is psychotherapy plus medication.

Finding support locally

My own help came through a network of women. First was Amy, the Illinois contact from PSI who directed me to the 24/7 MOMS hotline, 866-364-6667 (MOMS), a resource offered by NorthShore’s Perinatal Depression Program that’s serviced by licensed counselors with expertise in postpartum depression. The trained staff can listen to a caller’s concerns and refer them to perinatal therapists.

Michelle from the MOMS hotline then listened patiently to my experience. After our call, she emailed me a wealth of information, including a list of local therapists that accepted my insurance and local support groups. She also coordinated a conversation with Nancy Segall, LCSW, a clinical social worker and founder of Beyond the Baby Blues, a non-profit organization in Evanston that offers free therapeutic support groups run by licensed therapists for pregnant and postpartum women whose babies are under a year old.

Since 2010, Beyond the Baby Blues has offered a cost-free and low-barrier program for women struggling emotionally during or after pregnancy. Clinician-led postpartum groups and prenatal groups meet for six weeks. The sessions, which include the moms and their babies, are casual, with participants given the opportunity to talk about their feelings, experiences and concerns in a safe and non-judgmental environment.

“The primary strategies for dealing with perinatal mood disorders are therapy, medication and support groups,” Segall says. “Resources for the first two of these modalities can be accessed through obstetricians, midwives and the MOMS line, but professionally led groups can be harder to locate. Beyond the Baby Blues has been able to address that gap by offering six-week groups regularly throughout the year.”

Segall recommends the MOMS hot line and the PSI website as sources of support. PSI offers a variety of resources, including a state-by-state listing of support groups.

It takes a village to raise a child, but it also takes a village to heal a mother. The accessibility of the group, plus being with other moms and hearing about the diversity of perinatal mood disorders, was the perfect way for me to begin to understand my own experience while also adjusting to motherhood. Without the network of support I received from PSI, the MOMS hotline and Beyond the Baby Blues, I likely may have stopped at a simple internet search at a time when I needed the most support.

If a woman is aware that she is at a higher risk for perinatal mood and anxiety disorders, Kim suggests she can minimize her risk by building a safety net and social support. The Postpartum Pact, a downloadable form from the Postpartum Stress Center, also provides a tool for women to help identify and deal with symptoms.

Kim says many women also find it helpful to revisit previous counseling therapy or to start a new therapy program to cope with the stressors that occur. She also recommends seeking out support groups, noting that many organizations offer web and phone-based sessions.

If you or someone you know might be experiencing a perinatal mood and anxiety disorder, these local resources may be helpful: