New baby, new feelings.
More than 80% of new mothers experience the “baby blues” shortly after giving birth due to hormonal changes, fatigue and stress. The “baby blues” are characterized by rapid mood swings – from happiness to tears – but usually resolve within two weeks and do not interfere with daily functioning.
Postpartum depression and anxiety are intense, long-lasting and severely impair a woman’s ability to care for herself or her newborn.
Some women experience melancholic depression, when they feel uncomfortable, have little appetite or want to sleep more. In general, women face the stress of anxiety.
They worry about their baby and their mothering skills, which can interfere with the joy associated with the first days and months of motherhood.
Postpartum depression and anxiety aren’t the only mental health conditions a new mother may face in the year following childbirth. In fact, maternal mental health conditions are the leading cause of preventable maternal death and morbidity in the US.
Here are the important warning signs of these conditions – and the three biggest myths about the postpartum period.
Maintenance disorder
It can be difficult to make the big transition into parenting and adapt to the enormous needs of a newborn.
Breastfeeding can be especially challenging. A woman may have sore or cracked nipples due to poor suction or stress about low milk supply while feeling pressure to produce enough to feed her baby.
Adjustment disorder, which is halfway between the “baby blues” and postpartum depression, is about managing expectations.
Symptoms often resolve with social support and better sleep. Sometimes we recommend that women do not breastfeed exclusively because they need to rest. I firmly believe that sleep is an important part of recovery.
Obsessive compulsive disorder
Women diagnosed with OCD before pregnancy have a higher risk of postpartum OCD.
We also see women who develop OCD specifically around that time. OCD manifests as obsessive thoughts and compulsive behaviors surrounding infant care, such as repetitive checking behaviors, or strict cleaning rituals – and those thoughts can take over their mind.
Post-traumatic stress disorder
Sometimes pregnancy or childbirth comes with medical complications that can be life-threatening and traumatic, increasing the risk of postpartum depression and PTSD.
Significant depression is a common symptom, and may affect bonding with the baby.
Bipolar disorder
We assess mental health conditions during pregnancy and the first year postpartum by asking new mothers to fill out a questionnaire about their feelings.
One of the things we look at is bipolar disorder because bipolar disorder in women usually appears in their 20s or early 30s, the prime age for pregnancy.
And we must distinguish between unipolar depression and psychosis because the treatment strategies are different.
The risk of postpartum psychosis in the general population is about 1 in 1,000. Women with bipolar I disorder, the most severe form of bipolar, are at greater risk. Untreated bipolar disorder increases the risk to 1 in 4.
Postpartum psychosis is a mental emergency. It is treatable, but requires a psychiatric evaluation and often hospitalization.
Suicidal tendencies
Many screening tools used by medical providers ask questions about suicidal ideation, although not all do.
At NYU Langone Health, we think it’s important to check for suicidal ideation because it’s common after childbirth.
We need to determine whether it is the fleeting thoughts that come from stress or the persistent thoughts that can lead to a harmful process.
Treatment strategies
Treatment really depends on the patient, the severity of their symptoms and their preferences, but we often recommend a multimodal approach.
There are times when only psychotherapy can help – or at least be the first step. Most of the time, we recommend psychotherapy and medication.
Medications like selective serotonin reuptake inhibitors are our first line for depression, anxiety and PTSD. Recovery depends on how quickly a woman can access care.
The most common risk factor for postpartum depression is untreated depression during pregnancy. If we can improve the mood during pregnancy, that is a protective factor.
Useful resources
I often tell patients to tread carefully on social media and avoid the rabbit hole of the internet because what you find may be anxiety-provoking or negative. We want to guide you to reliable and direct online services.
I recommend Postpartum Support International and womensmentalhealth.org.
Myths about the postpartum period
Pregnancy is popularized as euphoric, which is a myth. Some women may have that knowledge, but many do not. There are so many variables – pregnancy and childbirth can be beautiful and stressful at the same time.
There is also the myth that sertraline, commonly known by the brand name Zoloft, is the only antidepressant that is safe for pregnancy. There are many antidepressants that can be safely continued in pregnancy.
In fact, the biggest myth is that women have to stop taking certain medications during pregnancy or they can’t start a new regimen. But stopping medication can have its risks, so I encourage women to weigh the pros and cons with their doctor.
Dr. Marra Ackerman is director of CL Psychiatry at NYU Langone Health and clinical associate professor in the Department of Psychiatry at NYU Grossman School of Medicine.
As a psychiatrist who provides comprehensive care, specializing in psychological care for pregnant women and hormone-related psychological problems. Additionally, she provides psychological support to patients undergoing treatments such as organ transplants or cancer treatment.
