How to treat Postpartum Depression
In part 2 of their feature on Postpartum Depression, Catherine Birndorf MD and Alexandra Sacks MD, co-authors of the new book, Mother Mind: The Emotional Guide to Pregnancy and Postpartum, discuss ways to treat PPD.
There is good news for sufferers of PPD: we can treat postpartum anxiety and depression. You don’t have to suffer; indeed, science shows that you shouldn’t.
The same talk and behavioral therapies and medications that are used to treat regular depression and anxiety at other times in a woman’s life are useful to combat PPD. If you have had depression before, you should consider going back to what worked in the past. If you don’t have access to a therapist or psychiatrist, the first place to start is by talking to your OB-GYN, Pediatrician, or other general healthcare provider.
Unfortunately, not every provider will screen you for PPD (though we think they should!). Try to find the courage to be as direct as possible in describing how you’re feeling, perhaps in concert with your partner, and your provider may be able to help, or at least connect you to someone who can. And if you want to take charge and find a mental health professional yourself, Postpartum Support International is an amazing resource.
Once you find a mental health professional, he or she will help you figure out which of the three categories of treatment is right for you: social (lifestyle changes.) psychological (talk therapy), or biological (medication). Sometimes, what may be most effective is a combination of all three. But it’s important to know that you don’t have to jump to pills first, as behavioral approaches and therapy are also powerful tools.
The following is a list of our top recommendations for treating PPD. Any woman could benefit from these wellness tips after giving birth:
- Get good sleep. Studies have shown that in order to treat depression, you need to get enough high-quality rest. The brain benefits from at least four hours of uninterrupted sleep in order to function well. This means you may need to ask for someone else to do one of the night feedings while you get a longer stretch of rest. This could be your partner, another family member, or, if it is within your means, someone you hire. Take sleep seriously: if you are having PPD, sleep is like medicine for your recovery.
- Keep perspective on breastfeeding. We’ve all heard about the benefits of breastfeeding, but these messages can leave you feeling like it’s the only valid choice. Furthermore, depression often makes life feel black or white, leading moms to oversimplify (“breast milk = good; formula = bad”). Among the many challenges of breastfeeding, the pressures to be “perfect” in timing, pumping, and production of milk can become a trigger for worry and exhaustion that makes PPD worse. Pressure to breastfeed every two hours can interfere with the sleep that can prevent PPD. If breastfeeding is presenting real complications, then it may actually be a healthier choice for you and your baby to switch to, or supplement with, formula.
- Keep your to-do list short and realistic. Many women think their maternity leave will be “time off.” But a day at home taking care of a baby is quickly consumed by mundane, repetitive tasks, such as feeding, cleaning, clothing, and soothing. New mothers often look at the clock at the end of the day and ask themselves, “Where did the time go?” Being overly ambitious in your to-do list and expecting yourself to be able to tackle large projects like reorganizing the closets or finishing your dissertation will leave you feeling like a failure. Furthermore, depression and anxiety may slow you down, making it even harder than usual to be efficient. Do your best to set realistic daily goals like eating enough, getting outside, and occasionally taking a shower, and praise yourself for achieving them.
- Ask for help with your childcare. For a new mom struggling with PPD, admitting that she is having trouble taking care of her baby on her own, or even having trouble enjoying the baby, may feel shameful. But pushing yourself to ask for help, and getting it, can be the first step in finding some relief. Connecting when you can and pursuing quality time with your new child is better for him/her than spending every hour together but feeling miserable.
- Reconnect with your old self. Even though PPD will likely be weighing you down, try to push yourself to do some of the activities that used to bring you joy. In the throes of depression, it may be hard to remember what you found fun. Ask the people who know you best to remind you about the little things that made you happy. It can be as simple as getting a coffee in the morning from your favorite bakery, watching mindless TV shows, reading the newspaper, getting a manicure, or taking a walk with a friend. Trouble motivating yourself is another depression symptom, so sometimes you have to “fake it ’til you make it.” Giving yourself an hour or two of alone time per week may prevent you from wanting to run away altogether from your new life.
- Don’t keep your feelings a secret. Shame and social isolation are other classic symptoms of PPD. Often, there is nothing more reassuring than validation and learning that you are not alone. You may feel that it’s your fault that you’re not experiencing more happiness during this “precious” time. But repressing and hiding your feelings can cause your despair to deepen, and it can isolate you from other new moms who are going through similar experiences and who could offer empathy and advice. Trust us on the following: 1) No one is judging you as harshly as you’re judging yourself. 2) The people who love you will want to help once they understand what you’re going through. 3) Find other like other like-minded moms you can share your experiences and feelings with.
- Make a list of your new psychosocial stressors. Sometimes simply naming the stresses in your life can be as emotionally soothing as fixing them. When you have a new baby, you may develop strong feelings about topics such as money, in-laws, sex, date nights, socializing, and work. In the long run you will be able to work on adjusting to this transition, but for the moment, spelling out everything that’s hard — and especially, talking it through with your partner or nearest and dearest — can provide quick relief.
- Eat healthy. Science now shows that the food you eat may be as impactful for your mood as some antidepressants. Even if PPD and baby-related exhaustion is weighing you down, try to find the energy to eat well and regularly, avoiding the processed foods and simple sugars that provide only brief pleasure before a crash.
- Exercise. Endorphins are real. They provide a serotonin boost and act as a natural medicine to fight and prevent depression. No matter where your body is in the postpartum period, find a way that works for you to get out and get moving. Trust us, you’ll be glad you did.
- Try body-work. Mindfulness, meditation, deep breathing, yoga, and massage are all soothing ways to calm the nervous system and get your GABA flowing. GABA is the same anti-anxiety neurochemical released by alcohol or pills, but you can conjure it naturally to get a much needed (and healthier) chill when you’re feeling wound up. There are many great meditation apps. We like Headspace.
In the postpartum period, the amount of change a woman must cope with can be dizzying. You’ve become a mother, but the identity may not yet feel real. Your family has shifted from the two of you as a couple to a threesome or an even larger unit, and that may be taking a toll on your relationship. Your free-time, domestic routine, and body are all in flux. Talking to a professional about these changes and your reactions to them may help you feel calmer, more in control, and less alone – all of which can be a huge step in relieving some of the worries that may be contributing to your PPD.
For years, most doctors, including psychiatrists, were reluctant to give pregnant and breastfeeding women medications for fear of harming the baby. Scientific data now shows that ignoring psychiatric illness during pregnancy and postpartum is not only bad for the mom, it’s bad for her infant and her family, too.
It’s a misconception that psychiatric medications are harmful during pregnancy and breastfeeding. That being said, it makes sense to consider behavioral and therapy interventions first, because for many women those treatments can be enough to help. If you’re not sure whether to continue, stop, or start an antidepressant during pregnancy, consult with a doctor. Experts can walk you through a risk/benefit analysis that compares the effects of the medication with the effects of the untreated illness.
Especially if you have a history of depression or anxiety, you may need to take medication during pregnancy or breastfeeding, because curtailing your use may result in a relapse of symptoms for up to 68% of women. If you’ve never taken medications before, but your symptoms are not getting better with therapy and behavioral treatments alone, it may be important to start. A mother’s health is always interconnected with her baby’s. If you’re treating your underlying condition, your baby will be better off.
We’re on a mission to empower women to prevent and obliterate the effects of PPD. We’ll be spelling out the secrets of how-to in our upcoming book: Mother Mind : The Emotional Guide to Pregnancy and Postpartum. To learn more, visit theemotionalguide.com.
Dr. Catherine Birndorf specializes in Reproductive Psychiatry, an important area in mental health which helps women with emotional and psychiatric conditions before, during and after pregnancy and throughout the life cycle. Dr. Birndorf helps patients understand their specific psychiatric problems during times of hormonal changes from menses to menopause. She works with her patients and their families to focus on these psychiatric issues and provides a range of treatment options during this time of transition in a woman’s life. Visit Dr. Birndorf’s website.
Dr. Alexandra Sacks is an Adult Psychiatrist who is interested in the biological, philosophical and emotional links between the mind, body, and brain. As a therapist, she believes that the best treatment comes from feeling understood. She uses medications as one tool in this collaboration to integrate with exercise, nutrition, sleep and behavioral wellness. In addition to her work in Adult Psychiatry as it relates to general anxiety and depression for men and women, she specializes in Reproductive Psychiatry/Women’s Mental Health. Visit Dr. Sacks’ website.