One of the most surprising aspects of the baby blues and Postpartum Depression for me to learn was how it can show up as irritability, anger, or anxiety. I know I personally never felt like a b*tch (Yes, I know from 16 years of recovery, 14 years of working in mental health settings, and a doctorate in Clinical Psychology that “bitch” is not a feeling) nearly as much as I did after becoming a mom. After becoming a mom, my “b*tch” feeling levels skyrocketed.
How does one know if these feelings (irritability, anger, sadness, loss of self-esteem) are in normal range of mommy/personhood and when they are of concern and needing attention and mental health support?
Shoshana Bennett, Ph.D. (co-author with Pec Indman, Ed.D. of Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression, 2010) offers two simple criteria:
1. The symptoms last longer than two weeks
Postpartum Depression, like non-perinatal depression, includes symptoms for at least two weeks that can affect changes in appetite, sleep, loss of self-esteem, and lack of pleasure. Hormone changes are dramatic postpartum and the baby blues are usually a result of feeling this dramatic change and resolve within two weeks postpartum. 50-80% of women experience the baby blues. The baby blues are much shorter in duration. PPD can be difficult to detect as what new mother isn’t struggling with changes in appetite, sleep, and self-esteem?! However, PPD is more persistent, and:
2. The symptoms are severe enough to get in the way of normal functioning, even if they occur during the first two weeks.
Perinatal mood disorders (including not only depression, but also anxiety, OCD, psychosis, and Bipolar) are more persistent and pervasive and can interfere mildly or dramatically in functioning and care for yourself and your baby.Postpartum Depression (PPD) affects 1 in 5 women (this is the latest evidence- it used to be 1 in 7. I imagine this is due to more women speaking up and receiving help, not more women being affected). If the symptoms are severe enough to get in the way of normal functioning, even if they occur during the first two weeks postpartum, it is considered to be PPD.
But what ARE the symptoms and how do they show up?
The following are a list of symptoms interspersed with statements made by women suffering from PPD (excerpted from This Isn’t What I Expected by Karen R Kleinman, LCSW and Valerie Davis Raskin, MD, 2013) and comparisons between the baby blues and PPD (excerpted from Kristin B. Hodson, a psychotherapist, and founder of The Healing group.com, a center for Women’s relationship health):
“Every little thing gets on my nerves lately. Sometimes, I am even furious with my baby. Often, I am angry at my partner.”
The Baby Blues: One minute you love your husband and the next you want to bite his head off.Postpartum Depression: You are beginning to wonder why you married your husband in the first place, you are continually angry at him, and you consider throwing the vase at him.
The Baby Blues: One minute you are smiling at the baby and the next you feel irritated that you have to get up to feed them the fifth time that night.
Postpartum Depression: You’re dominated by anger daily, not just waking up to feed but towards others and life’s situations that you used to be able to handle.
“I cry at least once per day.”
“I feel sad most or all of the time.”
The Baby Blues: You haven’t showered in three days, you have dried milk on your clothes, and you burst into tears at a moment’s notice.
Postpartum Depression: You haven’t showered in a week, you don’t remember the last time you did laundry, and you are crying most of the day, every day.
“I can’t concentrate.”
Baby Blues: You walk into a room and forgot what you were looking for.
PPD: You cannot remember/memorize facts and figures needed in your professional life, that prior to pregnancy, were easy for you and your baby is 9 months old.
Loss of pleasure/lack of sex drive
“I can’t remember the last time I laughed.”
“I have no interest in making love at all, even though my doctor says I’m now physically able to resume sexual relations.”
“I don’t enjoy the things I used to enjoy.”
Fatigue and difficulty sleeping
“I can’t sleep, even when my baby sleeps.”
“I have no energy, I’m tired all of the time.”
“I have no appetite and no enjoyment of food or I am having sugar and carbohydrate cravings and compulsively eating all of the time.”
The Baby Blues: You haven’t had a thought about putting makeup on in a week and you don’t care that you are wearing your pregnancy pants because your focus is on recovery and the baby.
Postpartum Depression: You’re feeling so overwhelmed and out-of-control that you start focusing excessively on your outward appearance so people don’t know how bad and out of control things really are for you.
The Baby Blues: You wonder from time to time if you are really cut out for this mothering thing.
Postpartum Depression: You think you are not cut out for the mothering thing and start having regular fantasies about getting in your car, driving to Canada, and never returning because everyone would be better off.
This list is not intended to diagnose or treat PPD. A full assessment and screening can be done by a therapist (MFT, Psychologist or Psychiatrist) trained in perinatal mood disorders.
If you are having thoughts or a plan of hurting yourself or your baby, you need immediate attention and support. The following is a 24-hour crisis line for new moms.Postpartum Depression Phone Support: 1-800-773- 6667 (1-800-PPD-MOMS). This helpline is available 24 hours a day, 7 days a week for anyone experiencing depression during and after pregnancy, as well as for anyone concerned about a new mother. The telephones are answered by trained crisis counselors who can provide information and referral for treatment.