Throughout each trimester of Jerri’s first and second pregnancies, she suffered in silence, until it almost became too late.
“Hotdog, hotdog, hot diggity dog!” sang the Mickey Mouse Clubhouse characters, to Jerri’s toddler, Zack, who was lying on the sofa. With eyes wide with excitement and fixated on the television screen, he did not notice that his mother could not stop sobbing as she cradled his newborn baby sister, Jhane.
As a 29-year-old mother, who had delivered her second baby two weeks ago – a beautiful baby girl – Jerri should have been happy. She should have been able to sit on the floor with her son, building Lego blocks and reading Sesame Street storybooks. She should have been able to play and sing lullabies to her newborn baby girl. Instead, she spent her time secretly throwing up in her bathroom, pulling out patches of hair from her head and crying incessantly for no apparent reason. Her husband traveled regularly and worked long hours, often leaving Jerri alone with their son. Now that baby Jhane had arrived, Jerri was at her wit’s end and felt overwhelmed by motherhood.
Without warning, baby Jhane began to cry. Jerri had just breastfed her, so she checked her nappies to see if she was wet, but she was not. She got up and began pacing and rocking her. She sang to her in soft tones. She tried breastfeeding her again, but to no avail. Despite all efforts, the baby was inconsolable. She would not stop crying. Jerri’s frustration grew, and grew. She walked over to the window and violently pulled it open. The sky was overcast; the clouds grey and ominous. She stared at the gloominess outside, matching the gloom within her. She and her husband had recently purchased a two-storey ‘fixer-upper’ and the workmen had not yet installed the metal burglar-proof bars outside the windows. She pulled it open wide enough to climb through, with baby in hand. She heard a distant voice say, “Jump.” She looked around. There was no one there except Zack still seated enjoying the Disney Channel. This voice – not an audible one, but one she could feel in her heart – told her to take the baby and jump.
Jerri had struggled with depression during her first pregnancy, but it was not as extreme as this. When she first felt herself slipping, she reached for her ‘happy bag.” She posted happy pictures on Facebook and Instagram. She went for long walks outside, cooked sumptuous dinners, kept a ‘happy journal’ and drank umpteen kale and cucumber smoothies. None of it seemed to help this time. Although her husband loved her, and was a wonderful Dad, he was always busy and had no idea how to help her. He simply waited for Jerri’s mood swings to pass.
Instead, her symptoms worsened. She could not sleep at night. She was anxious all day and felt riddled with guilt that she was not the kind of mother that her children deserved. In fact, she thought that she did not deserve to celebrate motherhood because she felt like a "failure as a mom."
What was happening to Jerri? Was she experiencing a bizarre hormonal imbalance? Perhaps, a psychotic meltdown! Was she losing her mind?
“Hotdog, hotdog, hot diggity dog!!” she heard the Mickey Mouse crew singing again. Two minutes from strapping her baby girl to her chest and contemplating whether to jump out the window, something got caught in her throat.
The word “Help!!”
Jerri immediately ran to the phone and called her doctor. Within the hour she had a referral to a psychiatrist, and before the day had ended, received a diagnosis of Major Depressive Disorder (MDD) with Peripartum Onset – also known as postpartum depression (PPD).
What is Major Depressive Disorder?
The fact of the matter is that Major Depressive Disorder (MDD) with Peripartum Onset (also known as postpartum depression) is different from a temporary mood disturbance after childbirth. However, it is significant to understand the intricacies of a major depressive disorder before addressing the specifics of postpartum depression.
According to the Diagnostic & Statistical Manual of Mental Disorders – 5th Edition (DSM-5), an authoritative handbook by the American Psychiatric Association that defines and classifies mental disorders, a major depressive disorder or clinical depression, is a common and serious mood disorder. Those who suffer from the disorder experience persistent feelings of sadness and hopelessness and lose interest in activities they once enjoyed. Aside from the emotional problems caused by depression, individuals can also present with a physical symptom such as chronic pain or digestive issues. To be diagnosed with depression, symptoms must be present for at least two weeks.
Depression DSM-5 Diagnostic Criteria
The DSM-5 outlines the following criterion to make a diagnosis of depression. The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.
1. Depressed mood most of the day, nearly every day.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
4. Insomnia or hypersomnia nearly every day.
5. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition.
• Major depressive disorder is associated with high mortality, much of which is accounted for by suicide. As a result, if you think someone you care about may be suffering from depression it is important to know the warning signs of suicide and to take suicidal statements extremely seriously. An active statement by someone with suicidal ideation might be something like, “I’m going to kill myself,” but other passive statements such as, “I wish I could just go to sleep and never wake up,” are equally worrying. If someone with depression exhibits these verbal markers, encourage them to consult a mental health professional immediately.
• Depressed individuals also present with irritability, brooding, and obsessive rumination, and report anxiety, phobias, excessive worry over physical health, and complain of pain.
How is Depression Different from Sadness?
What is the difference between depression and sadness? Given that the primary symptom associated with depression is sadness it can be hard to know how to make a distinction between the two psychological states.
But depression is more than just sadness, and not simply by a measure or degree. The difference does not lie in the extent to which a person feels down, but rather in a combination of factors relating to the duration of these negative feelings, other symptoms, bodily impact, and the effect upon the individual’s ability to function in daily life.
Sadness is a normal emotion that everyone will experience at some point in his or her life. Be it the loss of a job, the end of a relationship, or the death of a loved one, sadness is usually caused by a specific situation, person, or event. When it comes to depression, however, no such trigger is needed. A person suffering from depression feels sad or hopeless about everything. This person may have every reason in the world to be happy and yet they lose the ability to experience joy or pleasure.
With sadness, you might feel down in the dumps for a day or two, but you are still able to enjoy simple pleasures like your favorite television show, food, or spending time with friends. This is not the case when someone is dealing with depression. Even activities that they once enjoyed are no longer interesting or pleasurable.
In addition, when you experience sadness triggered by a certain something you are still able to sleep as you usually would, remain motivated to do things, and maintain your desire to eat. Depression, on the other hand, is associated with serious disruption of normal eating and sleeping patterns, as well as not wanting to get out of bed all day.
In sadness, you might feel regret or remorse for something you said or did, but you would not experience any permanent sense of worthlessness or guilt as you might with depression. In fact, one of the diagnostic features of depression is this kind of self-diminishing, negative thought pattern.
It is important to note, that those struggling with severe depression may have thoughts of self-harm, death, or suicide, or may even have a suicide plan.
What is Postpartum Depression?
In the first days and weeks after childbirth, a new mother goes through a variety of emotions. She may feel many wonderful feelings including awe, joy and bliss. She may also experience difficult feelings, including sadness. Sad feelings and crying bouts that follow childbirth are known as the “baby blues.” The baby blues are common and tend to decrease within a week or two. This type of sadness is often attributed to the dramatic hormonal changes that follow childbirth.
However, research has shown, around one in seven women will experience something more extreme than the typical baby blues. Women that give birth and struggle with sadness, anxiety or worry for several weeks or more may have a Major Depressive Disorder (MDD) with Peripartum Onset (postpartum depression (PPD). While the baby blues tend to pass quickly, PPD can be long-lasting and severely affect a woman’s ability to get through her daily routine.
What are the signs and symptoms of postpartum depression?
Postpartum depression can present different symptoms, depending on the person. But common symptoms include extreme difficulty in day-to-day functioning; feelings of guilt, anxiety and fear; loss of interest in pleasurable life experiences; insomnia; bouts of crying; thoughts of hurting oneself or the infant.
According to the Centers for Disease Control and Prevention (CDC), up to 20 percent of new mothers experience one or more symptoms of postpartum depression. Similar to other types of depression, PPD can include a number of symptoms:
Feeling down or depressed for most of the day for several weeks or more
Feeling distant and withdrawn from family and friends
A loss of interest in activities (including sex)
Changes in eating and sleeping habits
Feeling tired most of the day
Feeling angry or irritable
Having feelings of anxiety, worry, panic attacks or racing thoughts
While postpartum depression symptoms may start in the first few weeks following childbirth, some symptoms do not begin until months after birth.
Postpartum psychosis is a related mental health condition that can also develop after childbirth. This rare and serious condition includes symptoms of hallucinations (seeing or hearing things that are not there), paranoia, rapid mood swings and, at times, thoughts of harming one’s self or others. Some mothers have frequent thoughts about harming their children. These symptoms only occur in about 1 of every 1,000 births. Women who have bipolar disorder or schizoaffective disorder are at increased risk of having psychotic symptoms, but they can also occur in women with no prior history.
If you are experiencing signs of postpartum depression or postpartum psychosis, please tell someone. These conditions can be effectively treated and often respond best when treatment is started right away.
What causes postpartum depression?
A number of factors can lead to postpartum depression. Women with a history of depression and other mental health conditions face a higher risk of PPD. The following factors can also increase risk:
Hormonal changes that follow childbirth
Emotional stressors, including financial strain, job changes, illness, or the death of a loved one
Changes in social relationships, or lack of a strong support network
Raising a child with special needs or an infant that is challenging to care for
Having a family history of mental health issues
While some women are predisposed to experiencing postpartum depression, PPD can affect anyone, including women who experience a normal delivery and give birth to a healthy child. Since a personal history of depression can increase the risk of postpartum depression, let your doctor know if you have struggled with depression or anxiety in the past. By taking special precautions, you may be able to reduce your risk of developing PPD.
The DSM-5 specifically states, between 3–6% of women will experience the onset of a depressive episode during pregnancy or in the weeks or months following delivery. It must be noted that an estimated 50% of all MDD episodes actually begin prior to delivery or postpartum. For this reason, all episodes are now referred to collectively as “peripartum.”
Essentially, any new mother can experience postpartum depression, which means the disorder has no relationship to a woman's capacity to be a good mother. In fact, with treatment, a woman with such a diagnosis can be an exceptional mother to her children.
Previous depressive episodes and/or a family history of depression, lack of social support, anxiety, marital or financial problems, stress and substance abuse are high risk factors for MDD with Peripartum Onset. The risk of developing symptoms of depression has also been associated with being a stay-at-home mother and having unwanted pregnancies.
Women who have experienced one episode of post-partum depression have a 30–50% chance of experiencing it again. Like anything (and perhaps everything) in life, preparation is extremely important. In fact, discussing your concerns with your medical practitioner or mental health professional prior to the onset better prepares you for any unexpected occurrences. Oftentimes, this conversation makes a significant difference.
One of the criteria used to diagnose depression is appetite change. However, appetite may not be suitable for the diagnosis of depression in the perinatal (the period around birth: five months before and one month after) period.
Dramatic hormone changes—like those that happen during the perinatal period—can replicate symptoms of depression. During pregnancy, a woman's estrogen and progesterone levels increase. In the first 24 hours after childbirth, these hormone levels abruptly return to normal. Thyroid hormones may also decrease after childbirth. A blood test can determine if thyroid/hormone levels are responsible.
The key to recovery is seeking help as soon as symptoms are recognized. Treatment plans vary for each individual and include options such as individual, family or group psychotherapy, and/or antidepressant medication. If you are having symptoms of postpartum depression, talk to your doctor or a mental health professional. Your doctor may recommend that you meet regularly with a counsellor/therapist or that you start taking antidepressant medications. Often, both types of treatment are recommended. While PPD does, at times, go away on its own, symptoms usually go away more quickly with the help of medication and talk therapy.
Lifestyle changes can also help to reduce some symptoms of postpartum depression. The following strategies may help you manage the increased stress that accompanies new parenthood:
Getting enough sleep
Finding time to exercise
Surrounding yourself with a supportive network of family and friends
Eating regular, nourishing meals
Asking reliable and trustworthy caregivers to watch your child so that you can have a much-needed break
Also, some hospitals offer support groups for new mothers. Staffed by women’s health experts, this is a great place to share your feelings in a safe, supportive place with other women who understand what you are going through. Ask your doctor about new mother support groups in your community.
You can take steps to feel better
Studies suggest that women who experience postpartum depression have often had earlier episodes of depression that were not diagnosed or treated. If you have experienced an episode of depression and are planning to become pregnant, you can reduce your risk and improve your outcomes. The adjustment to motherhood can be very stressful as you learn to navigate your new role, balancing self-care and an infant (and possibly other children and family members). This can be demanding, exhausting and overwhelming. If you are a new mom with feelings of anxiety or depression, you may even feel guilty or ashamed. It is important to know that postpartum depression is not your fault. Remember, postpartum depression is a medical condition that can be treated.
Talk with your obstetrician or primary care provider about your concerns, bearing in mind that, contrary to cultural taboos and stigmatization, a psychiatrist, psychologist or other mental health professional can be your greatest ally.
by: Nichelle Dottin-John, BA, MA (MFT)/Candidate.