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.

As­so­ci­at­ed Fea­tures

• 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.

Di­ag­no­sis

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.

Treat­ment

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.