When a patient named Deborah gave birth in December 2008, it was anything but a joyous experience. Although her son was healthy, she began worrying excessively that something bad was going to happen to her newborn after she left the hospital. Worse yet, her thoughts centered on intentionally harming him.
Her symptoms were the telltale signs of a severe postpartum mood disorder. Because Deborah had several people involved with her care, including a doula and a supportive husband, her symptoms did not go unnoticed. She was referred to a psychiatrist who specializes in perinatal mental health issues to get through this difficult time. “Despite the best medical care and an amazing husband and community of family and friends, I still suffered tremendously,”
she recalls.

In the days and weeks after giving birth, it is not uncommon for women to feel depressed, anxious, overwhelmed or even angry. New moms may cry for no apparent reason, have trouble sleeping, show little or no interest in eating or feel ambivalent about caring for their baby. The so-called “postpartum blues” are normal and often diminish in the first month or so.

However, some women like Deborah experience more severe, long-lasting symptoms characterized by intense feelings of sadness, anxiety or despair. In fact, roughly 15 percent of new mothers have postpartum depression, anxiety or psychosis that fall under the umbrella of mood disorders, according to the American Congress of Obstetricians and Gynecologists (ACOG).  That amounts to as many as 1 million women each year in the U.S., making this potentially serious disorder surprisingly prevalent.

It is crucial to recognize the warning signs and seek help as soon as possible. As symptoms become more severe, the risks to both mother and baby begin to rise. The feelings can deepen to the point of having irrational thoughts, delusions, and even psychotic episodes where reality is distorted. The symptoms may linger and become chronic in some women. According to a January 2014 study published in the Harvard Review of Psychiatry, postpartum depression remains a long-term problem for 30 to 50 percent of women.  Likewise, a 2013 study of 10,000 women conducted at Northwestern University in Chicago found that 14 percent of the women screened positive for depression. Of that group, nearly 20 percent said that they thought of harming themselves.

It is no wonder postpartum mood disorders are so common. After childbirth, new mothers deal with fluctuating hormones and sleep deprivation while recovering from the physical pain of labor and childbirth and facing the challenges of caring for and, in many cases, nursing a newborn. The hormones associated with breastfeeding (not unlike in menopause) can also exacerbate or prolong postpartum depression and anxiety.

Many women may already have a mood disorder history. The condition can be controlled without medication in some women, and they may choose to go off a particular treatment. Others decide it is best to continue or even start medication during pregnancy. Although the medications available to treat these disorders carry some risk, discontinuing medication may pose an even greater threat. The decision regarding medications is typically made in consultation with the patient, the obstetrician and a mental health professional whose relationship with the patient may predate the pregnancy.

A woman with a mood disorder entering or arising during a pregnancy is at increased risk for even more serious problems in the postpartum period. The Northwestern University study found that many women with postpartum depression experienced at least one episode of depression before becoming pregnant and also had a preexisting anxiety disorder.

If there is no history of mood problems prior to pregnancy, the transition into actual depression may go unnoticed by both the patient and those around her. Women who experience mild depression after childbirth most likely don’t have a mental health professional to turn to. They call their OB/GYN, who refers them to a psychiatrist. However, many psychiatrists do not accept insurance, causing the patient to not follow up or end up paying out of pocket. Those who do will see a doctor they have never met. The obstetrician may feel comfortable restarting a previously prescribed medicine that was effective in the past. But, in many cases, the important and time-consuming psychological evaluation and the counseling that may help the condition, are more than can be provided in an OB/GYN’s office.

After childbirth, new mothers deal with fluctuating hormones and sleep deprivation
while  recovering from the physical pain of labor and childbirth.

If this sounds familiar, the first step is to call your OB/GYN to help determine whether you are experiencing normal postpartum blues or more serious symptoms. If you are a woman who has experienced depression or anxiety and are thinking about getting pregnant, broach the subject with your OB before you conceive. Talk to the mental health professional who has treated you in the past, so you can decide together whether your medication needs to be discontinued or tapered off.

Deborah received therapy and took medication and, in time, felt much better. She found and connected to an online community of mothers, which helped her find peace. “I felt for the first time since my son was born – and not just from a doctor telling me – that I was not alone on my occasional forays to the dark side of this disease,” she says.

Four years later, those terrifying days are a distant memory. “I love being a mom so much I even had a second baby!” says Deborah. She helped create a nonprofit organization, Postpartum Progress, Inc., to help people better understand perinatal mood and anxiety disorders. “I am dedicated to raising awareness and funding to make sure all mothers recognize these postpartum illnesses, know that they are the most common complication of childbirth, and know that they are temporary and treatable with professional help,” she emphasizes. “I want all mothers to feel safe to reach out for the help they need to get well and to be the best mothers they can be.”

Russell Turk, MD is the founder of Riverside Obstetrics & Gynecology in Greenwich, CT, part of Stamford Health Integrated Practices, an affiliate of Stamford Hospital. Riversideobgyn.com. See ad, page 24.