MORE THAN JUST A FEELING

New research on postpartum depression could change the way we talk about the “baby blues”

One week after her son’s birth, Sally was feeling down. “Everyone told me I would fall in love with my baby right away,” she tells Quartz. “When I didn’t feel this wave of maternal bliss, I immediately felt like a bad mother.”

Once Sally returned from the hospital, she was consumed by paroxysms of tears. She confided in a couple of mom friends who reassured her that she just had the baby blues–a common, and not totally unexpected, emotional response to the hormonal and lifestyle changes of new motherhood. “Don’t worry, 80% of new moms feel blue,” her friend told her. Sally found comfort in these words. She hoped her sadness would soon pass, as her friend had promised her it would.

As a perinatal psychologist, I meet many women who struggle to adjust to their new identities as mothers. Unfortunately, Sally’s mood did not improve after a couple of weeks. Instead, she felt disconnected from her baby. She was anxious and had trouble sleeping. She also felt guilty for having these uncontrollable feelings. She tried going for walks, talking with friends, and taking deep breaths, but no self-care measures lessened her suffering. Like many new mothers, Sally was suffering from postpartum depression (PPD), the leading complication of childbirth. As a perinatal psychologist, I meet many women who struggle to adjust to their new identities as mothers. 

Postpartum depression affects approximately one in seven women each year, according to the American Psychological Association. Yet the exact causes of this debilitating disorder are not entirely known. To date, social science and medical researchers believe that the hormonal, physiological, and identity changes of new motherhood contribute to a woman’s vulnerability—but we still don’t know enough.

Luckily, this is beginning to change. A new research study is helping doctors identify the emotional fluctuations that may increase a woman’s risk of developing PPD. This information can help obstetricians and nurse practitioners to screen pregnant women for prenatal depression and potentially ease their symptoms.

As I talked with Sally about the etiology of her symptoms, she disclosed that her pregnancy had been difficult, too. She described it as “nine months of constant PMS.” Throughout each trimester, her emotions had fluctuated, vacillating between joy, feeling overwhelmed, and sadness. But she thought these mood swings were just a normal part of her gestational journey.

I reassured Sally that she wasn’t alone. For many women, pregnancy awakens a surge of emotions, including anxiety, tearfulness, and irritability. Indeed, unknown to many pregnant women, postpartum mood symptoms often begin during pregnancy. Sadly, according to Postpartum Progress, 85% of women never receive the psychological help that they need after giving birth. A new research study is helping doctors identify the emotional fluctuations that may increase PPD risk. 

A recent call to action seeks to change this pattern. Last week, the United States Preventive Task Force (USPTF) recommended that all women receive mental health screenings during pregnancy, not just after giving birth.

In support of early diagnosis, a psychological study published in the March 2016 edition of the Journal of Behavior Therapy and Experimental Psychiatry states that mood instability–particularly when related to a woman’s self-esteem–may help predict PPD. This groundbreaking study screened women for depression during pregnancy and after delivery. The results indicated that a woman’s frequent fluctuations in self-esteem, especially during the second and third trimesters, are related to higher instances of her becoming depressed postpartum. This is one of the first research studies to exclude women who were previously depressed, shedding light on the factors that contribute to postnatal depression.

It’s important to reiterate that women who struggle emotionally during or after pregnancy are never to blame for their PPD. While our society portrays childbirth as a uniformly joyous event, the transition to parenthood is a stressful life change. As a matter of fact, a scientific theory called the diathesis-stress model demonstrates why women become more vulnerable to depression during stressful life events, including infertility, pregnancy, and childbirth.  For many women, pregnancy awakens a surge of emotions, including anxiety, tearfulness, and irritability. Due to a convergence of biological and social factors, prolonged stress makes it easier for women to develop negative beliefs and attitudes. Such stress can lead women like Sally to ultimately believe they are “bad mothers,” and that they are “failing at motherhood.” Over time, these negative cognitions can also perforate a woman’s self-esteem.

One of the most valuable messages from the Belgian study is that not all maternal depression is the same. “More and more data suggests that there are different forms of PPD that respond to different treatment approaches,” Dr. Anna Glezer, a perinatal psychiatrist at the University of California, San Francisco, tells Quartz.

Glezer says that this new research “can help guide treatment options.” She suggests that pregnant and new mothers who struggle with self-esteem instability may respond better to cognitive behavioral therapy or mindfulness-based cognitive therapy. Both of these therapies help women examine how negative thoughts and feelings impact behavior. Mindfulness-based cognitive therapy offers the added benefit of teaching the life skills of mindfulness and meditation, which can help women manage the intense symptoms of anxiety and depression. These forms of treatment are excellent options for mothers who are reluctant to take medications during pregnancy or while breastfeeding.

 Women who struggle emotionally during or after pregnancy are never to blame. There is great value in taking preventative measures during pregnancy. In an effort to enhance maternal care, many hospitals now include pregnancy support groups and mental health clinics as a standard part of prenatal wellness. Folding these services into the hospital system where women receive medical treatment helps reduce the stigma often associated with postpartum depression. With the new recommendations from the USPTF, this makes it much easier to screen all pregnant women for PPD.

For pregnant women and their families, it’s essential to get accurate and timely information about how to handle maternal mental-health concerns. There are many online resources, such as the Mind Body Pregnancy, Postpartum Progress and Postpartum Support International, that educate women about pregnancy and postpartum mood concerns. These sites also provide directories of maternal resources, including psychiatrists and psychologists who specialize in perinatal mental health.

Now that there are a bevy of resources available, pregnant women and mothers no longer have to suffer without an end in sight. These combined services help pave the way for women like Sally to receive early screening and treatment–two interventions that can reduce the length of maternal suffering.

Having a baby isn’t always the dreamy process portrayed in fairy tales and romantic comedies. But neither does it have to be a nightmare.

Follow Juli on Twitter at @dr_fraga. We welcome your comments at ideas@qz.com.

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