This month, our Whole Mamas team is publishing resources and stories related to postpartum mental health. If you need immediate help, the National Suicide Prevention Hotline is a free and confidential network of more than 140 crisis centers nationwide. It is available 24/7 to contact in a crisis at 1-800-273-8255. You can call for yourself or someone you care about.
For additional help, call Postpartum Support International’s warmline at 800-944-4773. You’ll get a return call within several hours. You can also visit their website www.postpartum.net. Click here to connect with your closest coordinator to get info, support, resources, and referrals to providers trained to treat PPD in your area.
According to the CDC, only 15% of women with postpartum depression ever receive professional treatment. This means about 850,000 women in the United States each year are not getting the help they need. This week, we are answering questions related to treatment options for Perinatal Mood and Anxiety Disorders. We consulted with Ann Smith, Certified Nurse Midwife and President of Postpartum Support International (PSI) and referenced the resources available on the Postpartum Support International website.
How do I get treatment?
Once you’ve decided that you need help, there are several things to consider.
You can consult with your healthcare provider; however, make sure to ask how much experience they have with mood disorders and if they feel comfortable treating patients with mood disorders. Some have experience and are good at treating, but many are not.
If your provider isn’t experienced or comfortable treating, ask if they know anyone in your area that can help. If they’re not able to provide a referral, or if you want to look into other options, you can visit PSI’s National Registry for a list of volunteers in your area to help you find support.
According to Ann Smith (our expert from PSI), it is important that you are treated by someone who is trained to treat Perinatal Mood and Anxiety Disorders if it all possible. Your recovery can be greatly improved when working with an expert in that area.
How do I know if I need to get treatment?
“Depression” can be a confusing word because the symptoms often vary. Women who are struggling may show the following signs: they can’t sleep, can’t eat, can’t sit still, are afraid of everything, are agitated and jittery, and/or have postpartum OCD with intrusive thoughts of something happening to their baby.
Some may have postpartum PTSD where they have terrible flashbacks of the birth, which may be real or perceived. Some women don’t feel bonded to their baby, they feel “off,” they’re angry, or they suddenly hate their partner. There are many manifestations that go from mild to severe.
If you have a PMAD it doesn’t go away on its own. Often it tends to get worse, even if it’s mild. Treatment plans are different for each woman, but might include increased self-care (such as proper rest, nutrition, exercise, and help with childcare), social support, talk therapy or counseling, and treatment of symptoms, with medication when necessary. Finally, medications are available to address both anxiety and depression.
Some women treat depression and anxiety with medication, some with natural remedies, some with diet and exercise, some with counseling, support groups, or spiritual practice and support. Many use all of them. Find what works best for you, make a plan of self-care, and prioritize it.
If you’re dealing with a mild illness, talk therapy and/or a support group may be enough. If it’s moderate to severe, the most successful treatment is usually a combination of medication and therapy.
A few non-medication based, evidenced-based therapies that may also help include Omega-3 fatty acids, Vitamin D, B-complex, Magnesium, light therapy, and acupuncture. While alternative treatments can help, they may not be enough to treat a moderate to severe PMAD. Remember that there is no shame in taking medication for a mental illness. Just as you may take medication to regulate other body systems, medication may be helpful in the case of PMADs.
How do I decide if I should take a medication?
There is a lot of fear, stigma, and misunderstanding around medications, and it’s a decision best made between you and your medical professional. Several medications are available to treat the symptoms of perinatal depression and anxiety, some of which are safe for pregnancy and breastfeeding.
Medications work individually with each person, so what works well for one may not work as well for another. If you have any questions about your reaction to medication, you should contact your provider and ask about it. You might experience side effects, especially in the first few weeks, but you should not feel worse on medication. If you have previously had a successful experience with medication, you might consider starting with that one. Work with your healthcare provider until you feel comfortable.
One in seven women respond physiologically to the rapid change in hormones during the pregnancy and postpartum, which affects the neurotransmitters responsible for mood that make us feel happy and stable. Think of it this way: once these neurotransmitters are out of whack, we need something to get them back in order. Diet and lifestyle habits can help, but medication is sometimes required for those suffering from moderate to severe PMAD.
Over a period of a few weeks and at the right time/dose, medication can gradually help these moms feel normal. Even for women who value natural health and non-medical solutions, medication can be important. Absolutely try nutrition and exercise, but if you can’t make it through the day (or even the next hour) without feeling sad, overwhelmed and overcome, these medications may be right for you. A good psychiatrist will know if you can try alternative treatments alone or if you will benefit from medication.
Why don’t some moms get help?
There are many reasons. Some moms:
- Don’t want to admit there’s anything wrong.
- Think this is just part of being a new mom, adjusting to life with a baby.
- Feel ashamed or embarrassed.
- Don’t feel supported by families or cultures that understand mood disorders or believe in treatment options such as medication/talk therapy.
- Don’t have the financial means to seek treatment.
- Aren’t sure what therapists will do, are scared of medications, of being told not to breastfeed, or worry that their child will be taken away.
If you can relate to any of these reasons, please consider finding one person that you can reach out to who will be understanding. Often confiding in other moms helps you realize that you’re not alone in feeling this way!
Can I still breastfeed if I have a PMAD?
Some providers think breastfeeding causes PMAD and will tell moms to stop breastfeeding. This is simply not true, especially since prolactin and oxytocin are “feel good” hormones and nursing may be one of the few things a mom can do to feel like they’re staying above water during this challenging time. Some providers say you can’t breastfeed if you take medication. This also isn’t true. Women can breastfeed and take medication. It is a decision best made between the mother and a provider who is informed on the latest research about using medication during pregnancy and breastfeeding.
For some women, breastfeeding can increase anxiety or cause anger towards their baby or themselves, so in those cases, a mom may choose to quit for personal reasons. If a mom is really struggling to breastfeed and is not enjoying it, quitting can ease stress, but it’s important to note that it can also cause a cascade of hormonal upheaval in someone who is on the border of having a PMAD. So, if a mom wants to quit nursing during this time, the best way is slowly and perhaps with the help of a lactation consultant.
In some cases, simply allowing mom to get a six hour stretch of sleep at night (while a partner, friend, doula, or family member attends to the baby) can help mom continue to breastfeed and to reduce the sleep deprivation that can often make things worse.
I’m the Partner… What About Me?
According to a 2010 study, about 4% of new fathers experience depression within the first year after the birth of a child. We don’t have access to similar research on same-sex partnerships, but we know they experience the same kind of struggles. As the main support in a relationship, a new baby and the changes your partner is experiencing can impact your mental health.
What’s best for baby is two healthy parents, so make sure to take care of yourself, too. If you are struggling after your child’s birth, find someone in your support network you can confide it and discuss treatment options with a trusted health care provider.
Continue the Conversation With Us
We are proud to join this important conversation to end the stigma surrounding perinatal mood and anxiety disorders. We’re here for you, mama, no matter your season of motherhood, and we hope the resources we bring you this month are helpful. Anything we missed? We’d love for you to join the conversation on Instagram or by email and let us know your thoughts and further questions. Over the next several weeks we’ll continue to share resources related to postpartum mental health, so stay connected!