New baby, new emotions.
Over 80% of new mothers experience the “baby blues” shortly after childbirth due to changing hormones, exhaustion and stress. The “baby blues” are characterized by rapid mood shifts — from joy to tears — but they usually resolve within two weeks and don’t impair daily function.
Postpartum depression and anxiety are more intense, longer-lasting and more disruptive to a woman’s ability to care for herself or her newborn.
Some women go through melancholic depression, where they feel disengaged, suffer from low appetite or yearn to sleep a lot. More often, women experience anxious depression.
They worry about their baby and their mothering skills, which can interfere with the bliss that accompanies the early days and months of motherhood.
Postpartum depression and anxiety aren’t the only mental health conditions a new mother may face in the year following delivery. In fact, maternal mental health conditions are the leading cause of preventable maternal mortality and morbidity in the US.
Here are the key warning signs for these conditions — and three major myths about the postpartum period.
Adjustment disorder
It can be difficult to make the major transition to parenthood and adapt to the overwhelming demands of a newborn.
Breastfeeding can be particularly challenging. A woman might experience sore or cracked nipples from poor latching or stress about low milk supply while feeling pressure to produce enough to feed her baby.
Adjustment disorder, which is partway between “baby blues” and postpartum depression, is all about managing expectations.
Symptoms often resolve with social support and better sleep. Sometimes we might recommend that women not exclusively breastfeed because they need to get rest. I strongly believe that sleep is a critical part of recovery.
Obsessive compulsive disorder
Women diagnosed with OCD before pregnancy have the highest risk of postpartum OCD.
We also see women who develop OCD specifically in that period. OCD manifests as intrusive thoughts and often compulsive behaviors surrounding infant care, such as repetitive checking behavior, or rigid cleaning rituals — and those thoughts can take on a mind of their own.
Post-traumatic stress disorder
Sometimes pregnancy or delivery comes with medical complications that can be life-threatening and traumatic, increasing the risk of postpartum depression and PTSD.
Significant distress is a common symptom, and it can affect bonding with the baby.
Bipolar disorder
We screen for mental health conditions throughout pregnancy and the first year postpartum by asking new moms to fill out a questionnaire about their feelings.
One of the things we look for is bipolar illness because bipolar disorder in women often emerges in the 20s or early 30s, prime pregnancy years.
And we have to differentiate between unipolar depression and bipolar disorder because the treatment strategies are different.
The risk of postpartum psychosis in the general population is about 1 in 1,000. Women with bipolar I disorder, the more severe form of bipolar illness, have a higher risk. Untreated bipolar illness raises the risk to 1 in 4.
Postpartum psychosis is a psychiatric emergency. It is treatable, but it requires psychiatric assessment and often admission to the hospital.
Suicidal tendencies
Many of the screening tools that medical providers use ask questions about suicidal ideation, though not all of them do.
At NYU Langone Health, we think it’s important to screen for suicidal ideation because it’s fairly common postpartum.
We need to determine if it’s fleeting thoughts that stem from stress or more persistent thoughts that can lead to a harmful plan.
Treatment strategies
Treatment really depends on the patient, the severity of their symptoms and their preferences, but we tend to recommend a multimodal approach.
There are times when just psychotherapy can be helpful — or at least serve as an initial step. Most of the time, we’re recommending psychotherapy and medication.
Medications like selective serotonin reuptake inhibitors are our first line for depression, anxiety and PTSD. Recovery depends on how quickly the woman can access care.
The most common risk factor for postpartum depression is untreated depression during pregnancy. If we can optimize mood during pregnancy, then that is certainly a protective factor.
Helpful resources
I often tell patients to tread carefully on social media and avoid the internet rabbit hole because what you find can be anxiety-provoking or flat-out wrong. We want to direct you to credible and positive online resources.
I recommend Postpartum Support International and womensmentalhealth.org.
Myths about the postpartum period
Pregnancy has been heavily romanticized as euphoric, which is a myth. Some women might have that experience, but many do not. There’s a lot of variability — pregnancy and delivery can be wonderful and stressful at the same time.
There’s also a myth that sertraline, commonly known by the brand name Zoloft, is the only safe antidepressant in pregnancy. There are many antidepressants that can be safely continued in pregnancy.
In fact, a major myth is that women have to stop taking certain medications during pregnancy or can’t start a new regimen. But stopping medication can carry its own risks, so I encourage women to weigh the pros and cons with their doctor.
Dr. Marra Ackerman is the director of CL Psychiatry at NYU Langone Health and a clinical associate professor in the Department of Psychiatry at NYU Grossman School of Medicine.
As a psychiatrist provides comprehensive care, with a particular focus on mental health care for perinatal women and hormone-related psychiatric issues. Additionally, she provides psychiatric support for patients receiving medical treatments such as organ transplants or cancer therapies.
