When Holly Betten, 28, came home from the hospital after a rough delivery, she had one day to adjust to her new life as a mom before her husband went back to working 12-hour days as a computer-software architect. Her son, Henry, became severely jaundiced, wouldn't breastfeed, and almost landed back in the hospital for losing too much weight. "All I could think was, 'What did I get myself into? I should never have become a mom,'" recalls Betten, of Grand Rapids, Michigan. "I felt totally overwhelmed and inadequate -- I couldn't even feed my child." Then Henry developed colic and began to wail all the time. Not surprisingly, so did Betten: "I'd be happy one minute, then crying hysterically the next. I just wanted to leave the baby in his room and walk away."
Her husband worried that Betten was becoming depressed, but she insisted that she could soldier on. "I just attributed it to stress and exhaustion, and refused to ask for help," Betten recalls. And she knew that "the baby blues" could make you feel sad, moody, or irritable. In fact, the condition, triggered by hormone shifts, can affect as many as 50 to 80 percent of new moms.
Such confusion about what life with a new baby is supposed to be like is a major reason women don't seek help. Another problem: "The shame and embarrassment that surround postpartum mood disorders also keep moms from acknowledging the issue," adds psychiatrist Ariel Dalfen, M.D., Toronto author of When Baby Brings the Blues. "But without treatment, postpartum depression can linger and become more severe."
Postpartum depression (PPD) can strike anyone, and it has nothing to do with how strong you are or how much you love your baby. When Brooke Shields wrote about her devastating bout with the illness in her memoir, Down Came the Rain, she helped put a very public face on the issue. "Her book showed that nobody, no matter how rich, famous, or beautiful, is immune to PPD," points out Margaret Howard, Ph.D., director of the Postpartum Depression Day Hospital at Women & Infants Hospital in Providence, Rhode Island.
Even Tom Cruise's diatribe on national television against antidepressants and Shields's use of them wound up doing a lot of good by bringing the postpartum-depression discussion into America's living rooms, says Birdie Gunyon Meyer, R.N., the president of Postpartum Support International (PSI), a nonprofit organization that promotes awareness, prevention, and treatment of mental health issues related to childbirth. In speaking out, Shields joined singer Marie Osmond, who also wrote a book about suffering from PPD, and Mary Jo Codey, wife of the former governor of New Jersey, who not only opened up about her own experiences but also helped New Jersey become the first (and thus far only) state to mandate that all pregnant women be screened for and educated about postpartum depression.
Soon such help may be available nationwide. A piece of legislation known as the Melanie Blocker Stokes Mothers Act -- named for a young mother who committed suicide after suffering postpartum psychosis, an extreme form of PPD -- would help fund related research and education, provide training to medical professionals about the disorder, and increase treatment options and support services. At press time, the bill had been passed in the U.S. House of Representatives and was headed for the Senate. (To learn more and to sign a petition in support of the act, go to PSI's website, postpartum.net.)
Understanding Your Risk
New moms should expect to feel overwhelmed at times, incompetent now and then, nervous about being left on their own to take care of the baby, and to overreact and tear up over seemingly minor things. What's not normal: a darkening storm of anxiety and panic. "The big difference between baby blues and PPD is duration and intensity," Howard explains. "It is a prolonged sense of sadness lasting for two weeks or more."
There are also different degrees of PPD, notes Dr. Dalfen. Women who are not enjoying motherhood but can go through the motions of taking care of the baby and themselves may have mild PPD, but are getting by. Those who feel down all the time, have trouble connecting with their baby, and find it hard to get through every day have a stronger case of the illness. Severe PPD sufferers are extremely depressed and unable to take care of themselves or their babies. All of these women need treatment, Dr. Dalfen emphasizes.
Scientists still don't know the exact mechanics of PPD, but they do know it is the brain's complex reaction to several forces beyond a woman's control. "The hormones progesterone and estrogen drop after the baby is born," explains Dr. Dalfen. "These hormones interact with brain chemicals such as serotonin, which controls your mood." For some women, PPD symptoms begin during pregnancy. Moms with a personal or family history of depression, or a history of premenstrual syndrome, are at increased risk.
Social factors come into play, too: Women who have a conflicted relationship with the baby's father, have limited finances and health care, have limited social support (friends, a sister, a mom to help with the baby), or who give birth to multiples or a demanding, colicky infant are also at higher risk for depression.
Getting the Right Help
The first step in treating PPD is to see your health care provider or find a specialist on postpartum.net. Therapy and, in some cases, medication, as prescribed by a doctor, can be essential. Several antidepressants, including Zoloft and Paxil, are effective and safe for breastfeeding women. "The top priority is for the mom to get well so she can care for her baby," notes Dr. Dalfen.
On the home front, new moms need to take care of themselves (get more sleep, eat healthier, take breaks from babycare) and ask for the help that makes that possible. Emotional support is also crucial: A recent study in the British Medical Journal found that simply talking on the phone with other mothers who had recovered from PPD helped at-risk new moms cut their chances of developing depression nearly in half. Find a support group in your area at Postpartum.net. Or log on to our community board on babytalk.com.
When Betten's husband finally convinced her to see her doctor, an antidepressant brought quick relief from her six-month siege. "Within a week it evened out my moods and gave me a lot more patience," she says. "If the baby started screaming, I didn't freak out and start sobbing myself. I thought, 'Okay, he can cry for a minute and then I'll pick him up.'?"
Now expecting her second baby, Betten is prepared to ask for help: "Now I realize that anyone who has ever had a kid understands that you can't do it alone."
Marisa Cohen is a mom and the author of Deliver This! Make the Childbirth Choice That's Right for You.