Expectant women may be familiar with the term “baby blues,” but what are they really in for?

“Postpartum blues are very common,” says Mary Mandell, M.D., a psychiatrist with FirstHealth Behavioral Services. “‘Baby blues’ have to do with feelings of sadness, maybe tearfulness, low energy, and feeling
overwhelmed by the new responsibility. Those are feelings that all new mothers have to some degree.”

According to Pamela Kantorowski, M.D., a board certified OB/GYN specialist with Southern Pines Women’s Health Center, postpartum blues occur in the first two weeks after giving birth. If symptoms persist, worsen or appear later in the postpartum year, the woman may be suffering from postpartum depression.

Doctors believe that the combination of hormonal changes and psychosocial stressors trigger postpartum depression.

Women with PPD experience an inability to get pleasure from activities they
used to enjoy. They experience sleeplessness (even when baby is sleeping), changes in appetite and energy, difficulty concentrating or making decisions, and feelings of hopelessness or worthlessness.

“The mother who has these symptoms for more than two weeks, for the better part of every day, needs to
see a doctor,” says Dr. Mandell.

“Other signs of PPD would be a mother not wanting to spend time with her baby,” says Dr. Kantorowski,
“or not wanting to leave the house.”

“PPD catches women by surprise,” says Dr. Mandell. “They don’t expect to feel this sadness. It’s supposed to be a happy time.”

A PPD story
Often, women feel so guilty for having such symptoms that they fail to seek treatment. Angela Thomas knows all of this first hand.

“Looking back now, I can see that my postpartum depression began in the hospital, two days after my C-section,” Thomas says. At the time, Thomas’s mother reassured her that it was normal to be nervous when visitors held her newborn. “It got to the point that I was almost in a panic,” Thomas recalls. “I couldn’t stand all these people breathing germs on her, and I would break down crying.”

Back home in Lillington, surrounded by friends and family, Thomas found that she still didn’t want people around the baby. She began to feel nauseous whenever the baby cried. She had no appetite and went for days without eating. Most disturbingly, she found herself not wanting to be around the baby.

“I was afraid that I would infect her,” she says.

Finally, Thomas went to see her family doctor. Recognizing a case of postpartum depression, the physician called Thomas’s mother in to explain the situation. “My mom was wonderful,” Thomas says. “It turns out she had experienced similar symptoms, to a lesser degree, when my brother was born.”
Thomas left the doctor’s office feeling hopeful for the first time in months. That was on a Friday. Forty-eight hours later, though, she found herself on the brink of suicide.

“I felt like I needed to be out of my child’s life,” she says.

Advised to head to the Emergency Department at FirstHealth Moore Regional Hospital, Thomas was taken straight back to see a Behavioral Services doctor. He explained that she was having a severe panic attack and that depression was causing her physical symptoms.

“I was asked if I wanted to harm my child,” Thomas recalls. “I was asked about weapons and poisons and access to vehicles.”

Thomas underwent intensive outpatient therapy, and her family agreed that she was not to be left by herself or alone with the baby. Now Thomas feels that the outpatient program may have saved her life. She attended three group therapy sessions on a daily basis, and one weekly individual session where she was prescribed an anti-depressant.

After two weeks, she began to feel more like herself.

“PPD is treated very effectively with a combination of psychotherapy and anti-depressants,” says Dr. Mandell, who notes that the drugs are safe for nursing mothers. “And group therapy helps in so many ways.”

“Once I reached out, people were very supportive,” says Thomas who encourages new moms not to put so much pressure on themselves to be perfect. “Let friends and family help you.”

Once a taboo topic
Health care providers are more aware of PPD today, but it once was a topic that was barely mentioned.
Dr. Mandell recently gave a talk at Sandhills Pediatrics, where new mothers are routinely given a questionnaire that screens them for symptoms of PPD.

“You might have a mother who looks like she’s holding up really well,” Dr. Mandell says, “but when you ask about specific symptoms, you find that she is depressed and needs treatment.”

How can Dad help? “Be really kind and supportive,” Dr. Mandell says. “Insist that the woman be evaluated by a professional.”

In extremely rare cases, women develop postpartum psychosis, a condition that is characterized by paranoid delusions and hallucinations.

Women who have already had an episode of depression are at an increased risk for PPD, as are women who have gone through particularly stressful or high-risk pregnancies.

“Our labor and delivery nurses look for patients with specific risk factors,” says Dr. Kantorowski, “and we note in the chart to discuss the pre-emptive use of antidepressants during the last few weeks of pregnancy.”

Moderate exercise may help avoid postpartum depression by boosting serotonin levels, but there is no foolproof way to avoid PPD.

“It doesn’t matter who you are,” says Dr. Kantorowski. “It can happen to anyone; your hormones are your hormones. The biggest thing is not to be afraid to talk about it. It doesn’t mean you’re a bad mother; you’ve got a chemical imbalance in your brain. And we want to take care of you.”