Postpartum (Peripartum) Depression

A Common but Treatable Condition

Sarah opened a baby shower card from one of her dearest friends. Below a sweet congratulatory message, she noticed a handwritten “P.S.” at the bottom of the card, which said “Hey, so postpartum depression is a real thing. Let me know when you’re ready for me to tell you about it so you’ll know what to watch for, just in case. I waited too long to get help and could have felt a lot better a lot sooner.” Sarah smiled at her friend, who was happily playing with her 2-year-old son, and made a mental note to have that chat with her before the baby came.

What happened to Sarah’s friend is actually very common.

According to a recent study, 1 in 7 women will experience Postpartum (now known as Peripartum) Depression (PPD), in the year after giving birth or during pregnancy.

Of those, approximately 50% will go undiagnosed and move through the daily struggles of PPD symptoms without treatment. But help is here for you, close to home.

Nicole Shirvani, MD

Psychiatrist

“I hope that we can work together to increase awareness and recognition of peripartum depression, to remove the fear or shame some women might have in seeking help, and to increase access to resources for support and treatment of peripartum depression.”

At Lakeland Regional Health, we are dedicated to building awareness about mental health and providing education for our patients, so they feel confident, heard, and cared for each day. During Mental Health Awareness Month in May, we wanted to share information about various mental health challenges and various treatment options. In this blog, we sat down with Dr. Nicole Shirvani to learn about PPD, the signs, and the treatment options.

About Dr. Shirvani

Nicole Shirvani, MD is a psychiatrist at Lakeland Regional Health, specializing in the treatment of mood disorders including PPD. During her psychiatry residency training at the Cleveland Clinic, she had the opportunity to work with amazing mentors and leaders in the field of women’s health. There, she developed a passion for this area of medicine, including the treatment of mood disorders during pregnancy and the postpartum period. She works with patients at the new Harrell Family Center for Behavioral Wellness.

How is depression different for women than for men?

Women’s Mental Health is a branch of psychiatry that recognizes how certain mental illnesses are unique to women or how they may impact women differently.

For example, the occurrence of depression is much higher in women compared to men. Additionally, pregnancy and the postpartum period are unique experiences to women because they create not only biological changes, but often social adjustments and financial concerns that may also play a role during this time in a woman’s life.

Treating mood disorders during pregnancy and postpartum not only promotes the health of mothers during this vulnerable time, but also impacts the health of their children. Babies whose mothers have untreated depression during their time in utero are at a higher risk of preterm birth. The implications could even last for years to come, as these children are more likely to have feeding difficulties and mood disorders later in life.

What is Postpartum (or Peripartum) Depression (PPD)?

Postpartum (or Peripartum) depression is depression that happens after having a baby or during pregnancy. Individuals with PPD may feel sad, anxious, or disconnected from their baby. Postpartum depression is now referred to as Peripartum Depression, as experts now recognize that symptoms can first appear during pregnancy, not just following delivery.

PPD lasts longer and is more intense than the “baby blues,” which is a shorter, less intense condition, and doesn’t require medical treatment.

Can you describe common symptoms of PPD?

Some of the main distinction between the baby blues and PPD is duration (in PPD symptoms may persist for two weeks or more) and often impaired functioning (with PPD). Many women experience several or all of these symptoms, but some may only experience one or two.

Feeling sad or depressed
Loss of pleasure in activities
Changes in appetite
Inability to sit still, and pacing or moving slowly
Difficulty concentrating or making decisions
Feeling badly about yourself (e.g. “I’m not a good mother”)
Trouble sleeping, sleeping too much, or not being able to sleep (i.e. Not being able to sleep even when given the opportunity to rest)
Crying without a known reason
Low energy and fatigue
Thoughts of suicide and/or feeling like you would be better off dead or your baby would be better off without you
Feeling disconnected from the baby, not having interest in the baby, or not feeling a bond with the baby

These symptoms can fluctuate in severity and can cause difficulties with daily function. Many women wish they did not feel this way, especially when the arrival of a baby is often viewed as a very exciting and happy time. Because of these symptoms, women may experience a lot of guilt or be ashamed to admit how they are feeling. However, women should know they are not alone. PPD is very common and when the condition is properly diagnosed, there are a variety of effective treatment options.

How long can PPD affect someone after childbirth?

Every woman and family experiencing the effects of PPD is different, and the timeline of the onset and duration of symptoms may vary.

However, the prevalence of PPD is estimated to be as high as 19.2% of women during the first three postpartum months or 20% of women during the first year postpartum. PPD is different from “baby blues” as mentioned before, but may present with similar symptoms. Baby blues impacts approximately 70–85% of women, but unlike PPD, having the baby blues does not usually impair functioning and is often limited to a 2-week period, whereas PPD, left untreated, can last much longer.

What types of treatment exist for PPD?

Our psychiatrists and behavioral health team are dedicated to ensuring the health and wellness of our patients, especially during such a vulnerable time. Treatment for PPD is not a one-size fits all, but is often guided by illness severity, prior treatment responses, and patient choice.

The most recent guidelines recommend that initial treatment of mild depression during pregnancy is psychotherapy, which entails treatments such as one-on-one therapy and group therapy, which aim to help identify and change depressive emotions, thoughts, and behaviors.

Peer support groups and mother-to-mother groups have also shown positive results in treating mild to moderate depression. In these groups, women who have experienced postpartum depression provide direct support to each other. Several studies have also shown perinatal yoga to be effective in treating peripartum depression.

Certain antidepressants can also be used to treat peripartum depression, either alone or in combination with psychotherapy. Women who are already taking antidepressants prior to pregnancy may, in consultation with their treatment team, choose to continue the medication during their pregnancy and postpartum time including those nursing. For women who wish to discontinue antidepressants prior to or during pregnancy, it may be beneficial to start psychotherapy prior to discontinuing their antidepressant.

What would you say to a woman who is wondering whether to seek help for PPD?

We are here to support you!

We encourage you to reach out so we can help you determine the next best steps. As a psychiatrist, my job is to support and find the best treatment options for your specific needs. Our team understands that each stage of life can bring on new challenges and we have resources and treatment options that can help you through each. I wish you a happy, healthy, and reflective Mental Health Awareness Month this May.

Harrell Family Center for Behavioral Wellness

A place of hope, connection, recovery, and support-close to home. At Lakeland Regional Health, we know that not every need a person has is physical, and we understand the powerful connection of mind and body. If you are facing mental health challenges, we are here to care for you. Our incredible behavioral wellness team at Lakeland Regional Health will partner with you through each step.

Learn more →

References

Diagnostic and Statistical Manual of Mental Disorders, 5th ed.: DSM-5. Arlington, VA: American Psychiatric Publishing, 2013.
Gavin NI, Gaynes BN, Lohr LN, et al. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 2005;106:1071–1083.
Gaynes BN, Gavin N, Meltzer-Brody S, et al. Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ) 2005;(119):1–8.
Field T. Postpartum depression effects on early interactions, parenting, and safety practices: a review. Infant Behav Dev 2010;33:1–6.
Shirvani N & Gonsalves L (2019). Women’s Health. In M Lavakumar, L.J. Rosenthal, & T. Rabinowitz (Eds.), Fundamentals of Consultation Liaison Psychiatry: Principles and Practice (1st ed., pp. 485-515. Hauppauge, NY: Nova Science Publishers.
Vigod SN, Wilson CA, Howard LM. Depression in pregnancy.BMJ 2016;24:352.

If you or a loved one are experiencing a mental health crisis, there are resources to help.

In the event of a life-threatening emergency, always call 911.

To reach National Suicide Prevention Lifeline call 1-800-273-8255.

To reach the National Maternal Mental Health Hotline call or text 1-833-943-5746 (1-833-9-HELP4MOMS) for free, confidential, 24/7 mental health support for moms and their families before, during, and after pregnancy. English- and Spanish-speaking counselors are available.