RHITU CHATTERJEE, HOST:
This is NPR's LIFE KIT. I'm Rhitu Chatterjee, a health correspondent with NPR. If you're pregnant or you've just given birth, it's supposed to be one of the happiest times in your life, especially now with all the Instagram and Facebook photos of happy moms posing with their happy babies. But for many women, that's not how it goes.
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JENNIFER PAYNE: There was this myth that women couldn't possibly be depressed during pregnancy, that it's such a happy time.
CHATTERJEE: That's Dr. Jennifer Payne. She's a psychiatrist and directs the Women's Mood Disorder Center at Johns Hopkins University in Baltimore.
PAYNE: And the reality is a lot of women struggle with depression and anxiety during pregnancy as well as during the postpartum time period.
CHATTERJEE: About 1 in 7 women experience this. And yet, we don't talk about it much. For 36-year-old Meghan Reddick, it kicked in shortly after she gave birth to her son last May.
MEGHAN REDDICK: I would force myself to see people and smile and say, yeah, you know, everything's great. And then the second I had a chance where I wasn't holding him, I could go to my room and cry. And I probably couldn't count how many hours a day I cried. Sorry (laughter), this is harder to do than you think it is.
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CHATTERJEE: This is NPR's LIFE KIT. We're talking about anxiety and depression during pregnancy and postpartum. I cover mental health for NPR. And over the past year, I've been doing a lot of reporting on this topic. In this episode, we'll tell you how to identify symptoms, find treatment and give you useful tips on how to manage your mood and well-being during this time. And this isn't just for pregnant women and new moms. It's for spouses, parents, siblings, close friends as well because chances are you will be the first person to realize that your spouse or daughter or friend is struggling, and you can help her find treatment.
We heard from over 300 women who wrote to us about their experience with anxiety and depression during pregnancy and postpartum. Many of them said it took them a while to realize they were depressed, and most of them felt ashamed and blamed themselves for it. Here's Meghan Reddick.
REDDICK: I felt guilty about how I felt, so I absolutely tried to hide it from everybody. And I would put on the best appearance I could.
CHATTERJEE: That's why most women don't seek help, says Dr. Jennifer Payne.
PAYNE: It is hard to become a new mother. But then if a woman's depressed on top of that, she's going to have negative feelings about herself as part of the depression. And it becomes an even bigger thing.
CHATTERJEE: But she stresses that depression isn't the mother's fault or her failing. It's a complication of pregnancy and childbirth.
PAYNE: Postpartum depression is actually the most common complication of childbirth.
CHATTERJEE: That's our first takeaway - depression and anxiety can be complications of pregnancy and childbirth, just like gestational diabetes and hypertension. They're mental illnesses, just like anxiety and depression at any other point of time. As for what causes it, Jennifer Payne says, researchers don't fully understand it. But most mental illnesses, she says, are caused by a combination of biological factors and life circumstances. In this case, she says hormones likely play a big role.
PAYNE: So we think in the postpartum time period that what happens is estrogen and progesterone levels, which have been increasing throughout pregnancy, precipitously drop. And so there's, basically, a massive hormonal withdrawal from the brain.
CHATTERJEE: And if someone has had anxiety or depression before they became pregnant, they're at greater risk now. What makes women more vulnerable at this stage is that major life transitions are big triggers for mental illnesses, like pregnancy and having a child.
PAYNE: It's a wonderful life change for many people, but that doesn't mean it's not stressful. You have to think about finances. You have to think about caring for an infant.
CHATTERJEE: All of these factors come together to create a perfect storm. And the reason it's really important to address this, says Payne, is that if left untreated, it has long-term consequences on the baby's health and development.
PAYNE: So babies whose moms were severely depressed in the postpartum time period have lower IQs, slower language development and more behavior problems probably because they're not getting that normal interaction that moms generally give their infants in the postpartum time period.
CHATTERJEE: And there are health risks for the mom, too. Some women end up feeling suicidal, and some even die by suicide in the first year postpartum. Others, like Meghan Reddick, who wrote to us, said they seriously thought about leaving their baby and spouse.
REDDICK: I thought that I wasn't good enough for them and that if I were just to leave, that my husband could find a better wife and my son could find a better mother, that he'd be able to find somebody to replace me who would be more adequate.
CHATTERJEE: Payne says it is important to get the mother into treatment as soon as possible because...
PAYNE: I always say if mom's not happy, no one's happy.
CHATTERJEE: Now, we're telling you this not to scare you. The good news here is that this is treatable. And with the right treatment, women recover and do well. But in order to get treatment, you first need to know if you're depressed. That's our takeaway No. 2 - know what symptoms to look for. And we're going to break them down for you.
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PAYNE: What I tend to look for are women who are, you know, barely getting themselves together and taking care of the baby.
CHATTERJEE: Dr. Payne says if you're struggling to do daily activities every day for two weeks or more, that's an indication you need help. Many women who wrote to us about their experience with postpartum depression said they felt detached from their baby, including Reddick.
REDDICK: I was afraid that I would never love him. I thought that this is the bond between a mother and child is the - it's the love that is so, you know, infallible. And I was afraid that I would never feel that because I didn't feel it in the beginning.
CHATTERJEE: And there's a whole range of other symptoms. Here's Dr. Payne again.
PAYNE: Many women when they're depressed have low mood, can't get out of bed, have trouble concentrating, trouble eating properly, don't sleep well, etc.
CHATTERJEE: Anger can also be a symptom.
PAYNE: Many women will get angry that the baby's waking them up again or will not settle down, and that can be a really overwhelming feeling. And then, of course, it's a vicious cycle because then the woman feels guilty, thinks she's a bad mother. And it just goes and goes in circles.
CHATTERJEE: She says many women also become really anxious.
PAYNE: Anxiety disorders are very common in pregnancy as well, and those can look like generalized anxiety or having panic attacks.
REDDICK: Or the anxiety is disguised as parenting worries - only for some women, the worries play on repeat in their head like they did for Angelina Spicer, one of the moms who wrote to us. Spicer is a comedian, and she's on a mission to normalize postpartum depression after what she went through.
ANGELINA SPICER: The thoughts for me were like, is she going to stop breathing? Is the dog going to come and eat us up? You know, it was just really random but vivid and recurring. And the intrusive thoughts would haunt me at night, mostly during, like, the 3 a.m. feed or the 5 a.m. feed when I was alone in a dark room with just my daughter and I.
CHATTERJEE: Now, if you're a spouse or a friend or family member and you're not with the pregnant woman or new mom for extended periods of time, you may not see all these symptoms. So how do you tell if mom is depressed?
PAYNE: When people are depressed, they look very different. Their eyes look different. They look sad and detached. If they smile, it doesn't go up to their eyes. Many people will become kind of slower in their thinking and their speaking process.
CHATTERJEE: So if you or someone you love has any of these symptoms, it's important to find help. That's our takeaway No. 3 - ask for help. Payne says the best place to start is with the doctor.
PAYNE: Women see two main doctors in the postpartum time period. One is their OB and the other is the pediatrician. And pediatricians are actually starting to screen as well because they recognize that, you know, mom being healthy is an important part of the child being healthy.
CHATTERJEE: You mean screen the mother for depression?
CHATTERJEE: But many people are not used to talking to a doctor about their mental health. So how do you start that conversation?
PAYNE: I think talking straight is probably the No. 1 tip I have. You know, I'm feeling depressed. I can't sleep when the baby is sleeping. I'm not getting enough to eat, and I've lost more weight than I expected. But just being very concrete and clear with the doctor that there is a problem.
CHATTERJEE: Your doctor can prescribe you an antidepressant, which has been shown to be safe and effective during pregnancy and when you're breastfeeding. And research shows that talk therapy is also very helpful. Your doctor can refer you to a therapist or counselor. Now, remember. Treatment will look different for everybody.
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CHATTERJEE: But even before you make that appointment with a doctor, many women face another hurdle - getting their family to understand what they're going through - you know, that myth about pregnancy and childbirth being a happy time. And there's still a lot of stigma around mental illness in general.
LEENA MITTAL: I hear that over and over again when I hear women disclose, in more personal ways, their stories but also when I am working with women clinically.
CHATTERJEE: Dr. Leena Mittal is a psychiatrist with Brigham and Women's Hospital in Boston.
MITTAL: I hear that it can be really difficult to engage in conversations about mental health or that we don't believe in that kind of thing in my family, or in my part of the neighborhood, that - we don't talk about those things. You know, so...
CHATTERJEE: She says this is especially common in many communities of color. Angelina Spicer, who's African American, says she just couldn't get her family to understand what she was going through.
SPICER: When I had my daughter and I would tell my family members that, you know, I was feeling disconnected, I was feeling scared and afraid and anxious, they all dismissed it. They all were like, oh, it'll be fine. You'll get over it. Or, why do you keep saying you're depressed? Why do you keep saying you're sad? You have this beautiful family.
CHATTERJEE: Spicer says another thing she heard from her family members was...
SPICER: Pray it away. Jesus is going to take it.
CHATTERJEE: If you've run into a similar situation, Dr. Mittal suggests starting a family conversation on common grounds.
MITTAL: Often, families and the person who's struggling with symptoms - they have similar goals. You know, the goal is to have a well mom, a well baby, to have the mom be able to be engaged with baby and in the care of the baby.
CHATTERJEE: She advises women to help their family understand that depression is a common medical problem. And she says consider taking a family member with you to your doctor's appointment.
MITTAL: And then that way, some of the myths can be dispelled, too, so we can talk about what treatment is and isn't and what the preconceived notions about perinatal emotional complications may look like.
CHATTERJEE: For Angelina Spicer, things got really bad before they got better. She tried to pray it away. She waited for the anxiety and sadness to lift. But eventually, she ended up in an inpatient psychiatric facility.
SPICER: I was like, oh, I can go somewhere and heal and feel better. I felt completely relieved. I was so elated to know that I didn't have to just suffer and that I wasn't the only one.
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CHATTERJEE: She was in treatment for 10 days before she could return home.
SPICER: And I just remember my daughter just reaching up and, like, grabbing me and kicking her feet and just being so happy to see me. The fog was still there. The cloud was there, but I could see it moving.
CHATTERJEE: Now, we should note that research suggests that being a woman of color makes it harder to access care for postpartum depression. Mittal points out that ideally, the health care system should be talking to and engaging women of color about these mental health issues. And she and some other providers are working on it, but since that might take a while to happen at a national scale, she suggests that women take the lead and start talking to their OBs about depression during their prenatal appointments.
MITTAL: It's really helpful to have the conversation, to say, like, what are my risk factors for depression? Should I be engaging in treatment or in supportive counselling or therapy ahead of time to prevent depression or not? Can you help me engage in those services?
CHATTERJEE: As for Megan Reddick, she resisted the idea of talking to her doctor for a long time. But her husband kept nagging her about it, so she finally brought it up during an appointment and filled out a questionnaire used to screen for depression.
REDDICK: That was the easiest for me. It was kind of just to pass a note to her, saying, I'm not OK. Please help me.
CHATTERJEE: And her OB did help her. She prescribed her an antidepressant.
REDDICK: She also encouraged me to sleep. One thing I had been doing because of my low breast milk supply - I had been trying to pump pretty much every three hours around the clock, producing very, very little.
CHATTERJEE: Her doctor said breast milk is important but not if it was keeping her from sleeping and being present in her baby's life.
REDDICK: Because it was the effect that it was having on me. She said, it is more important for you to sleep and to be able to spend time with your child and to not feel guilty about taking medication.
CHATTERJEE: We should point out that Reddick was lucky that her OB knew how to help her. We heard from listeners who said that they went to their doctor. Some even got the depression screening, but that was the end of it. The doctor did not help them find treatment. So if you run into a dead end at your doctor's office, what do you do? Where do you go for help? That's our fourth takeaway - an alternative place to look for help.
PAYNE: So there is a wonderful organization called Postpartum Support International.
CHATTERJEE: Postpartum Support International, or PSI, is a nonprofit that helps individuals and families find support for postpartum depression.
ANN SMITH: A family, a mom, a grandmother, a dad, a friend can call and say, I'm worried about myself, I'm worried about my wife, what have you.
CHATTERJEE: That's Ann Smith. She's a nurse midwife and the president of the board of the organization.
SMITH: We will talk to them and give them support and help them to understand that there is treatment and they can get well.
CHATTERJEE: PSI's website, postpartum.net, has a directory of local providers who have experience in treating postpartum depression. Smith says the organization will discuss your options based on your insurance, and they can also connect you with local support groups for moms, which also helps in recovery. She says you can call the organization's help line.
SMITH: That number is 1-800-944-4-PPD, which is 4773.
CHATTERJEE: Or, she says, you can text them at 503-894-9453, and a trained volunteer will get back to you within 24 hours. Smith herself recently helped a grandmother find treatment for her daughter, who developed severe anxiety after she gave birth.
SMITH: That's what this young woman had. It was tremendous anxiety and probably some obsessive-compulsive disorder.
CHATTERJEE: And she was resisting getting help, so Smith spoke to the grandmother, gave her a list of local providers. This time, she says, the grandmother used an effective tactic while talking to her daughter.
SMITH: She got resources from me, and then she kind of slipped them to her daughter without saying, you need to do this. She would say, you know, I found out about something called The Motherhood Center. And at the end, when the daughter finally ended up going to The Motherhood Center, I feel that she felt that it was her choice.
CHATTERJEE: Smith says the volunteers at PSI stay in touch with the family until they're sure the mother is in treatment.
SMITH: Without it, people fall through the cracks all the time.
CHATTERJEE: In the meantime, psychiatrist Jennifer Payne says there are some things you can start to do on your own that should improve your symptoms.
PAYNE: First and foremost, women need to be taking care of themselves.
CHATTERJEE: That's our fifth takeaway. Build self-care into your daily routine. Now, before you roll your eyes at the term self-care, let us explain. We're really talking about the basics here - eating well, resting, exercising. And it may sound too simplistic, but Payne says there's evidence that they can make a big difference in improving mental health because they help reduce your stress levels and help you cope better during this stressful time because let's face it. Taking care of a newborn is a lot of work. Payne says don't neglect your diet, and make sure you hydrate.
PAYNE: I've had a number of women who weren't eating because they were breastfeeding all the time or changing the baby. And so I had their spouses set up eating stations for them so that when they're breastfeeding, they can eat a granola bar, for example, and have water available.
CHATTERJEE: Then she says make sure you get a break every day.
PAYNE: I think getting a break from the baby regularly is key for women with depression and women without depression. And so arranging family support for that or social support for that is really important.
CHATTERJEE: Get your spouse or relative to keep an eye on the baby, or if you can afford it, hire a babysitter. And use the time to catch up on sleep because sleep, Payne says, has to be a priority.
PAYNE: Sleep when the baby's sleeping. So baby's taking a nap; that's not the time to do laundry. That's the time to sleep.
CHATTERJEE: She says consider sleeping in a separate room so you aren't waking up every time your baby cries.
PAYNE: New moms are wired to hear the baby cry. I have couples who, you know, every other night, the mom sleeps downstairs, and dad takes a turn in giving the baby food in the middle of the night.
CHATTERJEE: Studies also show that exercise can reduce symptoms of depression and anxiety. Now, that doesn't mean you sign up for a new gym membership or an intense yoga class. Payne says, think simple exercises that you can easily fold into your daily life.
PAYNE: And that can be going for a walk with the baby around the block.
CHATTERJEE: Another thing that can really help, she says, is finding community.
PAYNE: There are also lots of support groups for new moms. I cannot tell you how many mothers I've seen that think they're the only person who's gone through this, and it's just so not the case. And so meeting other moms going through something similar can be really rallying for people who are down on themselves.
CHATTERJEE: So remember, you're not alone. Postpartum anxiety and depression can be overwhelming. No matter what your path looks like, there's treatment out there, and you can recover.
SPICER: What worked for me was child care, Spanx and Zoloft, in that order, OK? (laughter)
CHATTERJEE: That's Angelina Spicer again.
SPICER: Child care was a huge relief for me because I had time to myself every day. And Zoloft - it really did help. It lifted the fog. It lifted my own confidence. And then the Spanx - I mean, come on. The - you know, your uterus after you have a baby just will not let you be great.
CHATTERJEE: For Meghan Reddick, the medication, the sleep, the social support - all of that worked wonders. And the disconnection she felt with her son is long gone.
REDDICK: He smiles at me, and I melt. Now I'm worried I'm going to love him too much and spoil him. But watching him grow and watching him learn the world around him is just such a gift. And to think that I thought - there was a time where I thought that I would not want to be there. It's so hard to even think about that. It seems - it was seven months ago, and it seems, like, just unthinkable.
CHATTERJEE: I know this might sound like a lot, but now you have the tools. Let's summarize the key takeaways. And remember, you can always find these in detail on our website.
Takeaway No. 1 - depression is one of the most common complications of pregnancy and childbirth. It's an illness, not a weakness.
Takeaway No. 2 - know the symptoms. They can range from feeling sad and weepy to feeling anxious and worried all the time or irritable and angry. Symptoms last for two weeks or more.
Takeaway No. 3 - treatment is available, so ask for help. Start with your OBGYN, pediatrician or your primary care doctor. They should be able to screen you for depression, prescribe medication and give you a referral for talk therapy if you need it.
Takeaway No. 4 - an alternative place to find help. Reach out to Postpartum Support International through their website or their help line. Their number is 1-800-944-4773, or you can text them at 503-894-9453.
Takeaway No. 5 - self-care is key. Basic things like getting enough sleep, eating well, getting exercise and having a community can help you recover but also prevent depression and anxiety. And Jennifer Payne says, let go of that myth of perfection during pregnancy and childbirth.
PAYNE: We need to get over this idea that everything's going to be perfect, that you're going to have a birth plan that is going to go to, you know, exactly how you want it to go. It doesn't happen that way.
CHATTERJEE: And that's OK, she says, because accepting that would reduce your stress levels and make it less likely that you'll struggle with depression at this important and exciting time in your life.
For more of NPR's LIFE KIT, check out our other episodes. We have an episode about how to start therapy, one on how to talk to kids about scary things in the news and a lot more. You can find those at npr.org/lifekit. And if you love LIFE KIT and want more, subscribe to our newsletter. And here, as always, a completely random tip - this time from Nathyn Bourque.
NATHYN BOURQUE: My life hack for you guys is if you put your phone out of reach when you go to bed and you wake up in the morning - well, when your alarm goes off, you're going to have to get up to go turn it off, and it makes it easier so you don't have to press snooze. So you won't be falling back asleep, and you're going to get your day started right OK.
CHATTERJEE: If you've got a good tip, leave us a voicemail at 202-216-9823, or email us at email@example.com.
This episode was produced by Andee Tagle. Meghan Keane is the managing producer. Beth Donovan is the senior editor. Our digital editor is Beck Harlan, and our editorial assistant is Clare Schneider. I'm Rhitu Chatterjee. Thanks for listening.
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