-You will “glow” and feel better when pregnant, so you are not susceptible to mental illness.
-Being with your baby will be such a special period of your life, you will be happy all the time.
-You can “do it all” and be back to normal in a few short weeks.

So go the myths of motherhood. It is true that this is a wonderful time in the life of your family. You felt ready to become a mother, and many of you tried diligently to get pregnant. The first year of your baby’s life is exciting, filled with tender moments and an unfathomable intensity of love for your child. So, why do you feel overwhelmed, irritable and sad sometimes?

The reality is that 20% of mothers will suffer from depression or anxiety while pregnant, and 15% of them will develop postpartum depression (Bennett, 2004). This is beyond the “baby blues” that the majority of women experience postpartum. At the moment of birth, hormone levels drop by a thousand-fold, creating moodiness, poor focus and concentration, insecurity, and emotional reactivity. Those feelings peak 3-5 days after delivery, but should resolve by themselves within 3 weeks (Miller, 1999). But for 1 in 7 women, symptoms worsen into a perinatal mood and anxiety disorder (a new term replacing the narrow definition of postpartum depression).

It all makes sense when you consider the multitude of changes you face as a new mother. Muddled by sleep deprivation, you negotiate new roles and responsibilities while fighting off fears and insecurities about parenting abilities. With the focus on your baby over yourself, you grapple with losses: of freedom, of control, of your old identity, even of your body image. If you add in birth or breastfeeding complications, marital stress, a return to work or unresolved childhood issues, you could have the perfect storm for a perinatal mood and anxiety disorder (PMAD).

If you polled a group of PMAD survivors, most would lament “how come nobody warned me that this could happen?” Maybe stigmas about mental illness or those myths of motherhood get in the way. Too many women suffer in silence because of shame that they do not fit the social, cultural or their own expectations of perfection. Some call it the “superwoman syndrome.” You know, the image of the mother with 6 arms successfully negotiating that elusive work/family/life balance. Other women let their depression go on too long thinking it will get better if they take some vitamins or “just get a little more sleep.” Additionally, family members and providers often miss the signs because a PMAD does not look like a typical depression. A mother is physiologically driven to protect and care for her baby’s survival. She cannot be curled up in a ball, weepy and unmotivated. A mother HAS to be functional. What she may feel instead is irritable, overwhelmed, alone and not like herself.

The way to discern baby blues from a PMAD is by looking at severity, timing and duration. You should seek help if your symptoms feel severe, if they began postpartum and you have struggled with them for more than 4 weeks. Here is a list of symptoms to watch for:

Postpartum Depression:
Sadness/persistent gloom
Sleep disturbances (early morning awakening)
Guilt and shame
Low energy (that rest does not restore)
Poor concentration/focus
Impaired functioning and physical slowing
Hopelessness and helplessness
Appetite changes
Irritability and anger
Feeling overwhelmed/like you can’t cope
Unexplained physical complaints
Loss of interest, joy or pleasure
Isolation, feeling alone or different
Suicidal thoughts

Postpartum Anxiety:
Excessive concern about baby’s/own health
Feeling on high alert
Appetite changes
Sleep disturbances
Constant worry
Racing thoughts
Shortness of breath
Heart palpitations

Other Symptoms Requiring Intervention:
Manic episodes
Panic disorder
Obsession and compulsions
Post-traumatic stress reaction

If you identify with symptoms of postpartum depression or anxiety, seek help. You deserve being the focus of care and attention. Do it for yourself AND your family. Because if a mother is not well, her family is not well.

Gina Borelli Moore, MA, MFT