Irritability, sleeping problems, and crawling out of your skin all might be signs that it's more than just the post-baby blues.
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The time before, during, and after pregnancy can be emotional. And if you're feeling down, anxious, confused, tearful...the-list-goes-on, you're not alone: About 14 to 23 percent of women experience depression during pregnancy and 5 to 25 percent suffer from it post-baby. Plus, 41 percent of women who've experienced PPD before will deal with it again in later pregnancies—and that's only considering women who actually seek treatment.
Some research finds postpartum depression (PPD), extreme feelings of sadness and anxiety that interfere with your ability to care for yourself or your family, affects about 900,000 women a year but only about 6 percent seek help.
A misunderstanding of what really defines postpartum depression could be at the root of the problem, says Samantha Meltzer-Brody, M.D., director of the perinatal psychiatry program at the University of North Carolina Center for Women's Mood Disorders. "What we call 'postpartum depression' is in many ways an insufficient term," she says.
The best new phrase for PPD is really perinatal mood and anxiety disorders (PMADs), explains Catherine Birndorf, M.D., a psychiatrist in obstetrics and gynecology at Weill Cornell Medicine and NewYork-Presbyterian, cofounder of The Motherhood Center of New York, and author of the forthcoming book What No One Tells You: A Guide to Your Emotions from Pregnancy to Motherhood. "It's much more inclusive of the time both before and during pregnancy and also of anxiety as well as depression." (Not pregnant but still feeling emotional? It may be one of these 19 weird things that can make you cry.)
So how do you know if you're suffering? First, think back. Women with a history of depression or anxiety suffer from PPD and other PMADs at higher rates—and about 50 percent of women who have postpartum depression had symptoms during pregnancy, says Dr. Birndorf.
This is all to say, you'll want to keep an eye out for these eight subtle cues that your mood has morphed.
Symptoms and Signs of Postpartum Depression and Anxiety
1. It's been more than a few weeks and "the blues" seem to have "gone bad." About 80 percent of mothers experience what's known as the "baby blues"—a term used to describe the feelings of worry, unhappiness, and fatigue that many women experience after having a baby. This is 100 percent normal. "Almost everyone has the blues," says Dr. Birndorf. "They are hormonally mediated after delivery because you go from this high estrogen and progesterone state, where levels are at their highest, to delivering—and losing the placenta and a ton of fluids—which leads to an abrupt shift within your body. Your hormones plummet." And that fluctuation can throw you into a state of hormonal flux—aka '"the blues," she says. You might be hypersensitive at the drop of a hat or laughing and crying at the same time, for example. (Related: Why Some Women May Be More Biologically Susceptible to Postpartum Depression)
The key difference between this and a PMAD? The blues are a passing phase. Your hormones equilibrate and women tend to feel better in a few weeks, Dr. Birndorf says. "Most people who get 'the blues' don't go on to get depression." If it's been a month and you still feel out of control, down to the point that it's negatively impacting your interest in things you used to love, or hopeless on a consistent basis? You could be struggling with a PMAD, she says.
2. You're unable to sleep when the baby sleeps. Dr. Birndorf always asks new mamas if they can relax and sleep when the baby is taken care of or sleeping. If the answer is no? You might be so wound up with anxiety that it's impacting your ability to rest, she notes. "Some people are terrible at napping, but if your baby is sleeping at night and you're lying there too anxious or worried to fall asleep, it can be a sign of PPD," adds Dr. Meltzer-Brody.
3. You feel like you can't enjoy your baby. It's normal to feel a certain degree of anxiety and worry when you bring a new baby home. "It's uncharted territory," says Dr. Meltzer-Brody. And not getting a complete kick out of middle-of-the-night feedings, a lack of sleep, and a new crying roommate? Again, totally normal. The important question to ask: How distressing are your emotions to you? If feelings of anxiety or depression *always* interfere with your ability to enjoy your baby, that's a signal that you should seek help. If feelings come and go? That's likely part of the reality of being a new mom, Dr. Birndorf notes.
4. You feel overwhelmed. "Becoming a mother is the most fundamental change anyone can go through," says Dr. Birndorf. Your life changes forever, you have someone who is completely dependent on you, and—while you're still your old self—you also become a brand new person. "There's such change and loss that has to be navigated," she says. The difference between what's normal and what's not? It becomes a matter of how well you're able to function, she says. With postpartum depression, you may feel so overwhelmed that you're not able to sleep or eat and you feel like you're struggling to make it through each day.
5. You feel like you're coming out of your skin or like you're not yourself. Can't lie down or sit still? Feel totally out of sorts? Crying uncontrollably? Don't recognize yourself? Some women describe this as feeling "activated," notes Dr. Meltzer-Brody. And it can be a sign of postpartum depression or another PMAD. (Related: 19 Women Sum Up What Postpartum Depression Means to Them In Once Sentence)
6. Obsessive thoughts race through your mind. Even women who don't suffer from a full-blown PMAD can suffer from intrusive, disturbing thoughts about harm coming to the baby, says Dr. Birndorf. "The brain and your physiology are on hypervigilant protective mode," she says. But when thoughts get stuck in your head and you're struggling to get through the day normally—you don't want to go near windows because you fear the baby getting sunburned, you had to hide all of the knives in the house because you're so worried the baby would get cut if someone cooks—your symptoms have likely crossed the line and are more likely a sign of postpartum depression or anxiety.
7. You're *seriously* irritable. Sadness and anxiety manifest in different ways. "For a lot of people, this comes out as irritability," says Dr. Meltzer-Brody. "You feel like you have a very short fuse, everything and everyone is getting on your nerves, and it doesn't take much for someone to say something that makes you feel like you're going to snap." (Related: How Changing My Diet Helped Me Cope with Anxiety)
8. You feel like you and your baby aren't bonding. Here's something that's important to remember: "You don't always fall in love with your baby right away," says Dr. Birndorf. "People have all of these expectations of what should happen, and when those things don't happen, they think something's wrong. But it's all an adjustment." That means that questioning yourself every now and then (what have I done?) and even worrying that your partner is bonding more than you are with that baby are both normal occurrences. If feelings worsen, last, or kick up in intensity or duration? Could be PPD.
If you notice any of the above signs of postpartum depression, talk to your ob-gyn or therapist for talk therapy or antidepressants (some of which can be used throughout pregnancy, too), both of which can help ease symptoms and help you feel more like yourself. Websites such as Postpartum Support International or Postpartum Progress can also provide helpful online resources.