What to do when the baby blues become overwhelming
Here’s the first thing to know about postpartum depression: You are not alone.
And the second: There is help available if you tell someone.
“We see postpartum depression a lot, and unfortunately it’s more common than we see because a lot of women just aren’t honest about it for various reasons when they come in for their postpartum visit,” said Joshua Lupton, DO, an obstetrician and gynecologist with Cape Cod Hospital. “Sometimes it’s because [the doctor] doesn’t have a relationship or rapport with the patient. But we know for a fact that women aren’t always honest in talking with us.”
Many women have what is sometimes called the “baby blues” in the immediate period after giving birth. Their hormones are going nuts. They are sleep deprived. Their relationships are changing or troubled. Their bodies feel out of control. There’s financial strain. Their support system is thin. But postpartum depression is more than a passing case of the blues. It affects not only a mother’s ability to return to normal function but her relationship with her infant, according to the National Institutes of Health.
“When women have that postpartum depression, they feel like they’re to blame,” Dr. Lupton said. “I think it’s important to tell them, you’re not alone, you’re not to blame, and there are people who want to help you.”
In the worst cases, postpartum depression morphs into postpartum psychosis, a rare mental health condition that is suspected in the recent case of a Duxbury mother who strangled her three children in January. While one in five women suffer some kind of postpartum mood or anxiety disorder (PMAD), and one in seven develop postpartum depression, only about 1 in 500 develop psychosis, Dr. Lupton said.
Death by suicide is a leading cause of maternal mortality and accounts for about 20 percent of postpartum deaths, according to a 2022 study by University of Washington researchers. Researchers recommended universal screening for perinatal depression and substance use disorder and integrating mental health treatment into primary and prenatal care.
Dr. Lupton recently answered questions about PMAD, including risk factors and treatments. Below is also a list of local resources if you or someone you know needs help. (Dr. Lupton’s answers have been edited for length.)
Who is most at risk for postpartum depression?
The biggest risk factors we see are a history of anxiety and depression, lack of social support, unintended pregnancy, a history of domestic violence, lower income, lower education, being a single parent, a traumatic birth experience, breastfeeding problems, being the mother of a baby that has to be admitted to the hospital for a prolonged period of time. I tell women that it doesn't matter how many babies you've had, every pregnancy, every postpartum period, is different.
We are incredibly good at hiding depression. And social media only amplifies that. On social media, women who have postpartum depression are still posting all of their pictures of how happy everybody is, and everyone's smiling. And obviously, that's not the case. And so, I think it's very important for everyone to understand that one in five women have a perinatal mood or anxiety disorder, and, if you know someone who's just had a baby, there's a one in seven chance that they're going to have postpartum depression.
What are some other contributing factors?
It's just a very complicated time period. In a lot of cultures, it's very common for the whole community, for family and friends to spend several weeks or a month with the woman and the baby helping with household tasks and food and cooking and different things. And in western culture, and certainly in the United States, you have this baby and then the next several weeks are just devoid of any sort of formal or informal support. And, I think what kind of makes depression and the perinatal time different is there's a lot more shame and blame that women feel.
How do you screen for postpartum depression?
Most OB/GYN offices use a validated screening tool. The most common is the Edinburgh Postnatal Depression Scale, which asks women to score questions such as have you been “sad or worried for no good reason” on a scale of 1 to 4. So that's what we use in our office for many of our patients who have risk factors. We screen them prenatally, and we screen everybody postnatally or postpartum. Women tend to be a little bit more honest on that because it's easier to take a piece of paper and you're not being judged.
Based on that score, it directs us how to have a conversation. That's really valuable because if we didn't have that tool, research is very clear that women just don't open up. They don't want to be judged. They feel ashamed. They feel like they're blaming themselves.
One drug approved by the U.S. Food and Drug Administration to specifically treat postpartum depression – Zulresso – is expensive and requires a 60-hour infusion. A new oral medication – Zuranolone – is awaiting FDA approval. What’s the current standard of treatment?
We talk about healthy diet, exercise, healthy sleep hygiene, knowing what support systems are out there. And then medication is just one tool that we offer women if they feel like it may be helpful. Some women are already on medication. Some women were on medication and stopped it because they didn't want to be on it during pregnancy. And so sometimes we just restart it for them.
The SSRIs – selective serotonin reuptake inhibitors – are the most commonly used medications for anxiety and depression, postpartum or not, and are considered safe for breastfeeding.
Where to find support
If you or someone you love is in crisis, call 911 for local emergency services or 988 to speak to someone on the national suicide hotline.
Sponsored by Duffy Health Center, the group meets the second Tuesday of the month from 11:30 a.m. to 12:30 p.m. in the Lorusso Conference Room at Cape Cod Hospital in Hyannis. Register for the group at the Cape Cod Healthcare website.
The task force offers a peer support group for women in Falmouth and is looking to expand to Brewster and the Outer Cape. It also offers nine hours of free in-home doula support for parents of children up to one year old. Executive Director Kerry McCarthy says she hopes to expand the program for Spanish- and Portuguese-speakers. The task force can also provide names of therapists licensed in perinatal mood disorders. In the future, it hopes to offer mom-to-mom mentoring and training for pregnant parents. Contact McCarthy, 508-240-3310, or kerry.mccarthy.miller@gmail.com, for more information.
Duffy Health Center offers facilitated support groups led by Mariel Bitter, a licensed clinical social worker, in Falmouth and South Dennis. More information is available by calling 774-487-7934.
First Steps Together is a state-sponsored program for parents in recovery. It offers free mentoring, home visits, support groups and resource referrals for anyone who identifies as the parent of a child 5 or under. More information is available from Christina Russell at Cape Cod Children’s Place, 774-722-3305, or crussell@capecodchildrensplace.com.
Postpartum Support International is a nonprofit that offers services and resources nationwide for providers and parents, including online support groups. Their hotline is 1-800-944-4773 or text HELP to 800-944-4773 (for Spanish, 971-203-7773).
