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Postpartum Depression Isn't Normal, It's Complicated

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When a friend says postpartum depression is normal, I get disappointed.

When a psychologist says postpartum depression is normal, I get worried.

When a New York Times best selling author and former U.S. congressional candidate with hundreds of thousands of followers says that postpartum depression is normal, I get livid.

It's one thing to be misinformed about postpartum depression, it's quite another to be educated and yet still come to the wrong conclusion.

But then I take a deep breath, meditate, pray, practice some yoga, down my SSRI with a delicious blueberry smoothie and decide to cut them all some slack. I get to writing because I remember that postpartum depression isn't normal, it's complicated, and my keyboard is my greatest weapon.

That said, though it's getting better, the media isn't much help. We often only hear about extreme postpartum psychosis and infanticide cases. A research article published in Issues in Mental Health Nursing concluded that popular press magazines contained "contradictory information about the definition, prevalence, onset, duration, symptoms and treatment of postpartum mood disorders."

A Canadian study on community awareness of postpartum depression found that "awareness of the term postpartum depression does not necessarily imply awareness of its symptoms" and that "public education is needed to address this fact in order to provide social support and encourage treatment for symptomatic women and their families."

Yet another study points to primary health caregivers' lack of awareness of postpartum depression as a major problem.

"It's a societal issue," says Kate Kripke, a licensed clinical social worker and founder of the Postpartum Wellness Center of Boulder, Colorado.

That's why we need to keep talking about it. Mothers need to keep telling their stories. Researchers need to keep sharing their findings. Advocates need to keep fighting.

And I need to keep blogging.

We have to get the truth out about postpartum depression.

Because women and men are suffering.

And so are their children.

"There is no simple answer to this," says Kate. "It is so confusing even to those who specialize in the field of maternal mental health."

The confusion over postpartum depression is causing clashes between postpartum depression debunkers and retaliating warrior moms on the battlefield of social media instead of a safe haven for women and men to be able to share their experiences and obtain factual information as well as emotional support.

"I think this really unfortunate thing is happening where we're kind of at war with each other," says Kate. "It's this ongoing debate which is so sad because everyone is talking about the same thing."

In a statement following her comments which enraged the postpartum depression community, Marianne Williamson continued to defend her stance: "While not all would agree with my position, I would hope that we -- particularly women -- could honorably debate issues without excoriating someone's character over a difference of opinion."

"It's a dangerous statement," says Kate. "We are setting women up for months and sometimes years of illness which then can impact the health and safety of children. The more we can get real, educated information out there statements like hers become less problematic."

Kate started her center in an effort to bring "skilled and appropriate perinatal mental health support" to women and families around Boulder County. She travels to hospitals and trains obstetricians, pediatricians, doulas and nurses on the difference between normal postpartum adjustment and postpartum mood and anxiety disorders.

"Clinical depression and anxiety are not a normal part of the maternal process of the postpartum period," says Kate. "There are extreme hormonal shifts that impact brain chemistry and some women are more prone to those shifts in hormones affecting brain chemistry than others."

About 80 per cent of mothers feel sad, worried, irritable and anxious two to three weeks after giving birth. That's what's called having the "baby blues." It's when those feelings last longer that it could be a sign of postpartum depression.

But it's not that simple.

About 20 per cent of women will suffer from a diagnosable postpartum mood or anxiety disorder which comes in many forms.

And many mothers with postpartum depression aren't depressed at all.

"Postpartum mood and anxiety disorders include a range of mental health issues that can occur any time in the first 12 months postpartum," says Kate.

And they are:

  • Postpartum Depression
  • Postpartum anxiety
  • Postpartum panic disorder
  • Postpartum post-traumatic stress disorder
  • Postpartum obsessive compulsive disorder; and
  • Postpartum psychosis

And there's more.

Karen Kleiman, author of This Isn't What I Expected: Overcoming Postpartum Depression, coined the term "postpartum stress syndrome" (PSS). Adjustment disorder or PSS includes mothers who are struggling more than expected and who do not fit the criteria for a postpartum mood disorders.

PSS is most common in mothers who are experiencing high levels of external stress, such as those who have had a difficult birth, have relationship challenges or who are caring for a sick newborn.

"Without appropriate support, PSS will often lead to postpartum depression," says Kate.

For that reason and more including better screening techniques and treatment planning, it's vital to make the distinction between what's normal and not in the postpartum period.

But until there's a blood test that can clinically diagnose postpartum depression, health care providers must rely on a mother's interpretation of her own experience as to whether what she is experiencing is normal or not.

"What I really encourage women to do is just listen to themselves and to trust themselves, and if they are worried about how they're feeling, then speak up to a well-trained professional," says Kate. "Baby step by baby step we're getting there. But it's going to take an army."

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