The “baby blues” is a passing episode of mood instability that affects up to 80% –or 8 out of 10–of new mothers and is usually characterized by tearfulness, sadness, irritability, mood swings and anxiety-all normal and expected behavior due to the huge hormonal shifts. The blues, which can begin as early as immediately after delivery and up to one week postpartum, generally subsides on its own, with no medical/therapeutic intervention, within 2 weeks.
You would think that obstetricians would be the experts on identifying PPD, but the sad truth is that even today, most of them still buy into the myth that any mood disorder experienced by the mother after delivery is merely a state of mind and a normal part of adjusting to motherhood. They will wave off your symptoms at the 6-week checkup and claim it’s just the blues and you’ll get over it. It’s frustrating whenever I read about mothers who do seek treatment and get the ol’ “Oh, it’s just the blues. Everyone gets the blues. You’ll be fine before you know it.” Then, when you aren’t fine before you know it, you then end up with this despair that you don’t know what’s wrong with you. It makes me so angry when I read about these stories. How many more doctors are going to wave off a woman–saying they have the blues, all is normal, it’ll go away by itself–who is claiming she has insomnia, appetite disturbance, inability to smile, laugh or feel happy 3 weeks or longer after childbirth?
A New Mom Needs to be Evaluated for PPD if….
Practically every book I’ve read indicates that a new mom needs to be evaluated if she experiences 5 or more of these primary symptoms of PPD for most of each day for two or more consecutive weeks:
- Persistent and mostly inexplicable sadness/tearfulness and feeling empty inside
- Loss of interest/pleasure in most of your usual activities; inability to laugh
- Overall impaired functioning*
- Sleep difficulties (either insomnia or sleeping too much)
- Weight loss (usually fairly quick) associated with a decrease in appetite
- Weight gain associated with an increase in appetite
- Excessive worrying (e.g., about the baby’s well-being)
- Difficulty thinking, concentrating or making decisions
- Feelings of guilt/inadequacy/of being a bad mom
- Urge to run away/disappear/vanish into thin air
- Onset of panic attacks
- Sense of despair and/or hopelessness leading to thoughts of death/suicide
*What I mean by overall impaired functioning is feeling unable to do anything. I prefer to use the “debilitating” to describe my experience. Debilitating meant the following for me: I would find myself frozen in one spot (either standing or sitting) not knowing what to do next and feeling helpless, useless and unable to function properly. All I could do was sit there, but even sitting there, I was deluged with feelings of hopelessness, in large part due to my not having a clue what was wrong with me. I couldn’t feel or think positively. I couldn’t smile. I couldn’t enjoy anything that I used to enjoy. If your symptoms are debilitating to the point that they interfere with your day-to-day functioning and prevent you from enjoying that which used to bring you interest/pleasure, you should be evaluated by a medical or mental health practitioner right away (don’t wait).
A sign for an OB/GYN that what you’re experiencing is PPD and not just the blues is if your symptoms are continuous, debilitating, and last beyond 2 weeks postpartum. The first question an OB/GYN should ask the patient to rule out PPD is whether or not the symptoms interfere with her everyday functioning. Usually, with the blues, you will feel weepy every once in a while, but the symptoms are not debilitating. In fact, they usually subside within 2 weeks with no medical intervention. My insomnia at 6 weeks should have been a clear indication to my OB/GYN (and his staff) that I had PPD at that point. Instead of merely prescribing me Ambien to help me sleep, they should have screened for PPD. Their insistence that I didn’t have the “classic” symptoms of PPD is founded on the minimal number of times I was willing to call the doctor’s office with a question or concern. They never once bothered to ask me if I had certain common symptoms of PPD. If I had a medical practice that was concerned about women’s health before, during and after pregnancy, I would ensure I was trained on PPD detection and treatment since it has such a high occurrence rate, and make sure I took steps necessary to detect and treat PPD in my postpartum patients. In fact, I would even screen pregnant moms too, since so many cases of PPD arise during pregnancy.
Remember, if your doctor tells you that what you have is the blues, and you are 3+ weeks postpartum and are experiencing 5 or more of the symptoms listed above, you will need to make a decision on what to do to help yourself get better.
If you’re comfortable with this doctor and prefer to stick with him/her, tell him/her he/she needs to screen you for PPD and reach out to Postpartum Support International (PSI) for information/resources.
Even better (since time is of the essence), ask him/her if he/she can refer you to a medical or mental healthcare practitioner who has experience treating PPD. You always have the option to find a psychiatrist who can screen you for PPD, provide you with a listening ear and advice, and prescribe any medications as necessary. If this is your first time experiencing a mood disorder, don’t be afraid to seek therapy. What matters is you must do what it takes to get well. Certain PPD patients do well with a combination of medication–especially if they are very symptomatic and need treatment for their symptoms before therapy can be beneficial–and therapy.
If he/she doesn’t have any referrals, go to the PSI website to look up your state coordinator who can refer you to local medical/mental healthcare providers.