This is the story I see most often. Mom comes in and she’s tired. She feels like any attempt to take care of herself is either blocked by a screaming child or would be implausible because of other life factors. Eating has been a struggle. When kiddo (or kiddos) are sleeping, laying down would be nice but falling asleep is hard plus there’s all of this work that should be caught up on. The thought is actually overwhelming so what gets done is not a nap or the work, but mostly the repeated thought that if she could somehow just do more, “things” would be better.
That’s why the Edinburgh Postnatal Depression Scale has a question asking whether you blame yourself for things going wrong, and uses that answer to estimate your statistical likelihood for having a postpartum mood disorder. Depression during and after pregnancy happens to about 15% of people, especially after childbirth. Now, not every story is the story I wrote above- everyone has a unique experience through depression. The most common symptoms of postpartum depression are:
- Feelings of anger or irritability
- Lack of interest in the baby
- Appetite and sleep disturbance
- Crying and sadness
- Feelings of guilt, shame, or hopelessness
- Loss of interest, joy, or pleasure in things you used to enjoy
- Possible thoughts of harming yourself or baby.
Do you have to have a lack of connection to your baby to have postpartum depression? No! This is a common misconception that the media really tropes up. You can be completely in love with your baby and still be struggling. Some examples of this are being afraid to take your baby down the stairs because you are sure that you will fall, or being afraid to let anyone else hold baby because you fear baby getting hurt by the care of others. Any emotional pattern that robs you of your freedom to make the choices that you want to make and made without difficulty in the past is a restrictive pattern. Depression is like your brain getting stuck in a rut, and being unable to change your habits to get out.
There’s a very physiological reason for this rut. Serotonin and the placenta engage in an intricate biochemical dance. Platelets, the cells that cause clotting, also secrete serotonin and can have a dynamic effect on fetal blood exchange. The placenta basically says “Hey, get that platelet out of here!”. The way that the placenta gets the serotonin (and therefore clotting platelets) out of the way is to upregulate a receptor called interleukin-1 beta which basically acts like a kid shoving all of their (serotonin) toys into the closet to keep the room (neurons and placenta) clean. The mechanism works really well to reduce clotting and impeded blood flow to the placenta- but if your body is exceptionally good at this “clean up”, you don’t end up with enough serotonin for your normal brain functions.
Pair that with another biochemical reaction called the serotonin shunt, and you get a problem. The serotonin shunt is where an oxidative challenge (stress and diet stuff) presents an immune-inflammatory response (aka your white blood cells anger your brain) that changes the way tryptophan (the molecule before it becomes serotonin) gets metabolized- and you don’t make serotonin or its subsequent metabolite, melatonin. This mechanism is related to some very common genetic defects linked to depression and anxiety in general that have an impact on antenatal and postpartum depression and anxiety. The oversimplified story is that not only can your placenta make you hide your serotonin, but your lifestyle and genes can make you not have enough of that neurotransmitter to begin with.
Mood disorders including depression and anxiety aren’t particularly rare during pregnancy and especially not during postpartum. The risk factors for developing postpartum mood disorders (PPMD) include:
- Personal or family history of depression, anxiety, or postpartum depression
- Premenstrual dysphoric disorder (PMDD or PMS)
- Inadequate support in caring for baby
- Financial stress
- Marital stress
- Complications in pregnancy, birth or breastfeeding
- A major recent life event: loss, house move, job loss
- Having twins or more
- Having a kid in the NICU
- Having gone through infertility treatments
- Thyroid imbalances
- And any form of diabetes.
You’ll note that a lot of those things could cause depression at any time in life, or are causes of oxidative stress in the body. If this sounds like you, please know that you’re not alone. Postpartum and pregnancy depression are common and treatable. There are a variety of ways to approach helping your health, and individualized treatment will evaluate your goals and personal health status. You can feel healthy again.