New motherhood is idealized as a time filled with joy and magic. But unfortunately, not every woman is able to experience that side. For some, postpartum depression steals away those feelings. Joy and magic are replaced with feelings of guilt, failure and shame, which can escalate, and in extreme cases, lead to the most tragic of consequences.

I discussed this in a recent NECN segment on postpartum depression and the controversial Charlize Theron film Tully, in hopes to spread awareness among new and expecting mothers and their families.

It is important for families expecting a baby to discuss this common affliction, even before the baby arrives, to be ready if they start to see signs and to know what to do. Most of all, families suffering from postpartum depression should understand that it is a real, treatable affliction, and that there is no shame or failure in suffering from PPD, only in ignoring it.

One news story a few years back tells of a new mother who seemed to have it all. Pictures on social media showed a glowing, happy mother holding a beautiful baby. She spoke to family members daily, sharing those small stories of new motherhood. But inside, Allison was suffering. Her best friend and sister, Mallory Hudson, said she never saw it coming. Allison wrote a 2-page email to her family, apologizing for her failings, checked her baby into daycare and then took her own life. As a practicing nurse, I have had firsthand experience in seeing how this affliction and painful outcome can unfold for a family. It’s critical that families are aware of what’s normal—and what’s not—when it comes to the postpartum experience.

What is PPD? It Isn’t the Baby Blues

Postpartum depression, known as PPD, is a mood disorder that affects 10-20% of women within the first 12 months after the birth of a baby. Feelings of sadness, anxiety and exhaustion are some of the symptoms. It is not the same condition as “baby blues” which can affect up to 80% of postpartum moms. Symptoms of baby blues, including feelings of worry, unhappiness and fatigue, can look very similar to PPD. The difference is the symptoms of baby blues are generally mild, last a week or two and resolve on their own without medication.

The feelings of PPD do not resolve as the new mother’s hormones start to subside, but, in fact, tend to escalate. A paper from March of 2016, “All-Cause Mortality in Women with Severe Postpartum Psychiatric Disorders” published in the American Journal of Psychiatry, shows findings that “… evidence of a causal link between postpartum disorder and suicide is extremely strong, highlighting the need for medical staff to be aware of the risk.”

Postpartum Psychosis, A Rare But Extreme Variation

There is another rare condition called postpartum psychosis (PPP), occurring in only 0.2% of postpartum mothers. Often, women with PPP have a history of bipolar disorder or have had previous psychotic episodes. These women initially experience signs of PPD, which quickly escalate into psychosis if left untreated. Signs of psychosis include delusions, hallucinations, inability to sleep and possible thoughts about harming the baby.

While women with postpartum psychosis are usually identified and treated with the proper medications, mothers with postpartum depression often fall through the cracks. Family members and friends attribute the mood changes to “baby blues” and do not pay particular attention to the signs, which may indicate a mom is in trouble.

PPD Isn’t Just for First Time Moms

Babies present big changes to mothers and families, even if the baby has older brothers or sisters. Difficulties to family members can include social, financial, physical and mental changes. These external and internal pressures often affect new mothers far more than other family members, and can be intensified by the huge hormonal shifts that occur in women after the birth of a baby.

One of the biggest pressures new moms feel is the idea of being the perfect parent. Many mothers think that experiencing any negative feelings means they are a bad mother. This pressure can have toxic consequences. PPD often goes untreated because family members dismiss the symptoms. Sadly, it is usually perceived judgment from family members that can lead to a mother taking her own life.

PPD can occur without much warning, at any time during the year after a new baby enters the home. It can happen to women who go back to the workforce or to women who stay at home. Even adoptive mothers may experience PPD.

What Family Members Should Watch For

It is important to understand that postpartum moms suffering from depression usually keep things to themselves. This makes it difficult to distinguish PPD from normal “baby blues”. Often times the new mom will give subtle hints about the overwhelming feelings she is experiencing. Most mothers experiencing PPD will not directly ask for help but may give subtle signs, for example, appearing teary but denying anything is wrong when asked.

As a postpartum nurse, I can usually tell a mom is in trouble by the emotional tone of her voice. When her feelings are validated, confirming the challenges of a new baby, these suffering moms often sob with relief, happy just to be understood, to not feel alone.

Family members need to be vigilant about the warning signs because these moms quickly progress into a danger zone. Family members should be alert and aware of signs that something is not right. If a family member suspects PPD, it is important to offer the mom non-judgmental support, empathy and validation of her feelings.

Identifying Signs

Families can help to avoid the tragedy if partners, families and friends know what to look for, and are willing to question behaviors. By starting this conversation early—during pregnancy—families can create a safe space for discussing their concerns if they see suspicious behaviors. An ounce of prevention is worth a pound of cure.

A woman suffering from postpartum depression may have one, some, or all of the following symptoms: 

Overwhelmed

This is not the simple, “Wow, this is hard!” but more like “I can’t do this, I won’t ever be able to do this, and I don’t think I should have become a mother in the first place! 

Anxiety

Worries and fears seem to multiply, her mind races and she can’t seem to feel calm or reassured.

Anger

Lots of new-parent moments can be frustrating, but the anger of postpartum depression is a constant irritation and annoyance, possibly a feeling of resentment for the baby, her partner, friends with babies, or even friends without babies. The anger always simmers below the surface.

Numbness and disconnection

A mother suffering from PPD is not merely tired or exhausted, she is just going through the motions, not connecting to the baby or others around her, and is not showing the happiness or connection one usually expects. The depression prevents mothers from bonding with the baby or others around them, causing them to feel apart or walled off from the rest of the world.

Sadness

PPD sadness goes beyond the typical “baby blues,” causing suffering mothers to cry uncontrollably, often without reason.

Unusual appetite

Mothers with PPD sometimes do not eat, or seem to only be able to eat. If her appetite seems unusual, there may be something wrong.

Sleep trouble

Most often mothers suffering from PPD can’t seem to sleep, even if the baby is sleeping, or anytime at all. Sometimes PPD can show up in the opposite extreme, where the suffering mother can’t seem to wake up, even to get basic tasks done.

Inability to concentrate and focus

The foggy feeling caused by PPD leaves sufferers trying to remember what they were trying to say, or do. Decision-making is impossible.

Mystery pain

Headaches, back aches, upset stomachs, nausea, or even panic attacks that make them feel as though they are having a heart attack, without any other cause can be a sign of PPD.

Expressions of Distress

A mom suffering from PPD may say things like she is having thoughts of running away and leaving the family behind. Or, in extreme cases, she may mention driving off the road, or taking too many pills, or finding some other way to end her misery. Most mothers know something is wrong. They feel like they’ve gone crazy, and they are afraid this is their “new normal.”

What to do?

If you suspect a family member is suffering from postpartum depression, the first thing to understand is that there is no shame or failure in PPD. Proper medication and therapy start working quickly, while a “wait and see” approach can allow the situation to escalate to a dangerous situation.

Her partner or a responsible family member should make an appointment with her doctor and accompany her to the appointment, to support and encourage her, and to ensure she tells the doctor how she is truly feeling. Many mothers experiencing PPD feel shame and failure and will hide their true feelings, for fear that the baby will be taken away from them. They frequently feel weak and hopeless, perhaps guilty that they aren’t a “better” mother.

To approach someone you suspect of suffering from PPD:

  • Voice your concerns gently. Don’t forget, she is scared. While you don’t want to make a new mom feel uncomfortable, don’t avoid the conversation because you are afraid of making her uncomfortable.
  • Schedule an appointment with her ob/gyn, and accompany her to the appointment.
  • Seek support and help from family members. Studies have shown women suffering from PPD recover more quickly when they feel supported by those around them.
  • Partners should also seek therapy. When one family member is suffering, it can hurt others.
  • Do not criticize the suffering mom. Talking to someone with PPD about their shortcomings can be extremely damaging, and send them deeper into depression.
  • Let the mom talk and say what she has to say. She may say hurtful things but rarely means them. She is suffering, scared and sometimes even feeling physical pain. Lashing out is a call for help. Let her vent and listen to what she is saying instead of telling her she is wrong and trying to fix her problems.
  • Give her the opportunity to leave the house for a few hours without guilt.
  • Make sure she is getting enough sleep at night. Sleep deprivation is a huge trigger for this mood disorder.

Preventing Suicide

Like most in my profession, I believe that women need screening for depression before and after the birth of a baby. Studies show women often exhibit signs during pregnancy. Early detection is significant in identifying and treating this condition before it spirals out of control.

Family awareness is also crucial. Spouses, partners and family members should be aware of the warning signs, especially if a mother has a history of depression or anxiety. Spreading awareness about this condition and seeking medical intervention at an early stage are two important keys to preventing maternal suicide.