For the New or Pregnant Mother Experiencing Extreme Sadness

By Danita Morales Ramos, PhD

Have you given birth in the last few months and feel extremely depressed or sad? Nearly 90% of new mothers commonly experience postpartum blues that resolve in less than two weeks after giving birth. These women report feeling exhausted and irritable and experiencing crying spells. However, more than 5% of new mothers experience extreme and other distressing symptoms for over two weeks after giving birth, which can be attributed to postpartum depression (PPD).

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Suicide is the biggest cause of death for mothers one year after childbirth. PPD symptoms can include mood changes (such as sadness, persistent anxiety, irritability, agitation, and apathy), trouble sleeping, memory and concentration problems, suicidal and homicidal ideation, feelings of worthlessness (e.g., not feeling worthy of having a baby), psychosis (e.g., delusions, hallucinations), aggression, and confusion. The latter symptoms are more extreme and are characterized as postpartum psychosis. (Note: If you or someone you know are a risk to themselves or someone, contact your local emergency services department or hospital. If you need to talk to someone and you are located in the U.S. call 988 or visit the Lifeline website 24/7).

Culture impacts postpartum symptoms and how mothers and others, such as family and mental health providers, interpret them. Some women are predisposed to PPD due to treatment for infertility, socioeconomic status, and a history of mental health problems. Women who undergo infertility treatment are more at risk as they often experience lower life satisfaction, greater anxiety, and more symptoms of depression. PPD can negatively impact how a woman envisions motherhood. Lack of or not feeling support, weight gain, hormonal changes, breastfeeding, and perceived obligations can also intensify PPD. 

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PPD during pregnancy may increase the likelihood of PPD, such as the mother’s age and the number of pregnancies. Neurological challenges such as norepinephrine, serotonin, cortisol, and other hormone levels are also associated with PPD. Women should be screened for psychological, biological, and environmental factors and stressors such as marital/relationship conflict, financial distress, and medical indicators correlated with depression before, during, and after pregnancy for early detection and intervention, particularly those with a history of depression. Pregnant women should be educated about PPD no later than their third trimester. 

Preventative measures for PPD are education, screening, debriefing after delivery, companionship, and support when the baby is delivered and during aftercare, brief counseling, adequate sleep, and psychopharmacological treatment such as antidepressants and hormonal treatment. Mothers should have at least 5 hours of good sleep. It is important that mothers have time alone; however, if they are feeling distressed and experiencing depression, companionship is vital. Depressive symptoms may be latent while the mother is breastfeeding. Therefore, it is important that the mother is screened at 6 weeks, 3 months, and 6 months postpartum. The Edinburgh Postnatal Depression Scale (EPDS) is the most often screening instrument used for PPD. Though medication is not ideal when a mother is breastfeeding, a medical provider may deem that medication is necessary for the mother’s health. It is recommended that mothers breastfeed an hour before taking antidepressants. 

Healthcare providers, family, and friends should take all clues given by women and people who disclose thoughts, feelings, or plans about depression and suicide seriously. PPD should not be left untreated due to its negative impact on the mother and the child’s development. Specifically, a mother with PPD has a higher risk of suicidal and homicidal ideations. A mother’s inability to connect with her baby can intensify her depression and result in the child having trouble focusing, having cognitive challenges, or developing special needs. Treatment can support mother-infant bonding for the infant to begin developing healthy attachment. 

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Men may also experience PPD symptoms often related to the mother’s depressive experience. They can also feel disconnected from the mother and the child when she breastfeeds or assumes other childcare roles as he learns to discover his new role as a father. Perceived support and resources for men are as important as for women. Helpful resources for men who experience PPD are education, support groups, counseling, and psychopharmacological treatment. 

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Some research suggests that natural progesterone can help prevent PDD. Communicating openly with your healthcare provider about your history, concerns, and symptoms is helpful. Family members and friends should also communicate with providers if the mother is open to family involvement. Online and local support groups can be helpful for new mothers, fathers, and their natural support system. Hospitals, churches, and non-profit organizations may offer workshops and support groups free to new mothers. Seek the treatment of a licensed mental health professional who can screen, diagnose, and treat women with PPD. Many LMHP professional post their businesses and contact information on Psychology Today. Individuals experiencing PPD or other life transitions challenge may be able to receive free, confidential counseling through an employee assistance program or EAP offered by their employer.

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