Can You Get Postpartum Depression AFTER the First Year?

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when can you get PPDLately I have received numerous calls from moms whose kiddos are past the one-year mark. A couple of recent calls have been from moms whose kiddos are as “old” as 3. These moms always start the same way: “My son/daughter is almost (1, 2, 3), and so I know that I don’t have postpartum depression.  But I am really unhappy and think that I need help.  I know that your specialty is PPD, so can I still come see you?”

While I can’t make a blanket statement about each and every woman who calls me, more time than not these women — 1, 2 or 3 years past the birth of their little ones — are struggling with a form of maternal distress that dates back, in one way or another, to their pregnancy, postpartum, or even before.  While these moms wouldn’t technically have postpartum depression any longer, they are often struggling with what I will call here continued postpartum distress that was never adequately supported when they first noticed symptoms.

When we use the terms prenatal/antenatal and postpartum depression we are really simply talking about an episode of depression or anxiety that occurs sometime during pregnancy or the first year postpartum.  We believe that early symptoms, whether mild or severe, are caused by hormonal shifts during pregnancy or following delivery, physiological stressors like sleep deprivation and nutrient depletion, psychological strain including thought patterns that are likely to cause distress (such as “should” statements, perfectionist thinking, black or white thinking, and catastrophic thoughts) and/or other environmental stressors such as trauma, relationship conflict or changes in finances, employment, or residence.  A postpartum episode of depression or anxiety can be triggered by one or more of the above.  While they aren’t aware of this when they first call, most of these moms can trace their initial symptoms back to the earliest moments of motherhood.  On the phone before they come in for a full assessment session, these moms will say things like, “But I was fine after I had my baby, and I didn’t start feeling bad until later.”  However any one or more of the following are usually what we discover when we are together in my office:

  1. This mom has a long personal or family history of diagnosed or undiagnosed depression, anxiety, or mental illness.
  2. The pregnancy wasn’t planned and this mom wasn’t certain that she wanted to be pregnant – although she never disclosed this with anyone.
  3. This mom had a difficult delivery that was never fully processed after her birth.
  4. This mom had significant breastfeeding challenges that she struggled with silently.
  5. This mom describes her early postpartum months as “foggy” and that she actually doesn’t remember enjoying them.
  6. This mom had always hoped for a boy/girl, but gave birth to the other.  While she loves her kiddo fiercely, she has never quite managed the loss she feels around not giving birth to the gender that she had dreamed of.  Or perhaps this mom has always worried about her attachment to her child.
  7. This mom experienced a move, death of a loved one, financial loss, or relationship conflict around the time of her birth and these environmental stressors were pushed aside because she felt she “should” be happy once her baby was born.
  8. This mom had an early childhood trauma or serious family of origin conflict and she notes that emotions around these issues resurfaced shortly after birth.
  9. This mom felt un-supported in the months following her birth and felt that she “had to do it all on her own.”
  10. This mom’s baby did not sleep through the night until many months or years after he/she was born.
  11. This mom has not wanted anyone other than herself or her partner to care for her baby, and so she has not taken more than a very short period of time away from her babe since he/she was born.
  12.  This mom became pregnant after months or years of fertility treatments, she used donor eggs to become pregnant, she had her baby through a surrogate, or she adopted her baby, and once becoming a mom she pushed all of her emotions around her efforts to become a mama aside.
  13. This mom is tired. Unrelentingly, frustratingly, understandably, deeply tired.

While the beginning of motherhood can feel exciting (perhaps sometimes even euphoric?) for many women, symptoms of depression and anxiety can develop or increase over such a subtle period of time that moms do not necessarily acknowledge that they are depressed or anxious until well into or past that first postpartum year.  Often, stress can be cumulative.  Months of inadequate sleep, poor nutrition, relationship conflict, and hidden emotional strain can take their toll on a brain.

Think of a minor running injury. While on a jog you trip and feel a slight pinch in your knee.  You keep running and barely notice it.  But each time you get back out to go for a jog, your knee becomes more and more strained (yet not painful enough to keep you off your feet).  Suddenly one day while running months later your knee gives in. It has had enough.  Your brain can do the same.

Why is all of this important?  Too often, women assume that they have found themselves in a life that is just characterized by suffering, and they assume that since they don’t have postpartum depression it is silly or unnecessary to reach out for support.   And so they keep on trekking while each day feeling overwhelmed, anxious, and farther from the woman who they know themselves to be.  We talk so much about postpartum mood and anxiety disorders and not enough about maternal distress and I fear that many women tell themselves that they have missed the window of diagnosis or validity for their struggle.

While being a mother is wonderful, it is also complicated.   Let’s make room for both no matter how far into the journey of motherhood you are.

~ Kate Kripke, LCSW

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  1. Wonderfully written. I was one of those mothers after the birth of my first child. I went undiagnosed for more than 18 months. When I finally saw a counselor, she pointed out that all of my symptoms began in the first month after my son was born and continued until that point. It never occurred to me that it might be PPD. Thank you for writing this. My hope is that others may read it and seek treatment sooner.

  2. I cant imagine going through my severe ppa and ppd for that long…..its such an awful feeling….a day feels like pure hell. I am 6 months post pardum and feeling much better now……hoping to never feel that way again. Lots of support to all moms suffering…it gets better eventually…..a great support system helps even more so.

  3. Love this post, Kate. Yes, “Too often, women assume that they have found themselves in a life that is just characterized by suffering, and they assume that since they don’t have postpartum depression it is silly or unnecessary to reach out for support. ” I’ll be putting this on the Mothers Matter FB page right away.

  4. I think that people fixate too much on labelling specific types of depression. It really doesn’t matter if a woman’s depression meets all the clinical criteria for “postpartum depression” – if a woman is depressed, then she is depressed and needs/deserves treatment.

    It may make women feel better to label depression as a way of finding a “reason” for it, but it’s often more complicated than that. I did experience a severe depression after my first child was born. However, I have always been prone to anxiety and depression, and mental illness runs in my family. At first I thought, “I just have PPD, I can get over that once my hormones go back to normal and I adjust to life with children.” But I’ve come to realize that I actually have a more chronic kind of treatment-resistant depression and that putting a PPD label on it has not helped at all.

    • Thanks for sharing your thoughts, Callie. Yes, so many women do enter motherhood with a preexisting depression or anxiety that goes beyond the “PPD” diagnosis. At the same time, I do think that the PPD diagnosis gives clinicians and moms something to work with. Often PPD is treated differently than general anxiety or depression simply because this treatment can’t overlook the very intricate pieces of motherhood that can contribute to distress; be this hormones, one’s own family of origin issues that resurface when she thinks of herself as a mother, the challenges and stigma of self care in motherhood, thought patterns that can interfere with mothering etc. When one is given a PPD diagnosis, this can set the stage for a treatment that is sure to look at all of the layers upon layers of biopsychosocial issues that occur in early motherhood (and that can be easily overlooked without appropriate direction).

  5. Thank you so much for this article! I was 18 months postpartum when my thoughts became so horrible I knew I needed to get help. Now that I look back it all started right after my son was born but I did not realize it at the time. I love the analogy with the knee-so true!

  6. Thanks for recognizing that mothers can struggle after the clinically defined one year mark. I had PPD with my second child within his first few months, making my diagnosis obvious. It wasn’t until I was recovering from that bought of depression and anxiety that I recognized I had PPD with my first child. Because it didn’t occur until she was 13 months old (right about the time I stopped breastfeeding) I assumed I was dealing with a different monster than PPD. I sought treatment differently than I would have if I had known what I was up against.

    • Kim- I can’t tell you how many times I have women come to my office in this exact situation. Truthfully, with a really good therapist it doesn’t always really matter whether someone is getting a “postpartum depression” diagnosis vs a general depression diagnosis- often, when the first year has passed, a woman’s depression or anxiety might be addressed in a similar manner to a more general diagnosis. However, women like you are still mothers, and it is rare that issues related to mothering- whether hormonally related or not- can not be ignored whether that baby is 1 month or 13 months….

  7. I think you’re missing one piece, which is what happened to me. Everything was fine until my period came back. Then hormones took over and my world turned upside down. Depending on how much or long a mom is breastfeeding, this also can delay the onset of PPD.

      • Thank you! I’ve felt like such an exception to the PPD rule, as I had no issue with stress or family support…but still couldn’t control my life because my hormones had (have) control over me. It is frustrating being an exception to the norm, as it is hard to find support that specifically addresses treating the hormonal problems – especially since it is so far after the typical PPD period.

  8. Yes, I agree completely. We changed the criteria of the women that we see to include those with a baby up to 2 years old for this very reason. I think for many the experience of having a baby is a bit like a stress fracture that can take some time until it finally breaks.

  9. Yes, I think the running analogy is very helpful. I see this so often in my clinical practice, the cumulative stress of little time for self-care, increasing isolation, & increased “shoulds” is a recipe for distress/depression. Bottom line – Moms need more support as do those that work with an interact with them.

  10. Kate this is comforting to read! I have 2 boys they are 10 months apart. Born Dec 07 and Oct 08. I had baby blues big time after my 1st son was born. High anxiety about being alone when my husband went to work a depressed empty feeling of him not being in my stomach any more (tried to get pregnant for about 5 years prior) pregnant again almost immediately what a shock! A little more troublesome pregnancy, diabetes & pre eclampsia in and out of the hospital. He was born 6 weeks early and went to nicu. He had a stomach surgery at 3 weeks old.(mind you I have a 9 month old) I have never had depression or anxiety until the birth of my 1st son. My question is I am fine normal all year until around October every year until December. I get really anxious and depressed about my babies getting bigger with an overwhelming since of wanting to leave my job and go get my kids and hold them. I love them so very much and I know growing is inevitable. I am a super proud mom, watching them learn just everything! Why do I only get anxious and depressed around their birthdays? Please help.

    • Tiffany- thanks for reaching out and I am glad that you found this useful. My first thought for you is that it sounds really important to reach out to a therapist in your area- while I can share some thoughts here, this certainly is no replacement for therapeutic support. You can find support in your area at: http://www.postpartum.net/Get-Help/Support-Resources-Map-Area-Coordinators.aspx
      sometimes, specifics like season change, anniversaries of a traumatic birth, and holidays can bring up distress for people, and so you may want to consider whether or not this applies to you. Please know that you have an army of support here…. reaching out to community can not be underestimated as a source of relief for many people…

  11. Thank you for this article! My beautiful baby boy is one. I still feel a struggle going on inside of me that I just couldn’t figure out. Not until I read this. I can relate to 9 out of the 13 items you listed! I guess I need to reach out; out past my loving husband. ;)

    • Yes- there are many options for support if you don’t have insurance (though, in some areas these are not easy to find). Most therapists who are self-pay providers offer sliding scale spots, and so I would always encourage a conversation about this if you find someone who you connect with. Community mental health clinics also offer low fee or free services to folks who qualify. And in many larger towns or cities, you will find opportunities to work with mental health trainees who offer low fee therapy. To find help in your area, visit: http://www.postpartum.net/Get-Help/Support-Resources-Map-Area-Coordinators.aspx

  12. I am still trying to decide if this description fits me. My daughter is 2. She just turned 2. I feel I should be happy that life is not so chaotic anymore because she is doing more on her own and her brother will soon be in grade 1. So, the work load gets less in some areas and more in other areas. When I had my daughter, my dad was hit by a driver. He was a pedestrian. he was in ICU for 2 months. We moved to be closer to him. He died two days after we moved in and three weeks before I was to give birth. My mom came from Germany. I also have a twin sister who was jealous at the time that I was pregnant with my second. The day after my daughter was born and we came home from the hospital. My sister told our mother over skype that her husband would pick her up from my house. I begged my mom to stay. My mom said that she was with me all until my daughter was born and now she has to be with my sister. My sister’s reasoning was that mom needs to spend time with her son as well to show her son she loves him just as much. I suggested we all be together and we go to my sister’s house, but my sister demanded no. She wanted moms time alone. So, I was mad that mom left and I have not really forgiven them yet. I think about when my son was born. My mom was not there, she had promised to come, but last minute could not. My husbands parents and his sister and my dad all came over and we had lunch together and dinner and they greeted us coming home from the hospital. I did not get that with my daughter. My mom and sister feel that they were right in doing what they did. My sister tells me you don’t know how tired I was. I think, it doesn’t matter, I offered to come over as well and she could have still slept. It was heartbreaking. My mom was also not at my wedding because she was working in Germany, but she was at my sisters years before. My husband and I married when I was 7 months pregnant with my first. I think I get angry when I think about how nonchalant my mom is with this relationship and pretends to be concerned that dad died just before my daughter was born, but she was not concerned the day after. She sends neat things for my kids for birthday and christmas’s and all that. I don’t really like my inlaws either. They treat me like I am not a part of their family and they walked out when I gave my eulogy to my dad. That made me angry. I have never shared this. I also don’t know when the right time is to go back to work and my husband never has time to discuss this with me, but he doesn’t complain that I should be working either.

    I don’t know. I have a lot of anger, but I can never regret that I don’t spend enough time with my kids. Everything I do, I do for them.

    • Tanja- thank you so much for sharing your story. I know that you wrote this a while ago, but if you have not yet found support, I really urge you to do so- you have had no much happening for you and are understandably needing support of your own. Katherine has several links to providers if you need help finding someone near you. We all send you support…

  13. This is me! We moved cities when my daughter was 6 months for my husbands work. While he is a wonderful hubby and father I am stuck unemployed (because I left my job in our old city) and overwhelmed with the idea of surviving off of one income, not having family around to help out, and trying to put on a happy face about our new “adventure” in a new city. I love my baby so much. We had a difficult pregnancy after a 2nd trimester loss and I feel I SHOULD be grateful and enjoy every minute but I feel quite depressed most days.

  14. Sometimes I have really bad thoughts about her and I realised today that I might have PPD..I love her very much but I’m really really tired,the fact that I can’t afford basic things for her doesn’t make it any easier…I’ll make an appointment with a psychologist as soon as I can..thank you for this page.

  15. My son will be two in a month and every once in a while I still feel anxious and/or depressed. It’s definitely not nearly as bad as it was right after he was born, but it’s definitely better. I have a health condition that adds to the stress so I’m one of those moms that fits in this article as one who has “early childhood trauma”. I’m also one who had to do it all on my own. I still don’t know how to process all of this that’s going on as motherhood alone presents a new challenge everyday. While I still struggle with continued post partum distress, I can’t imagine my life without my son. To the lady who mentioned that you cannot afford basic things for your child, I can totally relate. It gets better, though. I found programs to help me with the bare necessities until I could get back to work. Everything gets better with a little time.