6 Things: The 6 Stages of Postpartum Depression

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postpartum depressionRecovering from postpartum depression is, unfortunately, a pretty unwieldy process to get through. It’s not like you can take antibiotics and ten days later you’re all set and ready to go. The process of recognizing, getting treated for and recovering from postpartum depression can take months and months and sometimes years.

Yes, I know. That completely sucks.

I was thinking about the experience of going through postpartum depression as seen through the lens of the famed “5 Stages of Grief,” the process people go through when dealing with grief and tragedy. Developed by Elisabeth Kubler-Ross, a Swiss psychiatrist who wrote the book On Death and Dying, the stages are:

  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance

Per Wikipedia, “Kübler-Ross originally applied these stages to people suffering from terminal illness, [but] later, to any form of catastrophic personal loss (job, income, freedom). This may also include significant life events such as the death of a loved one, divorce, drug addiction, the onset of a disease or chronic illness, an infertility diagnosis, as well many tragedies and disasters.”

Could we look at the process of going through postpartum depression and postpartum anxiety in a similar way?

The Six Stages of Postpartum Depression

  1. Denial: This must be what new motherhood is like. I’ll be alright. It can’t be postpartum depression, because I’m not mentally ill. I’m sure it will wear off soon. I just need more sleep.
  2. Anger: Nobody understands what I’m going through. Why me?! This is supposed to be a time of joy. I don’t deserve this. I don’t want to have to take medication. I don’t want to go to therapy. I shouldn’t have to call a doctor. This is not fair.
  3. Bargaining: If I just exercise more and eat better I’ll be fine. If I could just get to the point where the baby sleeps through the night, I’ll be okay. If I get closer to God and pray more, this will surely go away.
  4. Depression: I should just leave my family. I’m bringing everyone down. They all would be better off without me. My poor baby doesn’t deserve a mother like this. I’ll never get better so there’s no point in going on.
  5. Acceptance: What’s happening to me isn’t normal and I can’t ignore it anymore. It’s not my fault. It is okay for me to talk to a doctor. It’s okay for me to ask for help. I can take medication or go to therapy or do whatever is necessary for my health and that of my family.

When it comes to PPD, I’d have to add another stage. The stage that comes after acceptance, after the treatment, after the time when you start feeling better but aren’t 100%. I call it the post-traumatic stress disorder, or PTSD stage because even after a year of getting treated and getting better it took me another year just to get over the trauma of what I went through and become comfortable with motherhood.

6. PTSD: I still worry that PPD will return. I’m constantly looking over my shoulder. Every time I feel bad I’m convinced that I’ve gone back there. I feel like I’ve lost a lot of confidence in myself and I don’t know if I’ll ever get it back. I worry I hurt my child in the long-term because of how I was when he was a baby.

It takes a while, but you’ll get past the PTSD too. At that point, finally, you reach complete recovery. You are able to experience the joy of motherhood. You are able to believe that you are truly over PPD. You feel the love that was always there, buried by PPD, for your child, and you trust that you are better and that you are a good mom.

Kubler-Ross believed that not everyone would necessarily experience all the stages in the exact same order or even have all of them. She felt that most people would go through at least two of the five stages, and that it was possible to switch back and forth between them. I imagine the same is true for postpartum depression.

My favorite part of the Wikipedia entry on the five stages of grief is something I want you to consider carefully. To make a point, I’ve replaced the word “grief” with “postpartum depression”:

“Significantly, people experiencing (or caretakers observing) the stages should not force the process. The [postpartum depression] process is highly personal and should not be rushed, nor lengthened, on the basis of an individual’s imposed time frame or opinion. One should merely be aware that the stages will be worked through and the ultimate stage of ‘Acceptance’ will be reached.”

Don’t compare your timeline to others. Don’t expect that you should be better before your time. Don’t give up. You will reach acceptance, and recovery. You will get there.

Note: This article won a 2011 Media Award from Mental Health America, given “in recognition of journalistic excellence in coverage of mental health issues.”   

Find more articles from the Six Things series on the right-hand sidebar.

You might also like:

How Recovery From Postpartum Depression is Like Playing Chutes & Ladders

Photo: Fotolia – © Tino Mager

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Tell Us What You Think

  1. Thank you. I cannot tell you how much this story meant to me.. I am in stage 6.. I hate that I have lost my confidence.. But I know I am not the only one who feels this way.

  2. You are not alone Janna. 4 1/2 years afer the birth of my daughter and I still haven't fully recovered. I live in stage 6 every day. One thing I have learned about PPD, you are never alone, no matter how much you might think you are. <3

  3. I know I can't speak for everyone, but again, Katherine, you nailed it. You definitely triggered some emotion in me as I can recall "circling" in the pattern of denial and bargaining for months. As a nurse I felt like I should have been able to "snap out of it myself" with any combo of exercise, better health, etc. I'm glad that you emphasize not comparing your timeline to others. I think many moms are so eager to feel better as soon as they start treatment that they "survey" others to get a benchmark on when they can expect to feel better. There are so many factors that affect one's own journey to wellness….and it's always good to hear that reminder!

  4. During therapy, we addressed the stages of grief and its so right on for me. Considering some PPMDs can be caused by early child hood experiences (at least for me), not only did I go through the grief of having PPMDS but also the grief of not a supportive childhood, etc. Tough work to go through, but it all make ssnese. thank you!

  5. I suffered PTSD in my early twenties. I now have PPA/PPD after giving birth to my son 23 months after having twins.
    The sixth stage you describe I also went through when recovering from PTSD. In your recovery you are so focussed on feeling "good" that any "feeling down" day becomes "the enemy". It takes a little while before logic takes over and you realise that every normal person has their ups and downs and not to worry about them. It is a matter of experiencing a down day without a major slide a few times to get confidence in yourself again. This Is Normal!!!

  6. WOW. That is really it! If only I had read that when I was in stage 6. The fear that every bad day is just a sign that you aren’t recovered, you won’t ever be, or that it is coming back all over again.
    I am so proud to say that I have kicked that PTSD outta here. A bad day is just a bad day now. Good bye timelines, expectations, guilt. Hello life! Hang in there mommas. Your time will come!

  7. OH. MAH you? Thank you for this. This is so 100% spot on.
    I was diagnosed with PTSD after I had a really bad relapse that triggered the painful memories of after my delivery. It was like I was living in a weird Deja Vu. In my mind, history was repeating itself and it was terribly frightening. I think I bumped back down to denial and then went through all of the steps again until I reached acceptance which is the hardest stage of all of them I think.
    I also like to point out that, EVERYONE’s timeline is different. Don’t beat yourself up if you aren’t at level 3 and so on.
    The thing is we should just know that we will get there in our own time. That? Is always true.

  8. Thank you! This meant the world to me….This is exactly what I feel I have been going through…
    Thanks again,
    Christina

  9. You took the words straight out of my head. Feeling down has indeed become the enemy. Thanks for sharing your thoughts…and my thoughts, too!! :)

  10. Stage 6 is key for so many. You think you're done, and then you realize not quite. That can be so painful. But it's a reality of what we go through, and it helps to know that and be prepared for it.

  11. Thank you for the postings. I am from Canada but am a teacher in Saudi Arabia. To the Saudi's PPD does not exist. When I went home this summer to Canada, I found a wonderufl support group that I still keep in touch with. I often well most of the time feel they are the only ones who understand me. I don't know what stage I am in because it changes so much. I am scared to have more children due to PPD and I know I never want to have another child when I am so far away from support. My daughter is ow 8 months old and not sleeping through the night. My advice to other moms with PPD is to write and find a support group. In the middle of the night when I can'tget back to sleep, this support group has been an incredible blessing. It can be lonely. Doctors don't tell you about these feelings while you are pregnant and it seems taboo to say you are tired or the baby cries too much to family or friends. Keeping your feelings inside is very dangerous. Keep communicating with others who will listen, not give advice. Best of luck to you.

  12. Reading this brought tears to my eyes, especially the praying and getting closer to God part….I'm at the acceptance stage, starting the treatment journey this week, after just realizing I'm tired of my boys seeing me cry and snap and flip out. I don't know if I had ppd after having my oldest, but 9 mos after having my youngest, I'm finally looking it in the face and deciding to just deal with it. Just found this site, what I've read so far has been very helpful- thank you.

  13. I am actually experiencing the 6 stages in a different order:
    1.Denial
    2.Bargaining
    3.Depression
    4.Anger
    5.Acceptance
    After almost a year in treatment- i realize that i am angry- VERY angry at my husband, mother and family for not noticing or saying anything to me that could have helped me get help earlier than 2.5 years into my PPD. It was quite an epiphany today.

  14. My daughter experienced PPD with the birth of her 4th child. Our granddaughter was born on a Tuesday afternoon and three days later her mother (our daughter) started crying and didn't stop for almost 2 years. I recognized it right away and called in sick for the rest of the week and stayed with her. Her older children, all girls, were 9, 7 &5 at the time. Her father and I made sure she was never alone, her sister in law pitched in too. When the baby was 2 weeks old, she came to live with us and I reduced my hours at work (eventually I resigned) and every day I would take baby Kerri and spend the day and sometimes late into the evening at my daughter's house. It was without a doubt the darkest time for our family.
    At that time, there was NO help nearby. Her OB-GYN turned his back on her. The nurse midwife in his office who had delivered 3 of our granddaughters tried to help but wasn't effective at all. We had trips to the hospital in the wee hours of the morning because they prescribed Ativan for panic attacks and she overdosed, she is also epileptic and the lack of sleep played havoc with that.
    However, she came out of this stronger than before and so did her Dad & I. We have no doubt that without us and her sister in law our daughter would not be here today.

  15. Thank you so much for this. My oldest son is 3 and I am still somewhat in the PTSD stage. I am more accepting of what happened but still racked with guilt over how I treated my son in those early months.
    I have since had another son and thankfully did not suffer with depression afterwards. It has been a blessing, but the joy of his baby days were tinged with guilt that my oldest wasn't rejoiced in like his little brother.
    You may enjoy a recent blog post of mine, entitled "on postnatal depression, combination feeding and guilt". http://www.alternative-mama.com/on-postnatal-depr
    Thanks for your wonderful site.

  16. I like the valuable information you provide in your articles. I will bookmark your blog and check again here frequently. I am quite certain I’ll learn a lot of new stuff right here! Good luck for the next! Best Regards, Pedro

  17. Hi, I am doing a project on PPD for my University Family Studies Class…I came across your blog and just wanted to say that to all those women going through PPD everyday to be strong and bold…no matter what the circumstances are. Know in your heart that what you believe can make you confident and committed to turn your PPD around in a new direction.
    Best Regards to ALL!

  18. My baby boy just turned 20 months and i am still fighting PPD. My life turned into absolute hell. My marriage is crumbling. I am alone, depressed, angry at myself and everyone around me for letting me down. Dark tunnel with no way out .

  19. Katherine, this is a really helpful post. I think that Elisabeth Kubler-Ross stages can be applied to almost any crisis which feels like a shock to the system and needs integrating into our psyches. We humans tend to put up a lot of fight against the intrusion of shocking experiences like loss or trauma or mental illness etc. However, if we can get support and integrate the new normal and what it means to us, we can be okay, sometimes even better than before with the right help and support.

    Thanks for all you do and continue to do. The new site looks great by the way!

    Kim

  20. Pingback: The “6 Stages of Postpartum Depression”: As Told by Katherine Stone |

  21. Thank you for this. I especially like what you said about adding a stage – ptsd. I’m in that stage, now. I thought I was better. I treated it, weened off the meds, was doing fine…. but I’m not 100% fine. I still feel resentment towards my baby and the poor kids is 13 months old. Even though he’s my fourth child, and as far as I know, fourth time with ppd, it’s nice to know I’m still “recovering” and that there isn’t anything permanently wrong with my brain. lol So, anyway, thank you. :)

  22. Pingback: Getting Better From Postpartum Depression

  23. How do you even go about getting treatment for PPD? I had twins 7 mo ago today and I hate the way I have been feeling for the past couple months. I have two older children also (5 and 3) and I will just sit and cry for no reason and I don’t want my children to see that anymore. I just want to be happy, I have 4 beautiful healthy children. I should be happy.

    • The best thing to do is call your doctor and discuss how you are feeling. You can talk to your OB, or your pediatrician, or your primary care physician. Whoever you feel most comfortable with.

  24. Pingback: Undiagnosed PPD Question - Page 2

  25. Hello,

    I just tried to ween myself off Celexa, my doctor told me I would know if my symptoms came back. I sure did. Trying not to worry about still being on the pills, it’s only been 7 months since I was diagnosed with PPD. Still working on it.

  26. Thank you so much for this post, my partner doesn’t understand and him reading this has giving him a new perspective.

  27. Thanks Katherine for this. My little guy is going to be a year old next month and you described it perfect when you said the last stage to recover is PTSD. I’m over my ppa and feel 100 percent back to myself but there’s not a day that goes by that I don’t think about what I went through and sometimes I will think about 20 times a day and I get mad because I can’t stop thinking about it. Some days are way better than others and I just tell myself that some day it won’t consume my mind any more. I guess I go through periods were ill go weeks were its not on my mind much and then bam it pops in mind for a week and I can’t get it out. I ate it but know like you this is the last stage and just to look forward . :)

  28. This final stage seems to be lasting forever, I constantly fear going back to that dark place and it often ruins the joyful moments I have. All I want is one day, or even one HOUR, where I don’t think about it. But it’s always on my mind and it’s so hard to try to enjoy life sometimes :-(

    • Dear Moms, I am 65 years old and went through terrible post partum anxiety/ depression after my two children were born 30 plus years ago. At that time I felt as if my Life was over. No one even knew what PPD was. Now I am a new Grandma to an 8 month old. It has been the purest of joy, healing, serenity, knowing. But here is some perspective from my lifetime of experiences. I have been involved in alternative healing ( Reiki level one trained) and related healing for 15 years, also B.Sc. In pre-med bio, microbiology, science teacher, and support group leader 12 years.

      Sometimes mantras help: ” I am learning from this experience, and am getting a little better each day.” ” I am strong and capable, even though the chatter is telling me otherwise. ” There are some wonderful healing meditations and positive affirmations on You Tube – search around until you find one that feels right. When you rest visualize a healing cocoon around you. This space is for your energy only.

      Metaphysical folks say that we choose our parents – to learn certain things. Consider that possibility. Even very young babies absorb. ” I am so glad you came to us. I love you just the way you are. We are learning together. ”

      Forgiveness seems so important. Others just can not understand much unless they have been here. Forgive your husbands. They are doing their best.

      So how do the babies/ children of PPD Moms turn out? Well, just fine. My two are highly motivated, kind, good people, now having their own families. Because of all that I went through, I feel well-equipped to help get these grand babies going. Adversity ultimately teaches us things we could otherwise have not known. I suspect PPD Moms are special in many ways – very sensitive, wanting to help all, kind, intuitive, can feel the energy / feelings of others- and absorb these. We don’t have to Perfect.

      This journey certainly isn’t easy, but know in your hearts and spirits that the greatest joys in Life are ahead. You hold a miracle in your arms. May you be Blessed with all that is good and beautiful as you travel.

      • I am certain that my new daughter-in-law has PPD but I don’t know how to approach her and my son is worried that it will make things so much worse for the family if I do. Any advice would be appreciated.

        • Diana, perhaps have someone approach her with whom she has a very close and trusting relationship, be it your son or a sibling or close friend. It’s definitely worth letting her know that many women struggle with a new baby and that if she is not feeling like herself and is suffering it’s possible she could have the very common but also fully treatable illness of PPD. If all of this is expressed out of full love and support for her and she knows that everyone believes she is a great mom and that she’s not at fault she may be more accepting of the conversation.

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  30. Pingback: My Journey Through Post Partum Depression Part 4 – Recovery | Short And Sweet Moments

  31. I am in a pretty interesting situation. My husband has bi-polar disorder and I feel the weight of that as well as my motherly duties bring me down. I cry a lot and I’m not sure what to do anymore. I am a stay at home mom so I don’t get to get out much. I really don’t know what to do anymore.

    • Alicia, you sound like you are struggling and have a lot of stress. Have you been able to talk to your doctor about this? Give him or her a call. Talk about what symptoms you are having and whether they are impacting your ability to function in your daily life? There IS help.

  32. Pingback: Post Natal Depression (PND) | Trials & tribulations of a first time mum

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  34. My final stage is the guilt. Oh man the guilt. Feeling guilty for having felt the way I did about my child, guilty for having thought the things I did about my child, guilty for the way my child would look at me when I would yell, the fear that I can remember seeing in his eyes. Now I just have to focus on the fact that it wasn’t me. I wasn’t the one who said those things. I am still flumoxed that I was so angry. That’s why it took so long for me to realize that I had PPD. I wasn’t sad, I was angry. Oh so angry.

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  36. I just recovered from postpartum sycosis and now pregnant again. I’m worried that this will reacure. Its only been two months since myrecovery. IM 38 and this will be my 6th baby. I fought so hard to get better and I made a full recovery before getting pregnant again. What should I expect? Thank you for your help

  37. I hate that I feel like this. It makes me feel like I am driving my husband away and that makes me even more sad.

  38. I have just entered stage 5. My baby is 9 months. All along I felt like I could kick this without drugs and wondered why I was a “weak” person and did not want to ask for help. I waned the feelings to just go away and be able to deal with it. I hope now that I will be medicated I will be on the road to recovery. I would love to hear anyone’s thoughts. I love my family so much and do not want to be a burden

    • My PPMD lasted 2 years. Now that I am past it I realize that we have grown closer as a family because of our struggle. We all had to change and grow a little because of it and I am actually in some ways grateful. I know that sounds strange but I think it helped us deal head on with issues that would have eventually surfaced. PPMD puts people in such a raw state. Things can’t be pushed under the rug as easily. That can actually be a good thing. I hope you feel better soon. You will eventually feel better.