The Impossible Simplicity of Treating Postpartum Depression

I’m pleased to introduce a new columnist here at Postpartum Progress: Kate Kripke. Kate is a Licensed Clinical Social Worker (LCSW) specializing in the prevention and treatment of postpartum depression. She is also a Colorado state coordinator for Postpartum Support International. Kate lives in Boulder with her husband and two daughters. She will be writing once a month at PP, so look for her!

The Impossible Simplicity of Treating Postpartum Depression

Is it even possible to say that the treatment of postpartum depression and other perinatal mood and anxiety disorders is “simple”? Of course, it doesn’t feel that way. For many, many women, getting over and through the challenges of a pre- or postpartum mood disorder such as PPD can feel unfairly complicated. And, in many ways, it is. We know PPD to be a complex illness, with roots in imbalances and disturbances that cross a woman’s physical, social and psychological being.

But, what if we were to think of the treatment of and recovery from postpartum depression in its most simple form? Would this be helpful?

In my Boulder, CO, private psychotherapy practice I get asked often – always, really — about how long recovery from PPD takes. Of course there is no one answer for this as each mom’s challenges and experiences are unique. But sometimes, looking at treatment and recovery as somewhat linear and specific can bring some hope and optimism at a time where it feels that both of these gems are lacking.

So, here goes: If there were a map of PPD treatment and recovery, what would it look like? What are some things that every mom can consider in working her way towards a stronger sense of wellbeing?

Again, we know that these illnesses stem from disruptions in a woman’s biology, psychology, and social systems, so, if we pull these three areas apart and look at each separately, we may be able to make some sense out of a very overwhelming situation.

Where are you being filled up in these areas? Where can you use additional support?

Biology or Physical Body: This is usually the first place to start. Making sure that you are getting your basic needs met is critical in your recovery. Hormone shifts post delivery that affect biochemistry put every childbearing woman at risk. Add sleep deprivation, nutrient depletion and possibly a personal or family history of depression, anxiety, or other mental illness, and many women suddenly find themselves thick in the midst of complicated emotions that they never believed would accompany becoming a mama. So, important questions to consider are:

  1. Do I have a genetic predisposition of depression, anxiety or mental illness? If the answer is yes you are at a 50% greater risk for developing PPD. And women who have a history of bipolar disorder are at the highest risk of developing postpartum psychosis, the most rare and also most severe postpartum mood disorder. For many women who are struggling, appropriate medication support can be incredibly helpful and important.
  2. Are you able to strategize around sleep? Can you get support during the day to nap or at night so that you can get at least 4-5 hours of uninterrupted sleep each night? Studies have indicated that sleep deprivation may play a greater role in the development of depression and/or anxiety than the temperament of one’s baby.
  3. Are you getting enough nutrients? It is easy for mom to become depleted during pregnancy, childbirth and breastfeeding. Adequate nutrition is an important part of your body’s ability to make and process the necessary “feel good” brain chemicals such as serotonin and dopamine.

Social Network: Ours is one of the few societies in which it is assumed (or expected) that mom can and will take care of a babe and everything else on her own. You’ve heard the term “It takes a village”- well, it does! So, it’s important to seek out the much needed and deserved support at this time, especially if you have postpartum depression.

  1. Can you enlist the help of friends, family or hired professionals to help with cooking, cleaning and even just holding the baby so that you can sleep, shower or get some time to yourself? Do you know of someone who is willing to set up a “meal tree” in which friends and acquaintances drop off much needed meals several times a week?
  2. Do you have other new moms who you can talk to during this challenging time? Isolation plagues most new moms, and so getting the emotional support necessary is imperative. Research shows that Mom’s Groups (therapy support groups or community groups) can decrease symptoms of depression and anxiety in many women.
  3. If you are married or partnered, are your relationship needs being met? We know that the first year after having a new baby is often the hardest on relationships and so it is hugely important to tend to these needs. Does your partner and/or does Dad need help understanding what you are going through? Is Dad suffering from PPD himself? Are you able to seek out a trained professional to help navigate some of these relationship challenges?

Psychological Processes: Even if basic needs are being met, the mind can take hold and truly wreak havoc on wellbeing. Receiving validation, working with a trained therapist and allowing yourself the care that you need can often help to shift thought patterns that contribute to unwelcome symptoms.

  1. Yes, new motherhood is surprisingly difficult for those of us who like to be in control, are perfectionists or who are not expecting the inevitable identity shifts that come along with becoming a parent. Understanding your triggers around this, being especially kind to yourself, and re-setting expectations and priorities so that they are appropriate for this time is imperative.
  2. Are there past or unresolved issues with your family of origin that are interfering with your ability to be present with and attach to your own baby? This is an important piece to consider and is usually quite unexpected. The same goes for previous trauma histories, if they exist. Understanding the past’s role in the present is hugely important.
  3. Are you able to regulate your emotions when necessary? Breathing techniques such as diaphragmatic breathing, progressive relaxation, and guided imagery are clinically effective in decreasing depressive and anxiety symptoms.

Of course, of course, of course I know none of this is ever as easy as it reads. The support of a trained mental health provider is almost always an important part in a mom’s recovery. And he or she should be able to help you navigate through these and other important questions as you strive for wholeness again.

Kate Kripke, LCSW

About Katherine Stone

is the creator of this blog, and the founder and executive director of Postpartum Progress. She has been named a WebMD Health Hero, one of the fiercest women in America by More magazine, and one of the 15 most influential patient advocates to follow. She is a survivor of postpartum OCD.

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Comments

  1. This was so. helpful. and encouraging.
    It seems as if I have a family history of depression. I do believe this has also contributed to my PPD.
    And my 8 month old is still waking up twice a nice… I haven't gotten more than 2-3 hours of sleep straight since before he was born… Probably before I was pregnant with him.
    But I have recently discovered that my medication does bring balance and I am grateful for it!

  2. twice a night* (typo)

  3. GREAT post. Funny to see the breakout and to see that I was "at risk" on all counts. No wonder I fell so hard the third time around. Still, knowing everything I did (or THOUGHT) I did about PPD, sometimes it just takes you by surprise, doesn't it? This is an incredibly helpful guideline.

  4. Great post! I knew about the 3 elements – but I haven't seen it written so well and consisely! Thank you. I'm passing it on to my therapists, doctors, midwives, and friends. My PPMDs definitly are rooted in all three. I hope have I have made lots of progress, because I'm due with Baby #2 in 3.5 months 🙂 and excited about it!!!

  5. What a great succinct post. I felt like I was reading my life two years ago….
    My family history made me very aware of my tendency to depression. Only AFTER my diagnose did I learn from my 99 year old great-aunt that my grandmother had been hospitalized for a month with PPD symptoms (although back then it wasn't recognized).

  6. Hi Emily-
    I am so glad that this post was helpful to you, Emily. Sometimes simply understanding where some of the risk factors come from helps to bring some clarity into a very confusing and complicated time. I am also so glad that taking medication has brought you relief. Sadly, there continues to be a stigma around antidepressant and anti-anxiety medication that keeps many women from receiving this type of treatment when necessary.
    Warm wishes to you!

  7. Hi Ninotchka-
    So many women are at risk, and don't realize it. And when risk factors are understood, strategies can be put into place that can ease some of the transitions. Many of us fall into the trap, though, of THINKING we know more than we actually do about PPD. I was a mental health professional and after I had my first baby, it still took me 5 months to reach out and get the help that I needed for the anxiety that I was struggling with.
    And, yes… It does take most women by surprise, no matter how much they know- There is often that "yeah, but it won't happen to me" thing that gets in the way…
    Best of luck to you…

  8. Kate Kripke says:

    Thanks for responding, Sabine. I am glad that this was useful to you. And warmest of wishes to you in your journey with Baby # 2!

  9. Kate Kripke says:

    You are right, Sara. PPD was NOT recognized in previous generations, although I hear often in my practice that mothers and grandmothers suffered (in silence). Hopefully, our generation and those to come will be increasingly comfortable about reaching out for support when needed.

  10. Great posting. I always talk about these three steps, plus one more: medication (or hospitalization) when necessary. But I LOVE that we can all approach treatment from a "simple" perspective with these steps. Thank you!

  11. This post is really helpful to me too. My daughter is 14 months but I look back and see where things went wrong. If I had someone to help so I could sleep, if someone would have brought meals, etc . . . I could be further ahead in my recovery. but, I know that I can recover if I get help. My medicine does help with balance but I still have bad days.

  12. Kate Kripke says:

    It is always easier to look back at what you COULD have done, isn't it, Heather. I am really glad that you are getting the support that you need and deserve now and it is absolutely true that with support and treatment you WILL get better. And remember, PPD recovery is often "3 steps forward, 2 steps back"- but even when you feel that you have bad days during your recovery, you are on the road to wellness again.
    Warm wishes to you on your journey.

  13. Great post! I had a very difficult time after the birth of my son and did not feel like myself for about 18 months. I realize now that lack of sleep, unwillingness to let others help out, and poor nutrition played a major role in my PPD.