Pregnancy Mental Health Series: Debunking Myths About Postpartum Depression

“I can tough it out through my pregnancy without treatment to protect my baby.”

Sound familiar? The topic of maternal mental wellness has seen much light in recent months, however despite increased coverage in the media, maternal mental health is still quite misunderstood. Reproductive Psychiatrist Dr. Carly Snyder has debunked the 9 common myths regarding postpartum depression and mental health to help you stay informed:

1. Myth: The depression and anxiety I am feeling while pregnant will self-resolve once the baby is born.  

Fact: Up to 1/3 of women who experience postpartum depression were sick during their pregnancies, and remained ill after delivery. Having a baby does not treat or cure any symptoms of depression and/or severe anxiety that a mom experienced while pregnant.

2. Myth: I should ‘tough it out’ through my pregnancy without treatment to protect my baby.

Fact: Having any moderate to severe symptoms of depression and/or anxiety during pregnancy can have serious negative lasting effects on a mother and her baby. Women with untreated mental illness in pregnancy are less likely to take good care of their physical health during their pregnancies by eating well, exercising, and obtaining appropriate prenatal care.

Babies exposed to untreated mental illness in-utero have an increased risk of being:

  • Premature
  • Smaller than expected at delivery (also known as being ‘small for gestational age’)
  • Irritable and easily agitated
  • Inattentive
  • Less active than babies unexposed to maternal mental illness
  • Emotionally distant and having developmental and/or behavioral problems later on in childhood.

3. Myth: I can will myself out of depression in pregnancy and postpartum depression.

Fact: Depression is a biological illness that can affect women at any stage of their life. 1 of 4 women will experience depression during their lifetime, and 15-20% of women experience depression in pregnancy and/or during the postpartum period. Like any depression, antepartum and postpartum depression cannot be willed away, and instead often require treatment from trained professionals.

4. Myth: As long as I have a good birth experience and I nurse my baby, I will avoid having postpartum depression.

Fact: Unfortunately, high-profile individuals who are untrained in maternal mental health have propagated the misconstrued idea that having a ‘natural’ childbirth, especially home-births, and nursing on demand, among other concepts will prevent postpartum illness. This is factually inaccurate, and inappropriately places blame on mothers who do experience postpartum illness.

5. Myth: I first realized I was depressed three months after my baby was born, so it’s not postpartum depression.

Fact: While the definition of postpartum depression traditionally required a diagnosis be made within four weeks of delivery, specialists in the field widely agree that this is not the case. Many women first present with symptoms of depression and/or anxiety within the first six months up to a year after delivery.

6. Myth: I am not crying all the time, and I can still take care of my baby, so it must not be postpartum depression, even if I am overwhelmed, anxious and irritable.

Fact: Postpartum depression and anxiety can present in many ways. Women may have several but often not all of the following symptoms of postpartum depression:

  • Sadness
  • Irritability
  • Anger (especially towards their spouse or partner)
  • Poor appetite
  • Impaired sleep
  • Hopelessness
  • Crying episodes
  • Decreased interest in activities and things once enjoyed
  • Impaired ability to bond with baby
  • Guilt
  • Anxiety about the baby’s health and safety
  • Thoughts of suicide

7. Myth: I am a bad mom because I have antepartum and/or postpartum depression and/or anxiety.

Fact: 15-20% of women experience antepartum and/or postpartum depression caused by many factors, none of which are under a woman’s control. Having mood symptoms during pregnancy or after your baby is born does not make you a weak or unfit mom. Instead, it means you are among the many women who suffered or are currently suffering with mood symptoms during or after pregnancy.

Women who show no risk factors for antepartum or postpartum illness beforehand can still experience mood symptoms during or after pregnancy. Some signs of risk for antepartum and/or postpartum mood disorders include (but are not limited to):

  • Genetics
  • Sensitivity to hormonal fluctuations
  • History of prior episodes of depression and/or anxiety
  • History of antepartum and/or postpartum illness with an older child:
    • Experiencing antepartum and/or postpartum depression in the past confers a 50% risk of having a similar illness during subsequent pregnancies and after delivery.
  • History of abuse and/or trauma
  • Social stressors
    • Financial instability
    • Marital stressors, especially domestic abuse
    • Poor social supports

8. Myth: Treatments for mood symptoms in pregnancy and after delivery will harm my baby.

Fact: It is important to weigh risks and benefits of any exposure during pregnancy and while nursing. The risk of untreated moderate to severe illness is often considered greater than the risks conferred by treatments typically offered women during pregnancy and while nursing. There is a great body of literature to help guide your physician when choosing the safest possible medication during pregnancy and while nursing. Psychotherapy alone for more mild symptoms, and in combination with medication for more moderate to severe illness is completely safe and does not confer any risk, and can be very beneficial.

9. Myth: Having postpartum depression means I am at risk of harming and even killing my baby.

Fact: Women with postpartum depression do not harm their babies; the greatest risk is that they harm themselves. Inaccurate reporting in the media has led to significant fear and stigma surrounding postpartum depression. The illness should instead be correctly classified as postpartum psychosis if a woman has harmed her baby and/or herself.

Women with postpartum psychosis (a completely separate entity from postpartum depression) are at risk of killing their babies and/or themselves. Postpartum psychosis occurs in 0.1-0.2% of women after delivery, and is considered a variation of bipolar disorder. In a state of psychosis, women are unaware of reality and in that state, may pose a risk to themselves and/or their babies; they do not willfully harm their children. Postpartum psychosis is a medical emergency, and requires immediate treatment by professionals, often in a hospital setting.

Carly Snyder, M.D. is a Psychiatrist in New York City with a focus and expertise in Reproductive Psychiatry. Dr. Snyder is the Clinical Course Director for the Reproductive and Perinatal Psychiatry Program at Beth Israel Medical Center. She holds faculty appointments in Psychiatry and Obstetrics and Gynecology at Beth Israel Medical Center, and a teaching appointment at Mount Sinai Medical Center. Dr. Snyder serves on the Board of Directors for Postpartum Support International, and is a member of the Women’s Mental Health Consortium in NYC. Dr. Snyder also sees patients in her private practice located on the Upper East Side of New York City. She received her undergraduate degree from Emory University, attended NYU School of Medicine and completed residency at Beth Israel Medical Center, with additional sub-specialized elective training at Weill Cornell’s Payne Whitney Women’s Program.

Dr. Snyder treats women experiencing emotional and psychiatric challenges at any age. Her approach uses a combination of traditional psychiatric methods with integrative medicine-based treatments to optimize the whole body, mind and well-being. Dr. Snyder provides individualized treatment that focus on improving a woman’s physical and emotional health. In addition to more traditional psychiatric modalities, she has extensive experience treating patients with natural supplements, either alone or in combination with pharmacotherapy. For more information, visit Dr. Snyder’s website, blog and follow her Twitter.

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