Baby blues, or postpartum depression (PPD)?

The arrival of a new family member is supposed to be the happiest time—everyone greets a baby with joy! Right? Except you, the person closest to the baby, can’t seem to find your smile—bundle of joy notwithstanding. 

“What is wrong with me?” you wonder. 

Well, let’s see… 

• You’re exhausted after an activity that works your body harder than running a marathon.
• You are sleep-deprived.

• Your brain has literally been switched around to accommodate your baby!*

• Your hormones have been running about helter-skelter.
• People want to come see you and the baby—and be seen to as ‘guests’
• You just feel under so much pressure to be the ‘perfect’ parent 

So with all this going on, it’s no surprise you have:

• mood swings
• feelings of anxiety or just being overwhelmed
• some degree of sadness, or feelings of loss, for the you-that-was as you adjust to a new normal
• some crying spells (eh, those pesky hormones!)
• loss of appetite
• fatigue
• sleep disruptions even while baby is snoozing
• poor memory and concentration

Them’s ‘just’ the baby blues, and affects some 80% of mothers! For some of us though, this can be a slippery slope to something more worrisome—postpartum depression (PPD).     

*PS: Just in case you’re wondering, the parenthood transition is huge for dads too—and yes, affects their brain’s neurology and their hormones too. And yes, that means dad can get PPD too, though there’s not a lot of information available yet on risk factors and manifestations. 

PPD vs the baby blues

You might think of the baby blues as a sort of snowballing of the same sort of hormonal trough you experience as PMS, or premenstrual syndrome. The key is that it is a natural fluctuation and the body eventually—not too late—resets itself to some degree of balance. With the baby blues, you still have proud moments and joyous ones when you bond with the baby, gush over them, share photos with strangers...

With PPD, it gets worse. Maybe you have already tried:

• Getting out in the sun for vitamin D regularly
• Getting some gentle exercise
• Napping when baby does
• Cutting back on chores and delegating as much as you can

And yet… with PPD, you are not getting better (sometimes this lasts for as long as 6 months!). Instead:

• You find yourself withdrawing from family, friends, even your spouse because they are exhausting/annoying/just don’t get it (NOTE: these are not the people you always found unhelpful or unreasonable; these are people who you used to think ‘got’ you) 
• You find yourself sapped of joy—the bright moments with your baby are either absent or too few and far between
• You constantly feel inadequate to the job of parenting, or like a failure or imposter
• It’s not just your memory; your decision-making ability is suffering a lag 
• You are often irritable—and may feel extremely angry at your baby too
• Either your baby’s crying makes you feel extremely anxious, unmanageably so, OR you do see they are upset but can’t bring yourself to do much about it
• You feel not so much angry or sad as… numb. You can’t bring yourself to care much about anything or anyone; you just want a break—or for it all to go away so you can sleep.
• You care—too much! People are telling you to stop being so very much of a perfectionist, so critical, or so demanding (again, these should be people who did not think of you this way before; eliminate the habitual gaslighters in your life!) 
• You want to sleep all the time, or you just can’t sleep at all, for days and weeks on end
• Looking back at the things you used to love doing, you can’t find that spark of interest any longer (with baby blues, you might feel sad because you are missing them!)
• The really scary one: you are thinking thoughts of self-harm or harming the baby. 

Risk factors

Postpartum depression affects 13% of us, at least, in the first year after childbirth (which is not to say it cannot turn up later—there’s something called the “toddler blues”!—often associated with weaning or at least reduced breastfeeding, or the return of periods, aka hormones running amok again). 

That said, some of us are at greater risk than others, thanks to our neurological wiring, moulded by our past experiences (basically, the brain can ‘learn’ to be depressed, and practice, sadly, makes perfect), and sensitivity to hormones. PPD disproportionately affects:

• those of us who already have a prior history of depression or another mental health concern—this is the largest risk factor
• those of us who have family members with a history of mental health concerns
• those of us lacking support from friends and family members
• those of us with a spouse, partner or co-parent who is struggling with depression or another mental illness
• those of us who have had negative feelings about the pregnancy (yeah, stands to reason)
• those of us who have had difficulties in a previous pregnancy or childbirth context (again, kind of follows, right?)
• those in financial difficulties or difficulties in their own marriage (or relationships with  co-parents and caregivers)
• those who have gone through other stressful life events
• those who are becoming parents at a young age    
• those of us with a substance use disorder
• those of us with any experience of domestic violence, whether in our birth families or in our subsequent partnerships
• those of us suffering from other chronic illnesses

Postpartum depression: diagnosis and help

The biggest difficulty with PPD, after the stigma attached to mental illnesses in general and the popular misconceptions around depression, is that it is common—that 13% means 1 in every 7 or 8 of us!—and yet is underdiagnosed, hence undertreated. 

You would think both family members and healthcare professionals would care more, given that we know it affects not just the mother (or father!), but also their spouses and children. Yes, your untreated PPD can mean developmental and behavioural challenges for your baby—so if you suspect it, please speak up and insist on help. 

However, for many of us, we might be on our own in trying to figure it out—or, best case, we are the spouse noticing things are significantly worse for our significant other, which is not an easy place to be either.

If you think our checklist above is raising red flags for you, please go see a professional or reach out for help online, anonymously even:

• First stop should be your gyne. Your mental health should be a part of the discussion as much as your physical well-being after childbirth at postpartum check-ups. (Moms-to-be, dads-to-be, if you find you are in the at-risk category, please mention it to your gyne or GP now!)
• Unsure of your reception? Speak to the counsellor. Most hospitals will now have a counsellor—this is typically a psychologist—who is available for antenatal and postnatal counselling, and will almost certainly have experience dealing with PPD.  
• Next, if going into the hospital for this, alongside the steep learning curve of parenting a newborn, feels like too, too much… consider online or telecounselling. Several organisations and professionals, especially in the Covid-19 context, are offering mental health services free or for nominal charges. (We’d like to update this post with a list—with your help! Please write in with your recommendations.)
• Finally, if your symptoms are severely disruptive, please research and get second, third, fourth opinions before you give up or refuse medication, if that is what is recommended by your doctor. Remember, the side effect of an untreated fracture is never regaining strength; the side effect of untreated depression can likewise mean you are letting go of a chance to heal. 

This Mental Health Day, we hope talking about postpartum depression helped you to know you are not alone—either with the baby blues or with PPD. That it is not something you just have to survive, that it can be made better—just like a broken arm can be put in a cast.

If you’d like, and if you feel up to talking, we are here to listen and hold hands—and help you find professional help, if that’s your need right now.

And for those of us who have been down that dark tunnel and emerged into the sun, please let us know in the comments what or who helped you! Share the love and the reassurance, make someone’s mental health today. 

Also, for those of us with new parents in our lives, we can reach out to offer help—real, practical support with meals, cleaning, childcare within our circles. This used to be a traditional setup in many cultures, to allow rest and recovery for new parents and to just be there—and it can make a significant difference to our risk of PPD.  

Let us all pledge, as parents, to watch out for each other—to have each other’s back, within our families and in our circle of friends, even the extended social circles of work and school and neighbourhood.  

Manidipa Mandal is a seven-year-old parent still learning about parenting. She also likes to read and write about ecology, biology (especially gender), food and travel.