Postpartum depression — more properly known as perinatal mood and anxiety disorder — affects 1 in 7 new mothers. And yet not many parents or doctors know how to recognize symptoms or treat it. A new Texas law, which took effect Sept. 1, puts in place some steps to make treatment easier.
The law establishes a five-year, statewide plan to set up a treatment network and resources. The plan is supposed to improve awareness about the illness for the public and care providers, reduce the stigma associated with it, establish a community health provider referral network and figure out how to use existing funds to assist with screening, referrals and supportive services.
While this kind of legislated plan cannot hurt, it may not be enough to help, either, said Ann Smith, president of Postpartum Support International. Misinformation and stigma make it hard to admit to the illness and to recognize and treat it. What's more, many care providers simply don't have the training.
With celebrities like Chrissy Teigen and Gwyneth Paltrow sharing their own experiences with perinatal disorders, the issue is starting to be less stigmatized, but there's still a lot of misinformation and fear out there.
The best-known name for the disorders — postpartum depression — is in itself a misconception. Many parents don't experience or exhibit any symptoms of depression and don't seek help because they don't feel depressed, Smith said.
Frequently, the disorder presents as anxiety. Those who do feel depressed might still not want to seek treatment because of the stigma surrounding metal illness in this country or because they're afraid they won't be believed. Others are told by family or friends that they're making it up or that they can just pray the pain away. Neither of these is true, Smith said.
“People don't realize how common this is, because they don't talk about it. I have so many moms who say, 'Well, all the other moms are having such a good time.' No, they're not (necessarily),” said Christy Doering a Plano-based therapist and social worker.
Becoming a new parent is the biggest change most people will go through in a lifetime. And while being overwhelmed is normal, if you can't sleep when the baby is sleeping, haven't bonded with the baby, worry that you're being a terrible parent, even when you're caring for the baby or are having an internal dialogue that seems illogical, that's all OK, but it's not normal, Doering said. But you can get help and get better.
Symptoms range from simply not feeling right or feeling as though life isn't as good as it used to be and being anxious, to not being able to get out of bed or eat. Anyone feeling like this is not to blame, Smith said.
For Smith, who had the disorder with her second and third children, it manifested as severe agitation and anxiety. Her pregnancies and births were relatively easy, and she had never had mental health issues. Although 50% of parents who have a perinatal disorder have had a previous mental health issue, it can happen with no prior history.
Smith's experience was roughly 30 years ago, when much less was known about the illness. Because she was a trained nurse midwife, she had heard the term “postpartum depression.” She knew something was wrong, but she didn't feel depressed. Instead, she was anxious, she couldn't sleep and she couldn't focus on reading long enough to finish a sentence. It was as though she was two seconds away from a terrible accident all the time.
“I felt like I had had 1,000 cups of coffee. I felt like I couldn't breathe," she said. "It was a really frantic feeling."
Smith knows now that her body was stuck in a fight-or-flight reaction. But back then she still thought it was a hormonal reaction or a thyroid issue.
Eventually she muddled through the confusion and found a psychiatrist who understood just enough to prescribe her an early version of the medication patients receive today. She started to sleep and gradually got better. By the time her child was about a year old, she felt wounded, but mostly like herself.
The second time it happened, it was no less painful but less frightening. She knew what to do.
The good news, Smith said, is that a lot more is known about the illness now than when she had it. It is very treatable and almost everyone gets better, especially if they get treatment early.
“We say, 'You are not alone, you're not to blame, and with the proper help, you will be well,'” Smith said.
And, although this is another common misconception, even though treatment commonly involves medication, it is not addictive or personality-altering and doesn't prohibit breastfeeding, Smith said.
The descriptor “postpartum” is also misleading, since 30% of cases of this illness start during pregnancy, she said. It's important to start checking on women while they are still pregnant.
But, even mandated universal screenings and education campaigns cannot address the issues if there aren't treatment possibilities.
“The only time that it really helps is if there's teeth behind it,” Smith said.
That's where Texas' legislation might fall short — the resources behind diagnosis and education efforts to treat and heal those who experience the disorders.
To start, it's important to understand that what happens is not a weakness. Perinatal mood and anxiety disorder is an illness and can be treated effectively. It is also critical that the treatment is provided by professionals who have been trained to understand and recognize the illness. General care providers cannot be expected to know exactly what to do, but they must be able to recognize the gap in their knowledge and know that they need to pass the patient along to a specialist, Smith said.
Another concern Smith hears is that the parent's children will be taken away. Any professional trained to understand what is going on will not try to take children away from the patient, she said.
That includes incidents of postpartum obsessive-compulsive disorder. In these cases, parents have recurring intrusive thoughts, often many times a day, of something terrible happening to their baby, sometimes even of doing it themselves.
Although this is frightening, it too is treatable, Smith said. A parent will know that the thoughts are not real and will have no urge to act upon them. Most parents are very ashamed and have a hard time admitting to these thoughts, which makes it hard to seek treatment, but if they do, they will get better.
Where the postpartum illnesses do risk harm to the child is with postpartum psychosis — a break from reality. This is very rare and different from obsessive-compulsive disorder.
“Intrusive thoughts after somebody has a baby, those are very common, but only 1 in 1000 women will have postpartum psychosis,” Doering said.
The key difference is that even in the case of the worst thoughts associated with perinatal OCD, the parent is horrified by them, whereas with postpartum psychosis, the parent believes she is doing the child a favor.
Understanding that delineation is important for new parents, family, friends and care providers. Parents experiencing postpartum psychosis will sound clearly delusional. Psychosis frequently has a religious element. Sufferers are often hyperactive and have hallucinations that lead them to believe that ending the child's life will eliminate or prevent suffering and send it to a better place.
“The sad thing is that it's usually an act of love,” Smith said.
An attack of psychosis is a medical emergency. It is very clear and not hard to detect. If you encounter someone with postpartum psychosis, Smith recommends contacting a family member, staying with the person and calling 911 if necessary.
“It is very clear that someone is talking to someone who is not in the room,” she said.
The disorders can also affect the non-birth parent, male or female. One in 10 men experiences a postpartum disorder. The onset is often sudden, and men tend to become aggressive and hostile, develop substance abuse problems or withdraw, Smith said.
Of course, it's normal for new parents to be exhausted, to worry some, to wonder if they're doing it right and even to feel a bit of grief, knowing life is never going to be the way it was before the baby, Smith said. But perinatal disorders go beyond those feelings.
“It's a visceral thing. When it happens to you, I think it's very clear that there's something very wrong with you,” she said.
Medical professionals need to be trained to recognize, treat and refer. And those treating parents must offer them safe, private spaces to talk and to feel OK admitting to their feelings, Smith said.
Doering wishes that Dallas had intensive dedicated services for moms who need serious help, particularly with postpartum psychosis. She pointed to a program in North Carolina that is just for women with the disorder and one in the United Kingdom that even allows moms to bring their babies. In Dallas, there isn't enough funding for breakout programs, and parents who need treatment are often slotted into groups with a variety of mental health concerns, which isn't the best environment for recovery, she said.
Dallas has a number of therapists trained to diagnose and treat perinatal mood and anxiety disorders, including Doering, who is also a resource for referral to other professionals. When she gets a call, email or text, she has a checklist she goes through to figure out what the caller's needs are and how best to address them. However people reach out, it is possible to direct them to help.
“It will be OK," she said. "These are some of the most treatable versions of mental health issues around."