When Postpartum Depression Doesn’t Go Away

Most of the mothers Olivia Bergeron treats for postpartum depression seek her out within the first three months after giving birth, desperate for relief from feelings of sadness, anxiety and hopelessness they cannot shake.

But for other moms, postpartum depression lasts longer.

“I have mothers of toddlers come to me and they say, ‘This doesn’t feel good, and it hasn’t felt good for so long. I just can’t continue,’” said Bergeron, a licensed clinical social worker who specializes in postpartum depression in her practice in New York City.

A sweeping new review shines a light on this subset of women, finding that while symptoms of postpartum depression generally diminish with time, an estimated 30 to 50 percent of moms affected with the disorder continue to struggle with major depression throughout the first year after birth — and beyond. The review, its authors argue, highlights the need for clinicians to view women with postpartum depression, or PPD, as a highly heterogeneous group, and to understand that for many, there is no clear beginning or end.

“In some mothers … depressive symptoms indeed decrease over time after childbirth, consistent with the assumption of many researchers in the field that a majority of depressive episodes after childbirth resolve within three to six months,” said Sara Casalin, a researcher with the University of Leuven in Belgium and an author on the study, in an email to The Huffington Post. “However … in a substantial proportion of mothers with PPD, levels of depression do not always significantly decrease, and particularly do not decrease to normal levels.”

Recent estimates suggest that as many as 1 in 7 women battle postpartum depression for reasons that are not entirely known. PPD differs from the so-called “baby blues” — postpartum sadness, exhaustion and mood swings that are common among many women — both in terms of severity and timing. Baby blues generally lasts for only a few weeks after birth, while experts generally agree that postpartum depression can occur anytime within the first year.

The new review, published in the January/February issue of the Harvard Review of Psychiatry, considered 23 studies on postpartum depression conducted between 1985 and 2012. It found that for 38 percent of women with PPD, the disorder is the “prelude to the development of a chronic depressive disorder,” or may be the continuation of a pre-existing problem or vulnerability.

Katherine Stone, founder of Postpartum Progress (a blog and non-profit), discovered only after she gave birth that she had been living with anxiety and obsessive compulsive disorder. Stone sought help almost immediately, after her symptoms suddenly became severe. “I didn’t know it was a perinatal mood or anxiety disorder,” she said. “I thought I had gone crazy.” In her first appointment with a psychiatrist, she was told she had been living with mental illness for years — a scenario, Stone said, that is not uncommon.

“I don’t think the lines [between postpartum depression and chronic depression] are as bright as we’d like them to be,” she said. “I get emails all the time, asking, ‘Can I still have PPD if I’m 18 months postpartum?’ Technically, if you’re looking at the DSM (Diagnostic and Statistical Manual of Mental Disorders), the answer would be no, because you’re past the year postpartum. But the more likely answer is, ‘If you were never treated and your symptoms persist, it certainly could’ve started in that time period. And now it’s continued on.’”

Experts say the new review affirms the pressing need for better screening and more widespread treatment, which can take the form of counseling, medication or a combination of both. “I find this [review] very troubling, because postpartum depression is extremely treatable, and the outcomes are much better if we treat it early,” said Bergeron. “It really speaks to the lack of screening, and that we’re not helping people early enough — or at all.”

Stone echoed the sentiment, saying she hopes the findings empower more women to seek help.

“This is such a difficult conversation to have. There’s so much fear and there’s so much guilt around PPD and related illnesses … for women to hear, ‘Hey! PPD can cause chronic depression’ … I feel the hearts of women around the country sinking immediately,” she said.

But Stone wants them to focus on a different message: With screening and treatment, it doesn’t have to be this way.

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  • 1. Sleep and diet can affect fertility.

    What makes one couple particularly fertile, while another struggles for months or years to get pregnant is, in many cases, a mystery. And though infertility is often due to factors that are entirely out of a couple’s control, more and more research suggests that, in some cases, certain lifestyle factors, like sleep and diet, can make a difference.a href=”http://www.huffingtonpost.com/2013/07/09/shift-work-fertility_n_3569047.html” target=”_hplink” One study found/a that women who do shift work (working outside of the typical 8 to 6 framework) may have disrupted menstrual cycles and reduced fertility, while a href=”http://www.huffingtonpost.com/2013/10/18/sleep-fertility_n_4122829.html” target=”_hplink”another found /athat getting between 7 and 8 hours of sleep each night was linked with the best outcomes among patients undergoing IVF. In terms of nutrition, a href=”http://www.medicalnewstoday.com/articles/264791.php” target=”_hplink”one preliminary study/a suggested that women with polycystic ovarian syndrome hoping to conceive may benefit from eating a large breakfast and a smaller dinner in order to help with insulin levels, which can affect hormones.

  • 2. Specific fertility treatments lead to more multiple births.

    a href=”http://www.huffingtonpost.com/2013/12/04/fertility-treatment-multiples_n_4386148.html” target=”_hplink”A major report/a that delved into why the number of twins and other multiples in the U.S. is so much higher now than it was four decades ago found that a third of all twin births, and more than three-quarters of all triplet and higher-order births (i.e. multiples of three or more) were due to the use of some form of fertility treatment. But notably, the report also found that in vitro fertilization — often singled out as the main culprit — was, in fact, no longer the greatest contributor to the rate of multiples. Instead, other treatments, such as ovulatory medications, were the top cause.

  • 3. Miscarriage is more common than most people know.

    When researchers with Montefiore Medical Center in the Bronx a href=”http://www.huffingtonpost.com/2013/10/17/miscarriage-cause_n_4116712.html” target=”_hplink”polled a group/a of more than 1,000 men and women between the ages of 18 and 69, they found that they grossly underestimated how common miscarriage, or the loss of a fetus before the 20th week is: More than half said it occurs in fewer than 6 percent of all pregnancies, but estimates suggest it actually happens in roughly 15 to 20 percent. Moreover, many respondents wrongly identified the major causes, citing stress, oral contraceptives and physical exertion, when, in fact, chromosomal abnormalities are most often to blame. The study wasn’t meant to stoke fear, but rather to point out how much misinformation there is about miscarriage, and how that can leave the women and men affected by it feeling very alone.

  • 4. Maternal exercise benefits newborns’ brains.

    Exercise is, understandably, the last thing on many women’s minds when they’re exhausted, sick and can’t remember the last time they saw their toes, but a href=”http://www.huffingtonpost.com/2013/11/12/exercise-pregnancy_n_4260874.html” target=”_hplink”one study showed/a that just a bit of moderate exercise (in addition to helping with things like mood and sleep) might also boost babies’ brain activity, by contributing to a healthy fetal environment. Babies born to women who clocked at least 20 minutes of moderate cardio three times a week appeared to be better at processing certain sounds, which may have implications for overall brain development. “Our results show that the babies born from the mothers who were physically active have a more mature cerebral activation, suggesting that their brains developed more rapidly,” the study researcher told HuffPost.

  • 5. Junk food addiction may start in the womb.

    It was a a href=”http://www.huffingtonpost.com/2013/05/07/junk-food-addiction-pregnant-mothers_n_3186552.html” target=”_hplink”highly preliminary study done in rats/a, but an investigation out of Australia nonetheless raised interesting questions about what can happen when women eat a significant amount of junk food during pregnancy. Researchers found that rats whose mothers ate diets high in fat and sugar (think sweet cereals and potato chips) had a greater preference for high-fat foods after birth than those whose mothers ate a diet that was low in fat and sugar — and the gene expression in the reward pathways of their brains was changed, so that they had a greater predisposition to a junk food addiction later in life. Though it’s too early to say if the findings can be extrapolated to humans, the study’s main researcher argued that the “take-home message for women is that eating large amounts of junk food during pregnancy and while breastfeeding will have long-term consequences for their child’s preference for these foods.”

  • 6. Pregnancy interventions are common … and not always welcome.

    Despite the fact that roughly 60 percent of moms in the U.S. who were included in a href=”http://www.huffingtonpost.com/2013/05/09/pregnancy-interventions-_n_3247480.html” target=”_hplink”a survey about birth practices and beliefs/a said they feel giving birth is a natural process that shouldn’t be interfered with unless it’s absolutely necessary for medical reasons. However, one-quarter of the women surveyed said they had at least three interventions during birth, from taking drugs to speed up or start labor to having a C-section. Twenty five percent of respondents who were induced or had an epidural said they felt pressured at the hospital to do so, as did 13 percent of those who had a C-section.

  • 7. Midwifery care is linked to better outcomes.

    Most women in the U.S. rely on doctors to provide their primary care during pregnancy and birth, but a growing minority rely on midwives, and a href=”http://www.huffingtonpost.com/2013/05/09/pregnancy-interventions-_n_3247480.html” target=”_hplink”a Cochrane review/a lent some serious support to that model. The review found that consistent midwifery care throughout pregnancy was linked to better outcomes for mothers and their babies, compared to women who saw family physicians, OBs, or some mix of health care providers. Women who worked with midwives had lower rates of episiotomy and epidural useand they were less likely to deliver their baby prematurely. None of the studies cited were conducted in the U.S., but the review’s lead author argued that the findings are still relevant in this country.

  • 8. Delayed cord clamping has benefits.

    The clamping and snipping of the umbilical cord can be a memorable post-birth moment — particularly for hands-on fathers and partners — but an a href=”http://www.huffingtonpost.com/2013/07/11/cord-clamping_n_3581036.html” target=”_hplink”investigation released in 2013 /asuggests its best done at least a minute or two after the baby is born. The review of 15 previously published trials from around the world found that delaying by just one minute can increase a newborn’s iron supplies for up to six months post-birth.