Health and Wellness

By Ranu Boppana, MD

Postpartum Depression

Manju, a 32-year-old South Asian teacher, just didn’t feel right after the birth of her second child. She found herself exhausted, overwhelmed, irritable with her three-year-old daughter, constantly on the verge of tears and barely able to get things done around the house. What’s more, Manju just didn’t know how she could go back to work after her maternity leave. She was having enough problems keeping it together at home. Manju and her husband, Manish, had just bought a bigger house. As a result, Manish was now working more and was less available to help around the house. The couple was also feeling the pinch of their increased expenses. At home, Manju was feeling increasingly isolated from the career she had built for herself and just didn’t see herself as a stay-at-home mom.

Unfortunately, Manju’s problems got worse before they got better. A few weeks later, Manju deteriorated to the point that she couldn’t get out of bed, was crying all the time and couldn’t sleep at night despite feeling very tired. That’s when Manish intervened and sought help for Manju from her obstetrician.

Manju’s doctor did some blood tests and, after listening to Manju’s symptoms, decided that she met the criteria for postpartum depression. Additionally, the lab work showed that her thyroid was underactive. Manju had always had severe premenstrual mood symptoms, but had never been diagnosed with depression before.

Postpartum depression is caused by a confluence of biological, emotional and lifestyle factors. After delivery, a sudden drop in estrogen and progesterone combined with sleep deprivation, a demanding baby, lifestyle changes and a redefining of one’s identity can all bring about such a crisis.

The “baby blues” experienced by many new moms, refers to a shorter lived, milder form of the depression that is marked by some anxiety, sadness, irritability and exhaustion. When these symptoms persist for weeks or impair one’s functioning, it’s best to be evaluated by a doctor for postpartum depression. In rare cases, postpartum depression becomes more severe and is marked by confusion, disorientation, hallucinations, delusions, paranoia and a fear of hurting oneself or one’s child. This is known as postpartum psychosis and requires immediate attention to ensure safety.

Manju came to see me after having been referred by her obstetrician. With thyroid replacement hormones, psychotherapy and antidepressant medication, she learned to get more help for herself, to let some things go, to get adequate rest, to exercise and to develop supportive relationships with other young moms. She also sought out work as a tutor, which was more flexibly scheduled than full-time teaching, but allowed her to use her skills and creative talents. Manju learned that taking care of herself allowed her to be a better mother as well. She also sorted out how her role as a modern South Asian mother was different from that of her more traditional Indian mother.

Manju and her husband were right to seek help for postpartum depression. Often out of shame and stigma, many women struggling with similar issues never do reach out, and their conditions sometimes become chronic, taking a toll on the entire family.

Untreated postpartum depression can lead to problems for children in the household as well. Kids with a mother who is depressed run the risk of behavioral problems and mental illnesses themselves. So for the wellbeing of the whole family, it’s best to seek timely help for these conditions. For further information about postpartum depression, go to www.womenshealth.gov/faq/postpartum.htm.

Ranu Boppana, MD is an Adult and Child Psychiatrist in private practice in New York, NY and a Clinical Instructor at the NYU School of Medicine.

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