Postpartum depression (PPD) can be treated and managed effectively with medication, support groups, therapy, and other measures.
But there are some misconceptions and obstacles that can affect postpartum depression treatment. And many women simply struggle through it.
“It’s very common for women to delay seeking treatment for PPD,” says Alison Hermann, MD, a psychiatrist at Weill Cornell/NewYork-Presbyterian in New York City who practices both general adult psychiatry and reproductive psychiatry.
From concerns about medications to a lack of support from family or friends, there are a lot of obstacles that could be keeping you from making the most of treatment for postpartum depression.
1. Perceived Lack of Family and/or Social Support
Feeling isolated or alone in your complex emotions during the postpartum period is challenging and, unfortunately, common — especially if you don’t have family nearby. In those cases, “You may have to think about social support in a different way than before,” says Dr. Hermann.
Don’t be afraid to ask friends, coworkers, or neighbors to help, even if you haven’t turned to them for this kind of support in the past. “People often feel uncomfortable asking for help from others, but the truth is that every parent needs a lot of help,” she says. “Most people are surprised at how willing others in their lives are to help them if they just ask.”
2. Hesitancy About Taking Medications
You might have concerns about starting an antidepressant, due to possible side effects or the fear of exposing the medication to your baby through breast milk. For others, says Hermann, reluctance to take medication may have to do with not knowing how the medication may affect them. “Sometimes it’s just scary to do something new that is intended to change how your body feels. Particularly for people who are already feeling anxious, this can be a tough step,” she says. “But in my experience, most of my patients tell me that, in retrospect, they think they waited too long to give it a try.”
If you are feeling unsure about whether to take a prescribed medication, keep in mind that most meds used to treat postpartum depression are safe to use when you’re breastfeeding and lactating, Hermann notes. Talk to your doctor about any questions or concerns you may have, and try to remember that treating postpartum depression is the path to taking better care of your baby.
Research has shown that mothers with postpartum depression have difficulty sticking with breastfeeding because of symptoms such as low energy and motivation. And untreated postpartum depression can cause stress in the home, which has been associated with developmental delays for children.
3. Not Getting Enough Quality Sleep
Inadequate sleep is pretty much par for the course when you have a new baby. For moms with postpartum depression, that can make dealing with the depression all the more challenging. “Chronic sleep deprivation can affect your mood dramatically and can even be a driving factor for PPD,” says Naomi Torres-Mackie, PhD, a clinical psychologist at Northwell Health’s Lenox Hill Hospital in New York City who specializes in women’s mental health and reproductive mental health. “It’s also tricky because mental health itself can impact sleep,” she says. “If you have depression, that can lead to insomnia, as well. And then the less you sleep, the worse your mood, and it can become this vicious, very difficult cycle.”
To get more, better-quality z’s, first figure out a plan with your partner or other family members to help with shifts taking care of the baby. Allowing everyone to get a four-hour stretch of sleep at least once every 24-hour period can make a big difference, says Hermann. “You may need to do some problem-solving about how to set up the home and how to feed the infant to accommodate this, but it’s worth it.”
Practicing mindfulness can also improve your rest. Dr. Torres-Mackie recommends doing a guided meditation as soon as your baby goes to sleep to relieve stress. “Do it immediately, because if you leave wiggle room, your thoughts will come up, and then it’s very hard to relax your nervous system enough to go to sleep,” she says.
Also, Hermann suggests considering working with your pediatrician or a sleep coach to improve your baby’s sleep (when they’re physically and developmentally ready). If you’re checking your baby or the monitor repeatedly overnight, she recommends discussing this with the pediatrician or your own doctor. “Some parents who are anxious will check on the infant too much, out of a fear of something bad happening,” Hermann says. “This tends to increase anxiety and worsen sleep deprivation over the longer term while not actually keeping the infant any more safe.”
4. Stigma and Fear of Being Judged
Postpartum depression in no way reflects a weakness or failing on the part of the new parent. But talking about it with others can still feel intimidating. “Stigma can make you feel like you are the problem, like you shouldn’t be struggling — you know, like there’s something wrong with you,” says Torres-Mackie. “There’s a lot of social norms around motherhood, about being joyous and grateful and that mothers are so strong. But all of that can end up being harmful expectations and barriers to treatment.”
Hermann suggests reminding yourself how many other people can relate to what you’re going through. “PPD is extremely common and the most common complication of pregnancy: Approximately one in five women have at least some active symptoms of PPD during pregnancy or in the first six months postpartum,” she says, adding that about 10 percent of new fathers experience it, too. “So, if you think you might have PPD, you are certainly not alone.”
If it feels difficult to discuss your situation with family because of cultural traditions or expectations, turning to an outside therapist or support group can give you an understanding sounding board.
5. Not Eating a Healthy Diet
When you’re focused on the baby, it’s easy to eat whatever is in front of you or skip eating altogether. “Women are often underfed or eating foods that are disruptive to digestion in the postpartum period,” says Torres-Mackie. “That can have a major impact on your mood and your well-being.”
Eating nutritious foods can prevent mental illness by improving cognitive function and regulating neurotransmitters. Some research has shown that deficiencies in certain nutrients (such as magnesium and vitamins B and D) are associated with an increased risk of postpartum depression. Prioritizing fish, fruits and vegetables, grains, legumes, and herbs could help reduce postpartum depression symptoms — along with medical treatment when necessary.
6. Concurrent Health Conditions
Certain physical or mental health conditions can make postpartum depression worse or tougher to treat. “If you’ve struggled with PTSD, substance use disorders, or obsessive compulsive disorder in the past, unrelated to a PPD diagnosis, those can really exacerbate PPD,” says Torres-Mackie. Some endocrine diseases — polycystic ovary syndrome, thyroid disease, and prepregnancy or previous gestational diabetes — have been connected to a higher risk of postpartum depression, as well.
7. Lack of Time
For many new moms, the idea of making time for therapy or a support group meeting to manage postpartum depression can seem daunting and is often a barrier to getting treatment. Video calls and other telehealth services can help reduce wait and travel times, and you can ask family and friends to pitch in if you need to attend in-person sessions.
Managing postpartum depression is a partnership. Discuss any obstacles you may be experiencing with your doctor, so you can work together to find the right path to feeling better.
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