I’m pleased to introduce a new columnist here at Postpartum Progress: Kate Kripke. Kate is a Licensed Clinical Social Worker (LCSW) specializing in the prevention and treatment of postpartum depression. She is also a Colorado state coordinator for Postpartum Support International. Kate lives in Boulder with her husband and two daughters. She will be writing once a month at PP, so look for her!

The Impossible Simplicity of Treating Postpartum Depression

Is it even possible to say that the treatment of postpartum depression and other perinatal mood and anxiety disorders is “simple”? Of course, it doesn’t feel that way. For many, many women, getting over and through the challenges of a pre- or postpartum mood disorder such as PPD can feel unfairly complicated. And, in many ways, it is. We know PPD to be a complex illness, with roots in imbalances and disturbances that cross a woman’s physical, social and psychological being.

But, what if we were to think of the treatment of and recovery from postpartum depression in its most simple form? Would this be helpful?

In my Boulder, CO, private psychotherapy practice I get asked often – always, really — about how long recovery from PPD takes. Of course there is no one answer for this as each mom’s challenges and experiences are unique. But sometimes, looking at treatment and recovery as somewhat linear and specific can bring some hope and optimism at a time where it feels that both of these gems are lacking.

So, here goes: If there were a map of PPD treatment and recovery, what would it look like? What are some things that every mom can consider in working her way towards a stronger sense of wellbeing?

Again, we know that these illnesses stem from disruptions in a woman’s biology, psychology, and social systems, so, if we pull these three areas apart and look at each separately, we may be able to make some sense out of a very overwhelming situation.

Where are you being filled up in these areas? Where can you use additional support?

Biology or Physical Body: This is usually the first place to start. Making sure that you are getting your basic needs met is critical in your recovery. Hormone shifts post delivery that affect biochemistry put every childbearing woman at risk. Add sleep deprivation, nutrient depletion and possibly a personal or family history of depression, anxiety, or other mental illness, and many women suddenly find themselves thick in the midst of complicated emotions that they never believed would accompany becoming a mama. So, important questions to consider are:

1. Do I have a genetic predisposition of depression, anxiety or mental illness? If the answer is yes you are at a 50% greater risk for developing PPD. And women who have a history of bipolar disorder are at the highest risk of developing postpartum psychosis, the most rare and also most severe postpartum mood disorder. For many women who are struggling, appropriate medication support can be incredibly helpful and important.
2. Are you able to strategize around sleep? Can you get support during the day to nap or at night so that you can get at least 4-5 hours of uninterrupted sleep each night? Studies have indicated that sleep deprivation may play a greater role in the development of depression and/or anxiety than the temperament of one’s baby.
3. Are you getting enough nutrients? It is easy for mom to become depleted during pregnancy, childbirth and breastfeeding. Adequate nutrition is an important part of your body’s ability to make and process the necessary “feel good” brain chemicals such as serotonin and dopamine.

Social Network: Ours is one of the few societies in which it is assumed (or expected) that mom can and will take care of a babe and everything else on her own. You’ve heard the term “It takes a village”- well, it does! So, it’s important to seek out the much needed and deserved support at this time, especially if you have postpartum depression.

1. Can you enlist the help of friends, family or hired professionals to help with cooking, cleaning and even just holding the baby so that you can sleep, shower or get some time to yourself? Do you know of someone who is willing to set up a “meal tree” in which friends and acquaintances drop off much needed meals several times a week?
2. Do you have other new moms who you can talk to during this challenging time? Isolation plagues most new moms, and so getting the emotional support necessary is imperative. Research shows that Mom’s Groups (therapy support groups or community groups) can decrease symptoms of depression and anxiety in many women.
3. If you are married or partnered, are your relationship needs being met? We know that the first year after having a new baby is often the hardest on relationships and so it is hugely important to tend to these needs. Does your partner and/or does Dad need help understanding what you are going through? Is Dad suffering from PPD himself? Are you able to seek out a trained professional to help navigate some of these relationship challenges?

Psychological Processes: Even if basic needs are being met, the mind can take hold and truly wreak havoc on wellbeing. Receiving validation, working with a trained therapist and allowing yourself the care that you need can often help to shift thought patterns that contribute to unwelcome symptoms.

1. Yes, new motherhood is surprisingly difficult for those of us who like to be in control, are perfectionists or who are not expecting the inevitable identity shifts that come along with becoming a parent. Understanding your triggers around this, being especially kind to yourself, and re-setting expectations and priorities so that they are appropriate for this time is imperative.
2. Are there past or unresolved issues with your family of origin that are interfering with your ability to be present with and attach to your own baby? This is an important piece to consider and is usually quite unexpected. The same goes for previous trauma histories, if they exist. Understanding the past’s role in the present is hugely important.
3. Are you able to regulate your emotions when necessary? Breathing techniques such as diaphragmatic breathing, progressive relaxation, and guided imagery are clinically effective in decreasing depressive and anxiety symptoms.

Of course, of course, of course I know none of this is ever as easy as it reads. The support of a trained mental health provider is almost always an important part in a mom’s recovery. And he or she should be able to help you navigate through these and other important questions as you strive for wholeness again.

Kate Kripke, LCSW