When Joanna Goddard returned home two years ago after spending an idyllic Christmas vacation with her husband and then 8-month-old son, something felt off. She was suddenly anxious and exhausted but had trouble sleeping at night. “I’d always had baby fever,” she says, “but now that I had a sweet, curious, beautiful baby, I suddenly couldn’t handle motherhood.”
The successful New York City blogger and freelance writer, who posts daily on A Cup of Jo, says the two months that followed were some of the worst of her life. She found it increasingly difficult and overwhelming to care for her son, even though she had been so excited to have a baby just a few months before. Some days, the thought of leaving her apartment was exhausting.
Goddard found out later that she was suffering from perinatal depression, an unfortunately common condition that affects one in eight women, putting them at risk of harming themselves and/or their babies. In this case, Goddard had recently decided to wean her son, Toby, and the hormonal flux that was occurring postbreastfeeding was contributing to her mood swings. Luckily, her body regulated itself, and she was eventually able to fully resume her life as a career go-getter and mother, welcoming her second son, Anton, earlier this year.
Like Goddard, many women experience similar ups and downs, but at different times. Given the immense changes the body goes through before, during and after pregnancy, it’s no surprise most women feel anxious, exhausted and vulnerable, crying at the smallest and silliest of things.
But showing extreme signs of sadness or anxiety for a prolonged period of time is no joke. Fortunately, perinatal depression is treatable, says Samantha Meltzer-Brody, MD, director of the perinatal psychiatry program at the University of North Carolina at Chapel Hill’s Center for Women’s Mood Disorders.
Meltzer-Brody has done research on the transitional release of hormones that occurs before and after breastfeeding and can contribute to mood disorders. And she says that education is a woman’s best defense against depression.
That’s because learning to recognize what changes are happening at different landmarks along your road to motherhood can not only prepare you for what to expect, but also allow you to recognize triggers that might indicate if you need to seek professional help outside of your established support group.
Here’s a look at what’s happening along the prenatal, postpartum and postbreastfeeding timeline, some of the common symptoms of depression, and where to turn for help if you think you might be depressed.
It should be an exciting nine months, but pregnancy can be overwhelming. Those fluctuating hormones make you particularly vulnerable to mood swings. “During pregnancy, female reproductive hormones (estrogen and proestrogen) rise to very high levels in order to sustain a healthy pregnancy,” Meltzer-Brody explains. “However, for some women who are bio-logically vulnerable, this time of hormonal flux causes mood symptoms, either due to genetic loading or a previous history of depression that has altered the biology or some other vulnerability.”
The New York State Department of Health lists crying, sleep problems, fatigue, appetite disturbance, loss of enjoyment of activities, anxiety and poor fetal attachment as common symptoms of prenatal depression. Although it’s normal to experience any or all of these during pregnancy, it is important to seek help if symptoms persist.
As a normal physiological response, those high estrogen and proestrogen levels you experienced during pregnancy fall rapidly postbirth. And similarly, that shift in hormone levels causes some women to fall into a funk. In fact, the chance of experiencing depression in the postpartum period (onset within the first three months postbirth) is greater than any other time in a women’s reproductive life cycle, according to Meltzer-Brody, who notes postpartum depression is one of the most common complications of childbirth.
And Margi Munson, IBCLC, RLC, a lactation consultant at Legacy Emanuel Medical Center in Portland, Oregon, explains that during breastfeeding, the changes can come on fast. “A woman who has just completed a pregnancy is going through many hormonal changes as her body makes the adjustment to the level of hormones needed to sustain life for her infant,” she says, which often leaves a new mother susceptible to the “baby blues.”
Experiencing signs of prenatal depression is one of the greatest indicators that a woman will also find herself depressed during the postpartum period. If you experience symptoms during pregnancy that are similar to those listed in the sidebar to the left, consider getting help as soon as possible. Doing so is key to preventing postpartum depression and its adverse consequences.
You may have made it through some of the most difficult times of your life—laboring and the postpartum period with an infant—but you’re not out of the woods just yet.
After baby weans, some women experience worsening moods or increased anxiety. That’s because your body experiences a significant drop in the hormone oxytocin after breastfeeding ends, and some women are more sensitive to this change than others.
In addition, women who stop breast-feeding early because of painful lactation are often depressed. “Women with depression are more sensitive to the perception of pain and have decreased pain tolerance,” Meltzer-Brody says. “In our research, we found that women who reported more painful lactation were also more likely to be depressed (at the time they reported the pain).” Unfortunately, this is rarely reported or diagnosed.
Meltzer-Brody does note, however, that most women are able to wean with minimal mood disruption and some even report an improvement in mood postbreastfeeding. Every body responds differently.