The term “postpartum depression” is actually a misnomer, and new research is changing the way doctors diagnose and treat this challenging — but highly treatable — condition

“I felt like such a failure. I was supposed to be a nurturing mom and I couldn’t hold my baby without having a panic attack. The guilt consumed me. Some days I couldn’t get out of bed. I would shut the curtains and literally hide under my blanket and wait for the waves of panic to overtake me”

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t was only in hindsight that Leah realized that her postpartum depression (PPD) started before she gave birth.

“I had these obsessive thoughts during my third pregnancy — like I didn’t believe the ultrasound that showed everything was fine with the baby. I knew I wouldn’t be able to relax until I was able to count those ten toes and ten fingers,” shares Leah, who was diagnosed with PPD after both her second and third pregnancies.

“During the whole third pregnancy, I kept saying to myself, ‘You’ll be fine, Leah, you won’t get postpartum depression like you did last time.’ I woke up with these obsessive thoughts, spent the whole day ruminating on them, and went to sleep like that.” Even more alarming was the rage that would wash over her while she was driving, making her want to crash into things.

Most people assume that “postpartum” depression begins after delivery, as the name suggests. But recent research indicates that, in many situations, depression and other mental disorders often begin while the baby is still in the womb. A 2015 study involving more than 8,200 women from seven countries found that in those with the most severe symptoms — suicidal thoughts, panic, frequent crying — symptoms most often began during pregnancy, not after giving birth.

These findings are backed by other research. “Of those women who present with postpartum depression, about 50 percent of the time the depression most likely started during pregnancy,” reports Meredith Weiss, MD, assistant professor of psychiatry at New York Presbyterian Hospital, and board-certified staff psychiatrist and assistant training director at The Motherhood Center of Manhattan, a facility that provides supportive services and treatment options for new and expectant mothers.

The term “postpartum depression” is a misnomer on another account, adds Dr. Weiss, because the condition is not necessarily characterized by classic depression, as previously thought. “We’re finding that women with this disorder have a lot of anxiety during pregnancy and the postpartum period. They also may have panic disorder, obsessive compulsive disorder (OCD), or psychotic episodes, among other psychiatric disorders.”

Tamara associated PPD with depression, so she never entertained the idea that she might be suffering from it during her second pregnancy. “I wasn’t sad, I was active. I was busy volunteering and participating in community events,” she says. Though Tamara wasn’t depressed, she did experience periods of inexplicable rage and emptiness.

Because of the confusion caused by the name PPD, most clinicians today actually refer to postpartum depression as PMADs — perinatal mood and anxiety disorders. This is just one example of how the medical community at large is changing its approach to both diagnosing and treating this condition, which, according to the American Psychological Association, affects up to one in seven women.

 Hiding Behind a Plastic Smile

Yad Rachel is a community-based organization in Lakewood, New Jersey, that services women suffering from, or who are at risk for, PMADs. The team there includes Bashie Reiss, LCSW, and Miriam Lowinger, LSW, who specialize in helping women suffering from anxiety and depression. They say that many clients don’t drag themselves into Yad Rachel looking disheveled, like they haven’t been out of bed in weeks (although there are those who do). “Many women look better than you or me. They’re put together; their houses are neat. They’re fulfilling all their outward responsibilities. But inside, they’re falling apart,” says Miriam.

“I didn’t stop functioning when I had my baby — I was over-functioning,” Leah shares. The fake smile plastered on her face fooled everyone but those she confided in. “Nobody knew that I returned to work four weeks after my daughter was born because I felt I needed to get away from her,” says Leah, who remembers giving her newborn daughter a bath and feeling hatred, with the terrible thought of “the water can go over her and drown her” going through her mind. “Even today, no one except for close friends knows that I’m taking three types of antidepressant and anxiety medications to function.”

Tamara says she was so deep into her disorder that even after her daughter was born, she didn’t realize anything was wrong. Thankfully, her husband did. “He noticed that I wasn’t bonding with my child at all,” she says. “He sat me down and said he was going to make an appointment with a psychiatrist for me. That’s when I burst into tears. I felt like such a failure. I was supposed to be a nurturing mom and I couldn’t hold my baby without having a panic attack. The guilt consumed me. Some days I couldn’t get out of bed. I would shut the curtains and literally hide under my blanket and wait for the waves of panic to overtake me.”

The psychiatrist, who first saw Tamara two months post birth, quickly diagnosed the problem: “He told us that my symptoms were classic PPD and immediately started me on medication.”

Everybody agrees that the sooner the disorder is detected, the more effective treatment will be. “This applies on many levels,” contends Bashie. “The earlier the woman gets help, the fewer unhealthy neural pathways are created, the less time it will take to lessen the symptoms. Also, the less collateral damage will be created. A woman who is suffering from PPD does not suffer alone — her husband and children suffer along with her.”

Another major concern is that PMADs affect bonding and attachment, which are vital for a newborn’s emotional, psychological, and physical development. A mother who is laid low by a PMAD will have a harder time bonding with her child.

“If the problem is treated after six weeks instead of nine months, the damage done to everyone will be much less,” Bashie emphasizes. And if you can catch the problem during pregnancy, all the better. Studies have shown that severe depression and anxiety can actually change the environment in the uterus. Cortisol, a hormone that’s produced during times of stress, is released into the uterus and may be unhealthy for the growing fetus. It has also been documented that women with very high levels of cortisol are more likely to give birth early and have babies with low birth weight and smaller head circumference.