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Are You at Risk for Postpartum Depression?

The risk factors for postpartum depression may be responsible for the experience of at least 13% of women who have felt the “thief of motherhood.” In this post, I’m going to go over common concerns regarding the risks of postpartum depression:

What are the symptoms of postpartum depression (PPD)?

What I’m talking about is not the ‘baby blues’ – which is medically defined as mild symptoms that resolve after two weeks, at most. We need to be careful about confusing the two. Sufferers are feeling fragile and awful enough without also feeling misunderstood or worse – dismissed.

By the time patients are referred to me for psychological intervention, they will report some or all of the symptoms I’m about to list below. The suffering will have already been going on for months, often in isolation. Sometimes the shame of not being happy with their newborn bundle of joy (or maybe noise and poop??) is accompanied by guilt.

‘Because your supposed to be grateful, happy and radiant with a newborn crying baby, sleep deprivation and a complete life-change for which there is no preparation or training, right??!! (Hmm….)


From baby blues to postpartum?

If you find yourself nodding and saying ‘yup’ a lot as you read through it the list below, remember that it’s OK. All of these feelings are normal postpartum (yes they are, you are not incompetent, weird or a bad mother) feelings. And these feelings persist for longer than a couple of weeks and it still feels bleak and unmanageable, that’s when you might be moving from ‘baby blues’ to PPD.

  • Tearfulness
  • Anxiety / fearfulness
  • Overwhelm
  • Loss of interest in yourself, grooming, washing, dressing etc
  • Absence of interest in the baby – ranging from indifference to loathing
  • Guilt for having those feelings
  • Loss of appetite
  • Lack of libido
  • Social isolation
  • Anger and rages
  • Mood swings
  • Emotional emptiness or numbness
  • Exhaustion
  • Sleep disturbance
  • Reduced cognitive abilities – memory glitches, speech or writing errors.
In rare cases women suffer from postpartum psychosis. The main symptoms of this are hallucinations, paranoia and severe confusion. The big risk factors here appear to be existing bipolar depression or schizophrenia. It’s usually treated with antipsychotics and mood stabilisers like lithium.


What medical professionals may do

Medical science cannot yet provide us with a full description of what happens during PPD – or indeed during depression itself. The serotonin hypothesis hasn’t fared too well in recent years casting doubt over the (still widespread) use of SSRI antidepressants.  

Many doctors though will still prescribe SSRI’s for depression and PPD – you maybe take them yourself. They are still in the top ten most prescribed drugs list in the US (showing us how commonly depression is diagnosed) generating a sales figure in 2014 of $4,095,537,942. #ChChing!!!

So medically speaking for now at least, what we are left with are theories, which I accept isn’t much use when you feel you’re in hell and what you want is a definite, preferably quick and easy way out.

But I do believe there is a way out. It’s just hidden from plain view.

What causes postpartum depression?

The physical aspect

The medical model tells us that estrogen, progesterone, and thyroid hormone levels are implicated in PPD. According to a recent study, a condition called Postpartum Thyroiditis and new onset Graves Disease should be ruled out with he latter being present in 7% of PPD patients as contrasted to 0.2% for the ‘normal’ population. It may also be useful to rule out Hashimoto’s as an underlying or triggering cause. Speak to your doctor about testing if they haven’t already done so.

Both estrogen and progesterone levels pretty much crash after giving birth. It is theorized that these hormones are connected very much to the female mood and sense of well being and health. This is why some women are prescribed hormonal treatments like the pill.

But what if antidepressant and hormonal treatments don’t work?

The emotional aspect

It seems to me that the problem and solution to PPD both lie within the emotional world of the mother. So I routinely check several things when a new client arrives with a medical diagnosis of PPD. If you suffer or have suffered maybe mentally walk through this with me and see if you can relate.

Possible risk factors

  • Is there a family history of depression and/or PPD?
  • Have you miscarried?
  • Are you or have you suffered through an unresolved bereavement?
  • How supported do you feel by your partner, if you have one?
  • Are you under financial pressure?
  • Have you moved house recently?
  • Did you want this baby?
  • Is your baby wanted by your partner?
  • What was the pregnancy like?
  • How did you handle the birth?
  • Did you have a birth-plan and did that work out?
  • How were you treated by your birthing professionals?
  • Did you feel safe and respected by your gynae/ midwife?
  • How does your baby sleep?
  • Are you still in physical pain after the birth?
  • Is breastfeeding more than you can handle?
  • How is your sex life?
  • Was this pregnancy the result of consentual sex?
  • Were you ever sexually assaulted, raped or abused?

Are unrelated emotional responses normal

Some of the connections here are obvious. But birth can also trigger emotional responses to issues that might at seem unrelated. And when I explore the above risk factors with clients, it transpires that these issues feature in PPD sufferers’ lives with great consistency. Indeed there is much research to confirm this. My experience is by no means isolated or special!

So these questions help me get the invaluable information that will ultimately help my client understand what has been triggered by the pregnancy and/or birth. We tend to forget what a big deal giving birth is, because it has become medicalized and scheduled.

A new mother can have emotional needs that go unnoticed, and unmet. This is why her relationships and their reliability are vital to her mental well-being. And you should never underestimate the importance of the connections you can have with different people and the places you visit. Sometimes the change, loss or any amount of reduced security we have can lead a diagnosis of PPD.

Asking for help

We are not immune to vulnerability, exhaustion and physical pain. There are no parent training manuals nor do we have parenting instincts that are immune to self doubt.


As you can imagine, no drugs will make these issues disappear. So if you are on medication for a known hormonal issue but still feel awful, then maybe what’s really going on is, or is related to something on this list. And that means it’s workable. It’ll just take some time, maybe some help. Both of which you deserve.

In my next piece I’ll look at some of these issues more closely. And meanwhile:

If you are finding that reading this piece is bringing up painful memories or feelings, please be OK with asking for help. Superwomen don’t exist!!




Sally O'Reilly

Sally O’Reilly is an IAHIP, ICP and EAP accredited Counselling Psychologist, Psychotherapist and Clinical Supervisor with nearly twenty years of professional experience. Her particular area of expertise and interest is work with teenagers. She enjoys a busy full-time private practice and has developed and facilitated a personal development, substance misuse and sexual health programme for teenagers for over 15 years. She is a regular contributor to national print and radio media.
Sally is also the co-author of Two Wise Chicks.
Feel free to follow Sally on: Facebook | Twitter | Linkedin


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