Postpartum depression.

by Dr. Lori Atkins and Dr. Andrea Palmer

Here you are. Mother of two. Living the dream. Two weeks ago you successfully delivered your second baby, your newest miracle.

Of course you aren’t sleeping well, but that you expected. You’re no rookie this time and you were braced for the exhaustion.

But now, your first born really wants to spend time with you, and you with her, but alas the new baby needs your attention and your milk.

You’re worn, frazzled, the laundry pile has taken on a life of it’s own, you have semi-malicious thoughts at your husband who casually strolls in and asks benign questions that seem to cut you to the core (i.e. “What’s for dinner?”).

You feel like this should be a most joyous time. You have two healthy children and a loving spouse. But you find you are tearful, anxious, maybe even frightened. You are starting to not trust yourself to care of these two small people who need you for their basic survival. You are literally keeping one of them alive with your body alone (as you did for the past 9 months).

You suddenly feel inadequate, lost and angry. You also likely feel like there is no one to talk. You are alone. You may be afraid to talk to your spouse, friends or parents—they may think you’re not able to handle two kids. So you begin to isolate, because you feel ashamed.


Postpartum depression affects about 15% of women with no prior history of depression. If you have a personal or family history of depression of any kind the rates are even higher. And even if you don’t have frank depression, the “baby blues” which is a mild and transient form of postpartum depression that self resolves occurs in up to 80% of women.

You are definitely not alone.

Why does postpartum depression happen? No one knows the exact mechanism for sure. We do know that in women who experience postpartum depression, there is an increased sensitivity to the normal hormonal fluctuations that occur after delivery. During pregnancy your estrogen, progesterone, cortisol and thyroid hormone levels are high. After you deliver, those levels all plummet. Each woman reacts to these changes differently, and may react differently from pregnancy to pregnancy.

Your likelihood of developing postpartum depression depends on your sensitivity to these changes, your genetics, your personal history of depression, your life stressors, and how well you cope with chronic sleep deprivation.

At FENOM, and in most OBGYN offices, we use a depression screening tool that is specific for the period of time around pregnancy and delivery. If the screening test is positive for depression, we typically recommend treatment. Treatment may be counseling, dietary changes, exercise, meditation or medication. I’ve discovered over the years that one treatment itself is not nearly as effective as combination of these modalities. I also have discovered that many women have had a low level of depression for years, but do not realize until we screen for it, identify it, and are able to address it.

Many women worry about starting medication. Is it safe? Is it okay to breastfeed my baby while I take it? The answer to both is yes. Another natural question may be — if postpartum depression is a hormonal problem, why not treat with hormones? Sometimes we do, if the thyroid is truly not functioning well, thyroid replacement works wonders. Some women who aren’t nursing can take combined contraception which can correct the loss of placenta estrogen and progesterone quickly. Another common concern regarding antidepressant medications is that you may have to take it forever, or you may get addicted to it. SSRIs (the most common type of antidepressant) are not addictive. The good news is that medication often only has to be used for a few months. Once sleep and your new structure of life can be restored and when your normal hormonal function returns, many women find they can stop medication.

Yes, you heard me right. For most women “normalcy” will return. Medications and lifestyle modifications are all done to optimize a new mom’s life, keep her and her family safe, and allow the her to really enjoy this time in her baby’s life.

It is so hard when you are in the throes of newborn baby care to really evaluate how you “are.” I have had two children. I am so fortunate to be insensitive to hormone fluctuations, but sleep deprivation is real and I am by no means immune to it’s effects. In hindsight, I know that I didn’t make my best decisions during the times I was up all night with my babies and still trying to be normally functional human being during the days. I didn’t see it then, but its clear now that I am far removed.

So moms, please know you are not alone. We have all been there, walked through the fire, and lived to tell the tale. But if you if you are experiencing the symptoms of sadness, fear, anxiety or withdrawal please talk to your doctor. You may or may not need medication. But you definitely need an ear to listen, a hug, maybe a good cry, and someone on your team fighting for you, your safety, and your peace of mind.