Treating Postpartum Depression with Cognitive Behavioral Therapy
As a new parent, you may be surprised to find yourself experiencing periods of sadness or symptoms of depression. If this is you, know that you are not alone. Many women experience low mood after birth, ranging from the “baby blues” to the more severe postpartum depression (PPD). Today we’ll discuss the signs and symptoms for these conditions as well as some ways that psychologists and psychiatrists can help.
The Baby Blues
As many as 70-80 % of women will experience mood swings and sadness after the birth of their child, and 15- 20% will suffer from postpartum depression. Sadly, it often comes as an unexpected shock to many women because it is not talked about nearly as much as it ought to be.
Most often symptoms of sadness or PPD will onset about 4 to 5 days after the birth, but for some women who had especially tough deliveries, this may happen earlier. The symptoms include:
Being tearful or crying for no clear reason
Impatience and irritability
Anxiety and restlessness
Fatigue or Insomnia
Difficulty concentrating
Sadness and mood swings
Why does this happen? During pregnancy many women experience a period of emotional wellbeing and calm driven to a large extent by the high levels of progesterone and other pregnancy hormones produced by the placenta. When a woman gives birth, she also delivers the placenta and hormone levels fall drastically. Since the ovaries were not active during the pregnancy it takes a few months after birth before the start producing the usual levels of hormones.
The hormonal changes taking place during and after birth can result in emotional shifts. In addition to physiological considerations, the life circumstances around giving birth can also contribute to low mood. For many women, the birth process itself is difficult, sometimes disappointing, and does not always go as smoothly as planned. It is also a big emotional change when a woman transitions from carrying this new life in her womb to caring for an infant, all while simultaneously recovering from the birthing process. If the birth was by a cesarian section, the woman is also recovering from major surgery. In addition the new baby is not yet skilled at feeding and sleeping and that means stress and sleep deprivation for the new mom. For these reasons, it is common for women to feel new worry and anxiety in the perinatal and postnatal (postpartum) periods.
Postpartum Depression
While the “baby blues” symptoms are common and the symptoms manageable, postpartum depression is a more serious concern. It can sometimes be difficult to distinguish between the two, but PPD is typically characterized by more severe symptoms. These include:
Intense anxiety that prevents you from sleeping or eating
Feeling guilty or worthless
Withdrawing from your partner or spouse
Difficulty bonding with the baby
Thoughts of self-injury or suicide
Your OBGYN, doula, or mid-wife will routinely ask about your mood and emotional functioning when you see them for check- ups. Remember that many women experience some type of emotional struggle, so it is important to be open and honest. This will allow your caregivers to support you with appropriate recommendations and referrals.
If you are experiencing low mood and want to do a self- evaluation, the Edinburgh Postnatal Depression Scale is one assessment tool available that can help you determine whether or not you may have PPD. A score of 13 or higher is indicative of a depressive episode and warrants that you follow up with a healthcare provider for a clinical consult.
While the “baby blues” usually goes away approximately 14 days after delivery, PPD may not remit on its own. Women struggling with this condition often need additional tools and support to address the symptoms. Many turn to psychotherapy.
How Can Psychotherapy Help Postpartum Depression?
Going to psychotherapy can be a great way to gain extra support as you deal with postpartum depression and adjust to new postpartum reality in general. If family and friends do not quite understand what you are going through, psychotherapy may be even more helpful to you. A psychotherapist is a neutral third-party who can provide a judgement free space in which you can rest and share. They will listen and provide helpful strategies as you move through this challenging period of time.
One technique that psychotherapists may use is Cognitive Behavioral Therapy (also known as CBT). This approach helps people to examine their thought patterns and unhelpful ways of acting. For new mothers, expectations for intensive parenting and pressure to be “perfect” can contribute to postpartum depression. A CBT therapist can help you examine those thoughts and shift them to more realistic expectations and positive self-talk.
In terms of behavioral change, many new mothers run themselves into the ground as they try to take perfect care of their new baby. A CBT therapist can teach you new strategies for taking care of yourself too. These can include relaxation training and mindfulness meditation. Remember, it is important to care for yourself so you will be able to feel better and take care of your baby and healthy and happy moms are good for babies.
What is the evidence to support CBT for Postpartum Depression?
In general, CBT is well researched and supported as a key treatment option for depression, anxiety, and other mental health issues. It is also a well studied method for effective treatment of postpartum depression.
“CBT interventions resulted in significant reductions in depressive symptoms compared to control conditions in both treatment and prevention studies.” -Sockol 2015
In a 2015 review study, Laura E. Sockol evaluated the effectiveness of CBT in both the treatment and prevention of PPD. After reviewing 40 scientific studies, she and her team found that CBT did help to reduce depressive symptoms both during the perinatal and postnatal periods. Pregnant mothers who received CBT were also less likely to experience postpartum depression. Overall, preventative efforts and early intervention were more helpful than later intervention and demonstrate how important it is to seek help right away if you experience symptoms.
A meta- analysis from Dennis and Hodnet also reports that:
“Results from nine trials involving 956 women found that both psychosocial (e.g., peer support, non‐directive counseling) and psychological (e.g., cognitive behavioral therapy and interpersonal psychotherapy) interventions appear to be effective in reducing symptoms of postpartum depression.”
They note that this approach may be more optimal than psychotropic medications, particularly as many women have concerns about breast milk transmission. It is worth noting, that treatment becomes more challenging when a new mother is nursing and consultation with a medical provider could be very helpful.
Where can I go for Help?
Your doctor, doula, or other pregnancy care providers are a great place to start when seeking a referral to a psychotherapist. Community groups on social media can also be a great resource.
Several practitioners at Mind Body Seven specialize in women’s health and can provide integrative support during pregnancy and postpartum. They may be able to help with psychotherapy, as well as other recommendations (such as nutritional supplements) that can support your emotional, mental, and physical well-being.
