The pop superstar gave an interview in the most recent edition of Vanity Fair and talked very frankly about her battle with postpartum depression, following the birth of her son. She said her postpartum depression made her feel "very inadequate" and as if she "made the worst decison of my life."

New moms experience all sorts of feelings, thoughts, and behaviors that their non-pregnant selves would never dream of! In the first few weeks after delivering a baby, about 80 percent of women will experience crying for no reason, impatience, irritability, anxiety, fatigue, sadness and trouble concentrating.

When do these feelings extend beyond “normal” and into the danger zone?

According to Diana Lynn Barnes, PsyD, an expert on maternal mental health, these are common feelings expressed by women with postpartum depression:

• No one has ever felt as bad as I do (helplessness)
• I have made a terrible mistake (anxiety)
• I am all alone and no one understands (isolation, withdrawal)
• I’m a failure as a mother, woman, and wife (guilt, diminished self-esteem)
• I will never be myself again (hopelessness)
• I’m losing it (despair)
• Everything is an effort (exhaustion)
• I have such trouble deciding (disorientation, confusion)
• I feel like I have soda fizzing through my veins (anxiety)
• Sometimes I think everyone would be better off without me (suicidal thinking)

Luckily, risk factors for postpartum depression are known, so at-risk women and their families can be proactive about their postpartum mental health. Make sure your pregnancy care provider knows about:

• Personal or family history of depression, anxiety, obsessive-compulsive disorder, postpartum depression or psychosis.
• Personal or family history of thyroid illness, chemical dependency, or alcoholism.
• Premenstrual dysphoric disorder.
• Past experience of trauma (physical, emotional, sexual abuse).

Postpartum psychosis is a serious, life-threatening illness that increases the risk of a mother committing suicide, killing her baby, or abusing or neglecting her baby. It occurs in about 0.1 percent of births, begins suddenly within two weeks of delivery, and may require emergent psychiatric hospitalization. A personal or family history of bipolar disorder, postpartum psychosis, or a previous psychotic episode are the most ominous risk factors, but women without any risk factors can develop postpartum psychosis. If you notice a new mom experiencing these things, it’s time to get help NOW:

1. Strange ideas or beliefs which are often of a religious nature, i.e. receiving prophecies, supernatural baby, evil baby (delusions).
2. Hearing commands.
3. Receiving secret messages from TV, music, books, online, etc.
4. Unwanted and disturbing urges to commit violent or other terrible acts.
5. Hallucinations involving smell, sight, or touch.
6. Intense fear of what she might do and a desire to escape.
7. Inability to sleep, a drastic increase in energy, euphoria (mania).
8. Not making sense when talking, easily distracted (disorganized speech, flight of ideas).
9. Frequent arguments, irritability, annoyance, and conflict with family members.
10. A false idea that people close to them are dishonest, dangerous, or trying to hurt them or their baby (paranoia or suspiciousness).
11. Confusion about where, when, and who they are time (disorientation).
12. Obvious lack of self-care.
13. Feeling unable to care for her baby, or extreme worry that she can’t keep the baby safe.

The great news is that postpartum depression and psychosis can be effectively treated, especially if help is sought early.

• The widely used screening tool - the Edinburgh Postnatal Depression Scale
• Postpartum Support International
• More about Diana Lynn Barnes, PsyD

I have to start with an apology.

It’s not that I didn’t care, or wasn’t concerned.

I asked about feedings and dirty diapers. I asked about sleep positioning. I asked about your plans for vaccination. I educated on how to take a temperature and what a fever is, whom you should call when you are concerned.

I know a lot about your baby from our little time together.

But, I often forgot to ask about you.

Sometimes, if you looked particularly tearful, concerned … I don’t know, maybe distraught, I asked how you were doing. You might have said “fine” and I probably left it that.

Recent news reports reminded me that I should be doing better.

Depression affects about 30 percent of women between 18 and 44 years of age. I don’t want to get bogged down with more stats, but about 15 percent of women in their reproductive years take antidepressants. Most experts agree that untreated depression carries much more risk to babies than medications for depression. Studies have shown mixed results with most indicating that they are safe and others indicating a slight increase in risk for birth defects.

A special US Preventative Service Task Force report stated that all adults should be screened for depression but placed particular emphasis on the importance of screening pregnant and new moms. They conclude that screening should be implemented “with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.”

If new moms should be screened for depression, who is going to do it if I don’t? Many don’t go back to their obstetricians until six weeks. What doctor are they seeing in the mean time? Who is going to screen them for postpartum depression? It has to be me.

Many pediatricians do this very well. They have built a system in place and screening has been part of their process for years.

Those of us who didn’t have many reasons…

Other priorities took over.

Checkup times are too short.

We’re not sure what we would do when we identified someone with postpartum depression.

But none of those are good excuses.

Because of this, I promise to work to develop a system that works.

I have to.

For you and for your baby.

I will report back with more soon.

Sincerely,

PS. Symptoms of postpartum depression can include:

• Increased irritability
• Loss of patience
• Quick mood changes
• Excessive energy or extreme fatigue
• A sense of feeling hopeless or overwhelmed

If you are someone you know is suffering from these symptoms, please ask for help from someone. Start with a friend or a doctor but do not suffer in silence. There are resources available.

“There’s a lot of misunderstanding,” she said last month on “Live! With Kelly and Michael. “There’s a lot of people out there that think that it’s not real, that it’s not true, that it’s something that’s made up in their minds, that ‘Oh, it’s hormones.’ They brush it off. It’s something that’s completely uncontrollable. It’s really painful and it’s really scary and women need a lot of support.”

Yvette R. Johnson, M.D., MPH, is medical director of Cook Children’s NEST Developmental Follow-Up Center, which provides support, planning and care coordination for high-risk NICU babies.

"Although the focus of the NEST clinic is to evaluate the developmental outcomes of high risk graduates of the NICU, we recognize the mental health of the family and mother are also critical factors in the growth and development of these infants," said Dr. Johnson, who has researched the impact of postpartum depression children. 

Social workers and parent peers are available for moms who are at Cook Children’s NICU, following the birth of their child. The NEST clinic plans to add a service to its current interventions that will include screening for postpartum depression, and assisting families to access mental health resources in the community.

“It’s difficult to tell how big of a problem postpartum is because it hasn’t been uniformly measured very well,” Dr. Johnson said. “Anecdotally, I have seen the negative impact on the baby’s long-term development. It can impact a child in his or her growth and outcomes, in ways such as behavior disorders and poor school performance.”

Symptoms of postpartum depression can include:

• Increased irritability
• Loss of patience
• Quick mood changes
• Excessive energy or extreme fatigue
• A sense of feeling hopeless or overwhelmed

Postpartum depression is likely more common than you think. If you are experiencing these symptoms, you are not alone.

For your own safety and the safety of your baby, don’t be afraid to ask for help. Your doctor or your baby’s pediatrician will have resources that can help.

About the source

Yvette R. Johnson, M.D., MPH, is the medical director of Cook Children's new NEST Developmental Follow-up Center. Dr. Johnson is a neonatologist with an interest in the area of neonatal developmental outcomes She earned her medical degree from Washington University School of Medicine, and continued with her residency at Saint Louis Children's Hospital and fellowships at Saint Louis Children's Hospital and Johns Hopkins Bloomberg School of Public Health. She is board certified in neonatal-perinatal medicine.

Just in time, a new study released online in Pediatrics (the journal of the AAP) describes the risk of depression in fathers of young children (0-5). They started following males in adolescence and followed them for 23 years using a depression scale to document their level of depression.

The scales asked some fairly pointed questions regarding depression. Here are some examples:

• Were you were bothered by things that do not usually bother you?
• Did you feel depressed?
• Did you feel you were too tired to do things?
• Did you not enjoy life?
• Did you feel that people disliked you?

I found the results very interesting:

During the first 5 years of their child’s lives, fathers showed a 68 percent increase in depressive symptoms.

Does this surprise you or not?

While the study did not specifically describe the rate of depression in the immediate period after the baby was born, I would suspect that many of these depressive symptoms began to emerge during that time.  I have done this new parenting thing a few times (3 times in 5 years).  Having a new baby in the house is incredibly exciting and brings so much unspeakable joy. However, that joy comes with many changes.

I never felt that my symptoms rose to the level of depression but there were, at times, feelings of sadness and loss. Let’s walk through some of the reasons and some potential solutions.
 

Loss of routine
I am a man of routine and consistency.I like waking up, having a cup of coffee, reading and getting ready to go to work. Staying home with my wife for a week after our babies were born was very important to me but I did start to miss my routine.

Try to keep some semblance of your normal routine if possible. Remember that your sleep at night will likely be broken up (I was always the water boy for my breastfeeding wife and the post-feed burper and rocker) so you might want to get to bed earlier than normal so you can keep your morning routine in some form or fashion.

Loss of autonomy
When you got married you might have realized that your decisions were no longer just about yourself anymore. For me, having a baby is that feeling, on steroids. You suddenly feel guilty for wanting to do anything for yourself anymore as if in some way you will miss something or will be needed and not be there.

It sounds like a line from a self-help book, but remember that in order to be a good provider, you have to take care of yourself to some degree first. Find some time to do something by and for yourself at least every few days. For you, that might look like going for a run or going to read a book at Starbucks. But, whatever it is, take a little time for yourself.

Loss of intimacy
Yes, I do mean in the physical way (those OBs and their rules - seriously follow those rules). But, it’s much more than that. All of the sudden, you realize that those deep conversations you had with your wife (that you might not have thought were important) are less frequent. You are both tired and have a singular focus that tends to dominate your conversations (When was the last feed? Did I start on the left or right side last time? Is this yellow, runny stool normal?)

Try to find the time and energy to start one deep conversation per day. One great conversation starter in this time period can be: “How are you doing with all of this?” Don’t settle for, “Fine.” Ask deeper questions. Then, after you’ve taken the time to hear mom out, you’ll probably get a chance to share some things yourself. You’ll be glad you did.

The overlying concern for these feelings is that you might begin to feel guilty about having them. You know in your brain that this time is supposed to be one of the happiest times of your life. This tension is common and normal. It might be helpful to seek out other fathers whose advice you feel you can trust to talk through it. They may have more specific advice that will work better for you. The important thing is to resist the urge to tough it out and do it on your own.

Ultimately, you may feel that you are passing over from feeling a little down to actually feeling depressed.  If you have concerns about this, it’s best to seek out professional help from your doctor or a counselor.