Myth # 1: Having a Baby Causes Postpartum Depression
The name says it all: “postpartum” depression is brought on by having a baby. It’s true that women are more likely to be depressed during and following pregnancy than at other times in their lives. Surveys of women who recently had babies show that about 13% are depressed which is higher than the normal rate for women in their childbearing years. However, this finding doesn’t mean that they became depressed after giving birth. Studies that follow women from pregnancy through the postpartum period show that up to 40% of the women who are depressed after childbirth also were depressed while they were pregnant. At this time, we don’t know how many of these women were depressed before becoming pregnant or what role the pregnancy played in their depression. At least some of these women will be depressed for reasons unrelated to their pregnancy, such as the death of a family member.
Myth #2: Postpartum Depression is caused by Hormones
Myth #2 follows from Myth #1. If having a baby causes postpartum depression then postpartum depression must be caused by hormones. You read it in magazines; you hear it from your doctor. This is the most persistent – and the least substantiated – of the six myths. For 50 years researchers have tried to find a link between hormones and postpartum depression. They’ve looked at the levels of estrogen and progesterone, both in isolation and together. They’ve looked at the rate at which these hormones return to normal. They’ve found nothing. There is not a single piece of evidence to support the myth that hormones cause postpartum depression.
However, the persistence of this myth is impressive. I’ve had the experience of sitting in my office with a postpartum depressed woman and telling her what I’ve just written only to have her say, “Well, yeah, but I’m feeling really hormonal.”
Myth # 3: Postpartum Depression isn’t the same as Regular Depression
This myth follows from Myth #2. We know that reproductive hormones don’t cause depression if a woman hasn’t recently been pregnant. So if postpartum depression is caused by hormones, it must be a different kind of depression. Some people argue that the symptoms are different; others believe that postpartum depressed women want to hurt their babies. The media are particularly keen to link postpartum depression and killing one’s baby.
What does the evidence say? When postpartum depressed women are compared to depressed women who haven’t just had a baby, there are very few differences. One is that the postpartum women tend to be less severely depressed. However, the types of symptoms they report and how long their depression lasts are the same.
Another issue is the predictors of postpartum depression. If this is a different kind of depression then it should be predicted by different factors. However, the predictors of postpartum depression are identical to the predictors of regular depression: life stress, a lack of social support and a difficult marriage.
In all the ways researchers have thought to look, postpartum depression looks the same as regular depression.
Myth #4: Postpartum Depression doesn’t need to be treated
This myth also follows from Myth #2. If postpartum depression is due to hormones then the woman just has to wait for her hormones to come back to normal. Physicians will often assure postpartum depressed women that their depression will get better as time goes on.
This myth is dangerous. It may be one of the reasons that postpartum depressed women typically don’t receive any form of treatment. But they should. Women who are depressed during or after pregnancy are at risk for more depressive episodes, both after the birth of later children and at other times in their lives. For many women, the postpartum episode is just the first of many. This finding makes it an important episode to treat because the research shows that every time a woman gets depressed she increases her risk for another depression.
Depression at this point in a woman’s life also can have enduring consequences for her baby and her marriage. When a new mom is depressed, her baby develops more slowly, cries more often and is less likely to form a secure attachment to her, which can create problems for the child later in life. Women who experience postpartum depression also are less happily married 5 years later than women who didn’t become depressed.
Myth #5: Postpartum depression occurs out of the blue to emotionally healthy women
This myth certainly reflects what many women tell me. However, the impression that they were okay before the baby simply isn’t borne out by the research. The majority of women who develop postpartum depression have sought help for emotional problems in the past. The strongest predictors of an episode of postpartum depression are: 1. A previous history of depression and 2. Feeling depressed during pregnancy.
Myth #6: Only women experience Postpartum Depression
Again, this myth follows from Myth #2. If postpartum depression is due to hormones then there’s no reason to think new fathers will become depressed. In fact, having a baby is even more disruptive for fathers than it is for mothers, and on average more distressing. Up to 10% of new dads experience significant levels of anxiety and/or depression. This rate is 1 in 4 if their wives are depressed.
So what is Postpartum Depression?
If it’s not what the myths say it is, what is it? The causes of postpartum depression are just as varied as the causes of regular depression. A woman can become depressed because one of her parents dies, because she loses her job in a bad economy, because she’s all alone in a foreign country. There are just as many causes of depression as there are individual’s life stories.
That being said, the research does suggest certain patterns. The typical woman who experiences postpartum depression is unhappy in her romantic relationship and may fear that her partner does not love her. She feels unsupported by him. Perhaps her partner does not help out around the house or with taking care of other children. Outsiders may see her partner as indifferent to her. These factors induce depression at any point in a woman’s life. When women are unable to have close and harmonious relationships with the people who are most important to them, they feel bad. I believe this is especially true when a woman is pregnant or has just had a child because the baby is a tangible sign of her commitment to her partner, and she is sensitive to any indication that this commitment is not shared.
There is a reason that women who’ve just had babies are more likely than other women to experience depression – it just has nothing to do with hormones.