Jennifer Byrnes, LPC, PMH-C, Discusses Baby Blues vs. Postpartum Depression (Rerun)

0:01 Hello, today I have with me Jennifer Burns. Jennifer is back with us today to talk about the difference between baby blues and postpartum depression. If you remember from previous episodes, jennifer Burns, lpc, is a therapist specializing in perinatal mental health and trauma. Jennifer, thank you for joining me. Thanks for having me back. I was really excited to come on. A lot of the people I've talked to lately have been pretty excited about learning a little bit more about the differences between baby blues and postpartum depression, because it's something that I think there's a lot of confusion about.

0:41 Yeah. So really, when we're talking about baby blues versus postpartum depression and which one is really going on, we're looking at a couple of things we're looking at the timing, we're looking at the severity and we're looking at the duration. So I'll start by talking a little bit about baby blues. So baby blues is something that is really really common. Just because something's really common doesn't mean that it isn't uncomfortable or difficult to manage. But we're looking at somewhere between 60 and up to 80% of new moms or birthing people experience this following the birth of their child, and it starts somewhere between around two days after the delivery and can last up to two weeks.

1:32 So that two week cutoff is pretty important. And we're looking at sort of peak symptoms being around sort of three to five days. And what causes this? Things like the extreme hormone fluctuation of birth and is very much exacerbated by the acute sleep deprivation, of fatigue that happens right after we have a baby, right. Some of the symptoms that can occur are things like crying, feeling overwhelmed with motherhood, being uncertain about how to care for the baby, theirself manage the transition to parenthood. I remember feeling like, oh my God, I can't believe the nurses are going to let me take this baby home.

2:14 I have no qualifications for this, so that's super overwhelming, and a lot of times, irritability accompanies that as well. What's important to really note about this time, though, is that the overall mood is happiness and that symptoms are generally mild. Okay, so that's sort of an overview of baby blues. When we start wondering about postpartum depression again, we're looking after that two week point. Symptoms are persisting. Past that point we start to wonder and look into more about postpartum depression. It's really important to note that postpartum depression is part of this umbrella term called perinatal mood and anxiety disorders.

3:02 We shorten that to PMADS, and PMADS are the most common and under diagnosed obstetric complication. So a lot of times we think about issues with labor and delivery and postpartum physical health, but it's really important to know that actually, this is super prevalent and very under diagnosed. I think we're getting better in that department, but we still have plenty of room to grow. So we're looking at the timeframe for postpartum depression being again after that two week mark and around up to one year, although I will say that there is kind of a push to extend the postpartum period for up to three years post delivery, just because you know, anybody who's had a child knows that there are these extreme changes in transitions that really happen all throughout that time.

3:55 So technically up to one year, but really and truly I think we are starting to look past that to up to three years, and the prevalence for this is about one in seven birth in people, one in seven moms, which is pretty high. So the chances are good you know, several people who've experienced this. You may have experienced this. So some of the symptoms that we're looking at are a low or depressed mood more days than not, right, that's sort of a persistent feeling of gloom. It's pretty pervasive and persistent.

4:35 There can be a lot of feelings of guilt and there's a lot of low self-esteem sometimes that accompanies it. Lots of difficulty with sleep that's outside of what we would expect with bringing a newborn home early morning, waking, things like that, not being able to go back to sleep. So again, this is outside of just the difficulty sleeping anyway after caring for an infant. Having a lot, very low energy where rest is not restorative so you may be getting rest time but it's not doing anything for you. Lots of fatigue Again new parenthood. Tons of fatigue. This is sort of outside of the realm of that. And again, not being able to get rest and find it restorative is a big piece of that.

5:20 Not enjoying things anymore that you used to really enjoy. Having a poor appetite or perhaps eating as a coping mechanism so you can kind of notice changes in appetite either way, sometimes things like suicidal ideation with plans and intent, sometimes lack of connection with your baby, and again, I want to be really clear that those the suicidal ideation and the lack of connection with baby those are things that can happen, but they don't always. So I think a lot of the people that I've worked with have really struggled to sort of get to a place of understanding that they might have postpartum depression because they feel very connected to their baby so they may not seek help sooner because they're kind of like, well, I don't meet criteria for that, so this must just be something that'll go away on its own, and so I just want to be really clear that that is something that can happen, but doesn't always.

6:22 Some of the risk factors for postpartum depression include family history of postpartum depression, a personal history of depression, either prior to pregnancy or during pregnancy. That's kind of the big deal. We want to be monitoring for these symptoms during pregnancy also, even things like a history of really bad periods, a history of PCOS, a history of premenstrual dysphoric disorder these are all things that can potentially be risk factors. Having sleep sensitivity Again, sleep is like everything. We do not feel well when we're not getting good sleep, so that's something that we really want to be conscious of. If you already struggle with sleep, we're really going to kind of want to keep a closer eye on that.

7:06 Things like having a traumatic birth Absolutely You're going to skyrocket your odds of having something like postpartum depression. And then also individuals with like helper personalities or perfectionistic tendencies. And, without getting into too much again, pmab sort of encompasses all kinds of mood disorders as well as anxiety disorders, and we can see a lot of overlap. These things are not mutually exclusive. Many things can be happening at the same time. So again, just to kind of recap, baby blues we're looking at up to two weeks. We're looking at pretty mild symptoms, even if they're concerning to you, like nobody likes to cry all the time but also the predominant mood being happiness.

7:48 Postpartum depression we're looking at that two weeks after birth and up to a year, potentially more. The symptoms are a lot more pervasive. You're experiencing these things more days than not and the pervasive feeling is one of like gloom, very low mood and depression. So then, what do we do about this? Right? How do we help? How do we decide something is in need of more intervention Because nobody wants to suffer, right? We all deserve a really positive experience during our postpartum period. Again, not all of us are lucky enough to get that, but we want to do what we can to promote that experience.

8:34 So what we really want to be looking at in terms of getting help again after that two week mark, if you're not sleeping for days, which is actually another pretty significant risk for things like manic or psychotic episodes Again, I don't want to confuse this too much, but that is a huge risk factor If you are not sleeping, there's the potential for a lot of pretty significant stuff to be happening If you're having thoughts of harming yourself or your baby. Again, not to be confused with things like postpartum OCD just because we have these thoughts does not at all mean that that is something that we are going to do.

9:16 But whether or not it's related to postpartum depression or something else, you probably want to talk to someone about that. They're probably pretty distressing to you. If you're experiencing intrusive thoughts that are worrying you, like, I'm afraid I'm going to do X, y or Z. I'm afraid X, y or Z is going to happen to my baby. So if you are loved ones, are expressing concern about your well-being. These are all times in which considering seeking some outside help perhaps starting with your OB or the pediatrician or some of the other perinatal specialists, is sort of the way to go. That's how we are going to get started. So what kind of treatment is there?

10:00 So again, I want to be very clear that this is an incredibly treatable, very discreet kind of mental health issue. It is related to becoming a new parent, experiencing all of the hormone fluctuations that go along with that, and it is incredibly treatable. So, individual counseling, either weekly or bi-weekly depending on your symptoms, whatever your treatment team decides is most appropriate. And there are specialists like myself that really work with this population. You know we're called perinatal psychotherapists. There are ways to find us.

10:42 There are certifications that you can look for, but just because someone may not have that certification doesn't mean that they don't have tons and tons of experience with this. So I'm sure in the show notes we can include some ways to find some perinatal specialists in your area. It can be an option. Again, this one can be kind of scary for a lot of people, but I do want to just kind of bring up that this can be a very temporary thing. Again, this postpartum depression period is a period of time that will end If symptoms persist back that time. After that time we're going to start looking at some other diagnoses.

11:23 But postpartum depression in and of itself does have an endpoint and medication can be a very helpful temporary for a lot of people option for treatment. And one of the things that often comes up is especially for those Parents who want and are able to breastfeed is how is this going to impact my baby if I take this medication? And so there are perinatal psychiatrists, and perinatal psychiatrists really spend a lot of time and energy learning and studying and continuing education, keeping up on all the research about the medications that are shown to be most safe during pregnancy, really giving people a very balanced idea of the risks and benefits.

12:19 Everything's a risk-benefit analysis when it comes to medication during pregnancy and postpartum. They're going to be your people who really know their stuff in this area, even more than obese in a lot of cases. This is their wheelhouse. So I strongly encourage people who are considering medication to seek out a perinatal psychiatrist, and there are also prenatal, perinatal, postpartum support groups. A lot of times they are free. A lot of times they're offered through your hospital. There are also a multitude of support groups through the organization postpartum support international, also known as psi.

13:04 They have groups for Mothers, they have groups for fathers, birthing partners, they have groups for spanish-speaking individuals, so they have a variety of options to get some ongoing support. If individual Therapy isn't immediately accessible to you or it's something you're not quite sure you're ready for, those things are accessible and they're free. I think it's really important that people know that those things are available. Okay, so who can you talk to about these concerns? A lot of times people are going to start with their OB. Um, hopefully, your OB and your pediatrician are doing some screenings.

13:49 Who can you talk to about these concerns? If you're feeling really concerned or worried, if you have a loved one who's concerned about you as well, you can typically start with your OB or your pediatrician. They are doing some postpartum depression screenings and asking the the hard questions about concerns that you might have, symptoms that sometimes we don't want to talk about. A lot of times people don't want to bring up that they're having thoughts that are concerning to them, about something happening to their baby or something happening to themselves, because they're concerned that if they seek that help, that the baby might be taken from them.

14:35 And while I understand that worry, um, that isn't Typically going to be the case. People are seeking help, people have support systems and if it gets to the point where it looks like a mother might need to be hospitalized, that is not a reason to take her baby from her. She is trying to get help. It's very treatable, and there are some places that will allow the baby to Stay in the hospital with them. Not all places, but that is occasionally an option. So A couple of things that we really want to be keeping an eye on, sort of in general postpartum.

15:25 I call them the five tenets of good mental health. These are the things that we just kind of in general, need to feel good physically so that we can focus on our mental health. So, really again, I can't, you know, reiterate this enough. We really want to be focused on getting sleep and and what we're shooting for In the beginning is really at least five hours of connected sleep. I know that this can be really challenging for those people who might be exclusively breastfeeding and don't want to introduce bottle feeding at all, but for those individuals who are open to Bringing in bottle feeding, working with their partner or support network, um, in order to allow them that at least five hours of connected sleep, that's really really important.

16:21 And if we're not there which again in the beginning is going to be really tough, but if we're not there, we want to do what we can to figure out how to get there. That's some problem solving to do um we really want to focus on Are you eating? Um, and this is less about you know all of the vitamins and nutrition that ideally, I think we just all want in general, but when we're sort of in that new parent survival mode, just are you eating? You need to be eating. Whether you are breastfeeding or not, nutrition is going to be important to keep you, to keep you going. Hydration Are you drinking water?

17:01 We really need to be focusing on making sure that we're hydrated. And again, for those people who are breastfeeding, this is also, you know, even more important, but in general, we need to be hydrated in order for our body to function the way that it needs to. Another important part of this is movement. Please don't confuse this with like exercise and the traditional way that we think about it. Movement meaning are you just getting up and around? Are you able to get out, go for walks, which is just, I think, good for our mental health in general. It can be very hard to be stuck in the home with a Titan baby and feel very isolated and trapped.

17:46 So, are you able to get out? Are you able to move your body a little bit? Is it? You know, 10 minutes of stretching? Is it going for a walk? We're not talking about, you know, doing these big, long exercise videos or classes. If you can do those, that's wonderful, but that is not the goal right now. We just want to make sure you're moving your body. And then, what's your support system look like? We really need to be leaning on those individuals around us, whether it's our partner, whether it is family, friends, support groups, whatever it is. Therapists, psychiatrists, obese pediatricians are all part of this as well who are those people that can help us through this time, that can catch us right If we are really starting to struggle, and bring that to our attention to help us get the assistance that we need in order to start feeling better.

18:40 So those are things in general postpartum we want to be keeping an eye on. There are things that tend to really go by the wayside when we're struggling a lot with baby blues and then postpartum depression or other P mats. There are also things that typically we can exert some level of control over, which I like to bring that to my client's attention, because I think when we bring home a new baby, we often feel pretty out of control because there's all this stuff that's happening that we, you know, we're trying to learn so many new things when we're operating on very little sleep and it's all just very, very overwhelming, and sometimes dialing it all the way back to the basics and really just kind of focusing on those couple of things that we are able to exert some control over can go a long way in terms of helping us sort of get through the day and some other things in terms of prevention and mitigation of these things like postpartum depression.

19:40 If you know out of the gate that you have some risk factors for postpartum depression. We want to be having these conversations with your OB prior to pregnancy or enduring pregnancy, really making some plans for you know. Do we want to consider medications? Do you know what is our support system look like? At what point do you think you might need some intervention to mitigate symptoms of postpartum depression or other P mats? So really doing what you can ahead of time if you know that these things are a potential risk. Also, again, if you know that these things are a real possibility for you and sometimes we don't know, because one of the things that's trickiest about postpartum depression is that it can come out of nowhere and we can have no risk factors for it and wind up with it and it's nobody's fault, it's just the cards that were dealt sometimes, unfortunately.

20:38 But if you do know that you have some history of depression, that there's some depressive symptoms during pregnancy, you can do some legwork ahead of time to set up some appointments with perinatal psychiatrists or find perinatal therapist, sort of get on their radar so that after you deliver you don't have to wait as long to get in. You know that's a very real frustration for a lot of new moms is. It feels very desperate because all of this new stuff is happening. We're really struggling. We've got this little person we're supposed to be taking care of and who has time to call around or find a perinatal therapist or psychiatrist.

21:19 If you do that ahead of time, that is one less thing that you may have to do after the delivery. Make a plan with your partner or support system about things like night wakings and plans for sleep and what are those potential risk factors your partner support system need to look out for. Having these discussions on the front end Again can make it much, much easier when we're in the moment kind of struggling. It's really sort of hard to see our way through things once we are in them. So if you can have these conversations ahead of time, make a plan for how, again, you're going to hopefully get at least five hours of connected sleep sooner rather than later.

22:06 Those things can really help mitigate some of these postpartum depressive symptoms. And again, arranging support from family, friends, support groups, nighttime doulas, nannies, anywhere that you can get that support ready to go ahead of time so it's less that you have to worry about once the baby is here, is going to be really, really helpful. Yeah, so one of the things I wanted to bring up was you mentioned that the peak of baby blues is day three to five, which is when most people are coming home from the hospital. So I just thought it was interesting to kind of throw that out to new moms, because that time, where you're going to about to be alone, is when you're going to be the most at risk for the baby blues.

22:53 Yeah, I really think that's a helpful observation, though, and I think it's one that would probably be helpful for a lot of moms to hear. Honestly, I didn't even get the dots there. Yeah, I just remember when I came home from the hospital just being really super overwhelmed and everybody being like what's wrong with you? You're supposed to be happy right now. And I remember both Pregnancies. That was when I was just like you guys, I just I need space, I need time, I need to be alone, you know. So that was really hard for me when I came home, because everybody had different expectations of me. Yeah, that's such a good point. And it's so hard because we don't know what we're gonna need necessarily or how we're gonna feel when we come home, we don't know what our labor and delivery experience is gonna be like.

23:43 We don't know how we're gonna feel about this little potato that is just kind of like there and crying and wanting to eat. We don't know what our feeding or breastfeeding journey is gonna look like if that is something that we're considering doing. So all of these are huge factors to consider and in real challenges that Every parent really faces when they're bringing home a new baby and I love that you mentioned that in terms of stressors, and one of the things I think is really important also about postpartum depression is that there are, I think, a couple of times where we really want to be paying extra close attention for new moms especially and and we don't always talk about sort of these other big transitions that happened during that first year, right.

24:36 So there's an enormous hormone shift that happens once you wean, and a lot of times that happens before, when you're in, and sometimes that happens After that, but no matter what, there's gonna be this enormous Shift that we don't really talk about or prepare people for. So that is a time where we're likely to see a big uptick in a lot of these symptoms. The hope is that once the hormone settled down, that the symptoms may settle down, but I think it's also important to realize that that could trigger some postpartum depression. It can develop any point at all during that first year. Things can be feeling fine and then it's like you're slapped in the face.

25:17 So I think that's super important for people to know, and I think also a lot of this stuff can come up around Transition back into the workplace. If you are a parent who is working outside of the home, there's a huge. I mean, being a parent that stays at home is hugely stressful, and also being a parent that is going back to work with these dual roles and expecting that you know things Will be okay because you're going back into perhaps a role that you're very familiar with. It can feel pretty Demoralizing when it's a lot harder going back than when you left, and so that's a big one. A lot of times there can be a lot of guilt around things like putting your child in daycare, if that is something that you need to do in order to be able To return to the workplace.

26:03 So these are all really big Transitions for people that we just really want to be paying extra close attention. And it's also really difficult because, especially with obstetrics, once that six week mark is over, there aren't any ongoing Complications. You're probably not gonna see them very often. So that's why it's really important that pediatricians to continue to assess for postpartum depression and other PMAs, in that, you know, first-year time period. They're really, really helpful safety net there. So just because you might be six or seven months into your postpartum year Does not mean that postpartum depression can't come up in rear.

26:48 It's okay mad. So you know how they say if you put a frog in water and slowly heat it up, that the frog won't notice that it's boiling. There are a lot of things that can be compounding factors during this, this time period, and it like for me it was hard to notice. I don't think I had postpartum pressure and I think I had postpartum anxiety, which is different, but it was hard to notice all these symptoms compounding and the pressure building. So it's it's just something that I think it's important for me moms to look out for, as, as they're looking at these symptoms that compare yourself to before, see how things have changed. Yeah, that's such a good point. You know, and we're having this conversation with the assumption that most other things are probably normal quote unquote normal, right, you know, if you're bringing home a medically complicated child, if you're having medical complications right, either from things that you've been struggling with before pregnancy and those things have been exacerbated, or you have other things that come as a result of it, those things are automatically going to to be more of a challenge.

27:56 There's all kinds of surprises that come out of that first year of parenthood and, yeah, these stressors aren't discreet. These situations don't exist in a vacuum. So, you know, you may be bringing home a child where you have another child or several other children, and you may, you know, unfortunately, be bringing home a child into a tense relationship, right, there's huge shifts and dynamics that happen we could do a whole episode on just that when you're bringing home a child into a relationship. So there's all kinds of other psychosocial factors that may be happening, physical and, you know, emotional factors that might be happening during this time of probably one of the biggest, if not the biggest transition in your life.

28:47 So that's such a good point that we can't just assume that these things are going to be immediately noticeable to us that they can happen slowly and, over time, build, and so I think again, that's one reason why our support network is so important, because people are able to reflect things to us that we can't see. This is obviously part of a much larger conversation. Conversations about postpartum depression versus postpartum anxiety versus PTSD, I think, are all really really, really important distinctions to make. But at the end of the day, if you are not feeling okay, no matter what the actual diagnosis might be, that's a time to be asking for help.

29:34 Yeah, it's not a time to diagnose yourself. Right, if you're struggling, it doesn't matter. You don't need to know all of the different symptoms. It's always worth asking for help. Jennifer, as always, it's been very informative, very helpful. I know you've got things to do afterwards, so I think we'll stop there and we'll talk about the other PMADs at a later date, because there's so much that moms need to know. Absolutely. Thanks so much for having me back. I really appreciate it. I look forward to other conversations in the future. I hope this is helpful for some people. Till next time. Thank you for joining me. Let's face it Moms are busy. We're so busy taking care of others that we rarely have time to take care of ourselves.

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