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When Your Friend Is Pregnant and Depressed

Destigmatize the idea of getting treatment, then help her find it.

Credit...Amanda Eliasson

This story was originally published on Dec. 19, 2019 in NYT Parenting.

A common refrain in my office, where I take care of women suffering from perinatal mood and anxiety disorders, is some version of: “I’ve been miserable for months, but I didn’t think it was bad enough to get help until my friend helped me find you.” For most women, it takes weeks, if not months or years, to make it into my office.

On one hand, pregnancy and motherhood are idealized in our culture; women face enormous pressure to experience new motherhood as the best time of their lives. On the other hand, pregnant women are quickly exposed to the gantlet of postpartum horror stories via family members and friends. So, when you’re expecting chronic sleep deprivation and an emotional roller coaster, it’s hard to know if your misery is outside the range of normal. That’s where observant loved ones can step in and help a new mom recognize that she may need help.

[Saying ‘no’ is self-care for parents.]

One in five women will experience a mood or anxiety disorder during pregnancy or in the first year postpartum, with rates even higher in women of color. While it’s true that pregnancy-related mental health conditions are hormonally driven illnesses impacting brain circuitry, we also know there are significant psychological and social risk factors that can contribute to their development.

“We have clear and overwhelming literature to show that lack of social support is a problem,” said Dr. Lauren M. Osborne, M.D., assistant director of the Women’s Mood Disorders Center at the Johns Hopkins University School of Medicine, who points out that poor social support is a strong risk factor for developing a pregnancy-related mental health condition.

There’s also emerging data that having a supportive community can help protect against postpartum depression, said Dr. Osborne, who co-wrote a 2015 paper in the Archives of Women’s Mental Health detailing recommendations for prevention of postpartum depression.

Women experiencing postpartum depression symptoms often describe having guilty thoughts, and a feeling of emptiness and hopelessness. Postpartum anxiety disorders can include unrelenting anxiety about the baby’s health, intrusive scary thoughts and difficulty with decision-making. Trouble sleeping even when the baby is asleep and trouble caring for the baby are also common symptoms in both conditions.

[How to be a supportive partner during and after pregnancy.]

These illnesses can disrupt mother-child attachment and even lead to thoughts of self-harm or of harming the baby. If someone close to you has been exhibiting these symptoms for more than two weeks, she may be struggling with a pregnancy-related mental health condition.

Here are some steps to take if you are worried:

Research shows that women suffering from pregnancy-related mental health conditions don’t feel comfortable talking openly about their despair, and this is a significant barrier to getting help. Instead of simply asking, “How are you feeling?” ask, “How are you feeling about being a new mom?” Or, “How are you coping with the additional stress of a new baby?” You’re signaling interest in how she’s navigating her new role, while also taking the pressure off of her to acknowledge the demands of having a newborn. Resist the urge to share your own experiences or give unsolicited advice. This is about her, not you.

Dr. Alison Stuebe, M.D., professor of obstetrics and gynecology at University of North Carolina School of Medicine, said: “It really does take a village. We’re really supposed to have a community around us” when caring for a baby. “That community nurtures the mother so that she can nurture the baby.” But, with families often scattered across the country, and friends who are tending to their own growing families, new moms can be isolated. Moreover, women with postpartum depression or anxiety are often too overwhelmed to delegate what they need in terms of help. One way to show your support is to provide practical help, without being asked. Tell her you’d like to drop off dinner one night — does she prefer home-cooked or takeout? Or, you’d love to spend time with the baby so she can nap — does she prefer Saturday or Sunday? Make it easy for her to say yes.

Dr. Osborne explained that many women don’t reach out for help because there’s a stigma against mental health treatment, especially in at-risk populations. Women wonder, “If I admit this vulnerability are you going to take my kids away?” she said. So, it’s important for moms to know that these conditions are common and that getting help does not make them a failure. Family and friends play an important role in destigmatizing treatment. Furthermore, studies show that one of the most powerful aspects of social support is “reassurance of worth,” which is the active acknowledgment of her mothering abilities. Cheer her on when she makes it to the shower, or when the baby latches. Remind her that emotions can be contradictory. It’s O.K. for her to love her baby whole heartedly while also feeling drained by him.

[You can treat postpartum depression and still breastfeed.]

As a culture we don’t do a great job of openly expressing our concern because we don’t want to offend or overstep. But, this means moms suffer alone for longer than they need to. So, it’s best to be direct while also expressing warmth. You can couch your advice within the framework of wanting what’s best for her: “You know I’m here for you, and I want the best for you and your family. You deserve to enjoy this time with your baby. Things aren’t going to get better on their own. I think you need professional help.” Pick a time that’s private. If you’ve been in treatment yourself, this is a good time to consider sharing your own positive experience.

Studies show that women suffering from postpartum depression link their symptoms to the relentless burden of caring for an infant. She may say, “What I need is someone to wake up and feed the baby, not another appointment.” While it’s true the demands of motherhood play a role in depression and anxiety, getting treatment will enable her to think more clearly and to communicate her needs effectively. Sharing evidence-based information about the biological basis of this illness and the effectiveness of treatment, such as this guide to postpartum depression symptoms and treatment, is great place to start.

Once she’s ready, offer to help her find a clinician. Her obstetrician may be able to start treatment — help her make that appointment. Offer to search Postpartum Support International’s directory of specialists. Given that women cite lack of child care as a top barrier to treatment, watching the baby while she goes to her appointment would go a long way.

There can be strong internal pressure to avoid acknowledging something is wrong in the postpartum period. Give your loved one space and time to come around. If you feel your friend is getting worse, and is resistant to getting help, you may need to enlist her partner or family. Ultimately, you cannot force someone to see a mental health professional. (Note: If your friend’s symptoms are severe — for example, if she’s worried she might hurt herself or the baby — it’s important that she seek immediate medical attention.)

In the process of supporting your family member or friend, you may find yourself taking on a considerable emotional load. It’s important to have your own support system in place, and, if you need to, seek out professional help of your own.

[Read more about postpartum anxiety and prenatal depression.]


Dr. Pooja Lakshmin, M.D., is a perinatal psychiatrist specializing in women’s mental health, based in Washington, D.C. She is a clinical assistant professor of psychiatry at George Washington University School of Medicine.

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