Dr Sarah Allen: 5 Things Everyone Should Know About Postpartum Depression

An Interview With Jake Frankel

Authority Magazine Editorial Staff
Authority Magazine

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Emotional self-care is also important, and I think as a mother, it is important to not be hard on yourself. Women can have very high expectations of themselves. We can blame it on societal beliefs, stereotypes and what we see on social media, but often new moms tell me that they believe they should know automatically what to do and they feel like they are failing if they don’t know. Moms often become the default parent where they end up being the one that knows best how to feed the baby, calm the baby, do everything really and they get it right and because the other parent doesn’t get as much practice, they don’t do things the right way! This means they don’t get the breaks and support needed to be able to manage.

Postpartum depression affects millions of women worldwide, yet it remains a topic that is often misunderstood and stigmatized. Through this series, we aim to shed light on the various aspects of postpartum depression, including its symptoms, causes, treatment options, and the impact it has on individuals and families. As part of this series, we had the pleasure of interviewing Dr. Sarah Allen.

Dr. Sarah Allen is a leading maternal mental health expert. She completed her psychology doctorate at Southampton University in England and her dissertation was one the first research projects to look at the connection between traumatic childbirth and postpartum depression. Upon moving to the USA in the late 1990s she realized that there was little awareness and support for postpartum depression in Illinois, and she founded the Postpartum Depression Alliance of Illinois in 2003. Since then, she has worked on a state-wide basis to get legislation and a wider awareness of what postpartum depression is and how it can negatively affect women, their children and families.

Dr. Allen is also in private practice at Dr. Sarah Allen Counseling, where she works with clients in the Chicago area and throughout Illinois and Florida through virtual counseling. She has over 25 years of experience treating maternal mental health issues and has presented at conferences and published research on postpartum depression.

Thank you so much for joining us in this interview series. Before we begin, our readers would love to “get to know you” a bit better. Can you tell us a little about yourself?

Hello, I am Dr. Sarah Allen, and I am a psychotherapist who specializes in working with pregnant and new parents in the Chicago area and throughout Illinois and Florida through virtual therapy sessions. I have over 25 years of experience treating maternal mental health issues and I have also presented at conferences and published research on postpartum depression. In addition to my private practice, Dr. Sarah Allen Counseling, I am the founding director of a state-wide non-profit organization called the Postpartum Depression Alliance of Illinois.

Ok, thank you for that. Let’s now jump to the primary focus of our interview, about postpartum depression. Let’s start with a basic definition so that all of us are on the same page. Can you please tell us what postpartum depression is?

Postpartum Depression (PPD) can affect between 15–20% of all new mothers. It is much more common than most people realize, and it is very treatable. Symptoms are characterized by lack of motivation, sadness, tearfulness, worry and intense feelings of inadequacy, guilt and anxiety. There may also be physical symptoms such as headaches, fatigue, lack of appetite, sleep disturbance and rapid heart rate, and moms may feel disconnected from their baby.

Symptoms differ for everyone but might include any of the following:

  • Crying and sadness.
  • Withdrawal from social activities and loss of interest in once-enjoyed hobbies.
  • Feelings of anger that can be intense outbursts, or chronic irritability.
  • Lack of interest in the baby.
  • Appetite changes such as appetite loss or overeating.
  • Sleep disturbance such as insomnia or excessive sleeping.
  • Feelings of guilt, shame, or hopelessness.
  • Anxiety or worry.
  • Inability to concentrate.

Postpartum depression (PPD) is diagnosed when depression symptoms occur in the first year after childbirth typically, but not always, in the first six months, and are persistent for more than 4 weeks. Symptoms can interfere with a new parent’s ability to function and care for their baby and themselves.

Can you discuss some common misconceptions about postpartum depression and why they are harmful?

The misconception about PPD that I consider one of the most harmful is that postpartum depression and postpartum psychosis terms are used interchangeably by the media. I am frequently contacted by media sources who confuse postpartum depression with postpartum psychosis, and this impacts what women, and their families think Postpartum Depression is. Many journalists want to run a story following a tragedy where a new mom has harmed or killed herself or her baby, and they report that she suffered from PPD. The media tends not to be interested in stories about typical women’s experiences of postpartum depression as it is not deemed interesting enough and won’t get the attention of readers.

Postpartum psychosis is rare (0.1% or 1 per 1000 births) and women with psychosis committing infanticide or suicide is even rarer (4–5% of the 0.1%). Research shows that postpartum depression affects between 15–20% of new mothers but if women with PPD are only seeing stories about such tragedies in the mainstream media it makes them worry that they might also hurt their babies. They also worry that if they tell someone how depressed they feel, doctors or family members might think that they could harm themselves or the baby too. This leads to women with moderate to severe PPD not telling anyone how they are really feeling and suffering alone unnecessarily. This is why it is so important to have articles like the one we are currently doing so we can normalize postpartum depression, reduce the stigma, and bring more awareness to how treatable it is and very different from the postpartum psychosis tragedies that hit the headlines.

It is important to note that if anyone is experiencing postpartum psychosis it must be treated by medication immediately so please go to your nearest ER or contact your physician if you are worried that you have postpartum psychosis symptoms.

Can you explain the role of hormonal changes in postpartum depression, and how does this influence treatment approaches?

Pregnancy triggers significant hormonal changes in the body that may for some women result in mood swings and potentially lead to PPD. Following childbirth, a sharp decline in hormone levels can intensify emotional instability, thereby precipitating depression. Women who are sensitive to hormonal fluctuations during their menstrual cycles or suffer from Premenstrual Dysphoric Disorder are at an increased risk of PPD. Women who are sensitive to hormonal changes may also be more likely to experience mood changes when stopping breastfeeding or starting oral contraceptives after birth. I always ask my pregnant clients if they are typically affected by hormonal swings and then let them know that these changes can affect their mood so they can incorporate more self-care strategies during these times and if necessary, discuss medical options with their OB/Gyn or Family Doctor.

Brexanolone (Zulresso) has recently been approved by the U.S. Food and Drug Administration specifically for postpartum depression in adult women. Brexanolone slows the rapid drop of certain hormones after childbirth that may lead to postpartum depression. The first form of Brexanolone was an IV and required a stay in a health care facility and monitoring while receiving the medicine through a vein over 60 hours. They have recently been working on a pill version but the high cost and insurance companies not covering it, means that it is not widely available yet. Although the medication may benefit severe PPD, therapy is useful for all severity levels as it targets the adjustment to motherhood and relationship issues arising from being a new parent.

What are some of the best ways to treat postpartum depression?

Early intervention and appropriate treatment by mental health professionals with specialist training are essential to successfully managing postpartum depression and preventing adverse effects on the parent and infant. Some of the most effective treatment options include:

Psychotherapy with a state licensed maternal mental health psychologist or counselor who has undergone specialist training so they can provide targeted psychological support and understand the unique challenges faced by new parents Evidence-based therapies like cognitive-behavioral therapy (CBT) or interpersonal therapy (IPT) have proven beneficial in helping parents cope with PPD symptoms.

CBT is a proven and effective treatment for postpartum mood disorders. It focuses on the link between thoughts, feelings, and behaviors, giving new mothers strategies to change negative thinking and adopt positive behaviors. CBT provides a comprehensive approach to supporting maternal mental health after childbirth.

IPT is another therapy form that centers on the personal relationships of the new mother, recognizing that postpartum mood disorders often affect and are affected by the social and interpersonal context of a woman’s life. It addresses issues related to the role transition of being a mother, encourages useful communication patterns, and fosters stronger connections with significant others.

Medication such as antidepressant medications, specifically selective serotonin reuptake inhibitors (SSRIs), can help regulate mood and alleviate symptoms of PPD. It is crucial to discuss the potential benefits and risks of using medication during breastfeeding with a healthcare provider who has specialist training in medications for pregnant and postpartum women.

Support Groups: New parent support groups can provide a safe space to share experiences, discuss coping strategies, and gain valuable social connections during the postpartum period. These can be local, usually found in hospital outpatient settings where women gave birth, or online.

Based on your experience and research, can you please share “5 Things Everyone Should Know About Postpartum Depression?”

1 . There are many factors that put a woman at risk for postpartum depression and it is important to find out if you have any risk factors when you are pregnant so you can seek early treatment.

There are numerous factors that contribute to the emergence of postpartum depression, both genetic and biological factors as well as environmental and situational factors too. It is important to assess any risk factors during pregnancy, as well as shortly after birth, to make sure women can get appropriate professional help they need. This can reduce the effects PPD has on the mother, baby, and family.

Here’s are some of the most prevalent triggers:

Hormonal Changes: Pregnancy triggers significant hormonal alterations in the body that may result in mood swings and potentially lead to PPD. Following childbirth, a sharp decline in hormone levels can intensify emotional instability, thereby precipitating depression. Women who are sensitive to hormonal fluctuations during their menstrual cycles or suffer from Premenstrual Dysphoric Disorder are at an increased risk of PPD.

Mental Health History: Women with a background of depression, anxiety, or other mental health conditions are more likely to develop PPD. This could be attributed to genetic predispositions or previous challenges in dealing with stress and emotional health.

Distressing Birth Experience: Difficult pregnancies, birthing complications, or any other hardships during delivery may heighten the risk of PPD. Such experiences can induce feelings of guilt, inadequacy, or trauma, which can then trigger PPD.

Lack of Social Support: Inadequate support from family, friends, or partners during the postpartum period can increase the risk of PPD. Emotional and practical assistance is essential during this demanding period for new mothers.

Sleep Deficiency: The relentless demands of caring for a newborn often result in substantial sleep deficiency, impacting mental health. Fatigue can then amplify feelings of irritability, sadness, and depression.

Biological Triggers: Multiple childbirths, such as having twins or triplets, and having a baby younger than 20 years old can increase the probability of developing PPD. Studies have also found connections between biomarkers for inflammation, heightened stress hormones like cortisol, and thyroiditis.

Environmental Pressures: Risk factors also include having a child with special needs (such as premature birth, medical complications) or a baby that cries excessively or is difficult to soothe. Financial stressors, family strife, or the loss of a loved one can also amplify the risk.

If OB/Gyns screen for these risks in pregnancy they can then help women identify appropriate help if they need it during pregnancy or shortly after birth. It is usually much easier to connect with a therapist when pregnant than during the first weeks postpartum. You already have that connection and can get in to see the therapist more quickly if you need to.

2 . The second this I want people to know is that a new mom may feel alone right but it is important to know that help is available and postpartum depression is very treatable.

Recognizing that you are experiencing symptoms of postpartum depression: is the first step towards seeking help. A new mom is right in the middle of it all, putting her baby’s needs before her own and likely sleep deprived and she may find it hard to find the time and energy to be self-reflective or research where to get help from. If it is her first baby, she may not realize that not everyone feels the same way as she does or alternatively, she might think everyone else is coping and there is something wrong with her that she can’t manage her emotions. It is crucial to normalize how common PPD is and stress that she isn’t alone in feeling the way she does. The first step is to reach out to a healthcare specialist specializing in maternal mental health. These professionals possess specific expertise and perspectives on the numerous challenges, emotions, and encounters commonly faced in the postpartum period.

Consult Your Health Care Provider: Your gynecologist, midwife, or primary care physician can play a crucial role in addressing postpartum depression. They can assess your symptoms, refer you to a counselor, and offer additional local support and resources.

Seek Guidance From A Mental Health Professional: It is important to see a therapist that specializes in maternal mental health to gain deeper insights into your situation and develop a tailored treatment plan. This plan may involve therapy, medication, or a combination of both to address your needs effectively.

Connect with Support Groups: Women facing postpartum depression can access various local and online support groups. These platforms offer a safe and comforting environment to share your journey and gather wisdom from others in similar situations.

Involve Your Partner and Those Close to You: Open up about your feelings and experiences to your spouse and most supportive friends and family. Their emotional and practical support during this time combined with their understanding of your unique situation can make a significant difference in your recovery.

3 . A question I am often asked is “Is Postpartum Depression or Anxiety — What’s the Difference?”

When a postpartum mom comes in to see me, I assess symptoms to see if a diagnosis of postpartum depression or anxiety is appropriate, and some of the symptoms such as worry, agitation, inability to concentrate, appetite and sleep disturbance (which can look like appetite loss and insomnia) are very similar to postpartum anxiety. The relationship between the two can therefore overlap. So how do we know whether someone has postpartum depression or postpartum anxiety? Is it even important to differentiate between the two?

I often see that the two conditions overlap and many women who have postpartum depression also have significant symptoms of anxiety, typically relating to their baby’s well-being and protection.

When a baby arrives, every new parent worries that they don’t really know what they are doing and somehow, inadvertently, they may do something, or not do something, that causes harm to their baby. These little humans are totally vulnerable and now you are responsible for it! This can be scary, but these worries are totally normal, and everyone gets them occasionally. But postpartum anxiety is more intense and persistent than typical new parent concerns and may involve fear or dread and rumination.

Studies have shown that women with more severe PPD, often also have higher levels of anxiety and women with postpartum generalized anxiety (GAD) often report that they feel helpless about symptoms and have depressive symptoms too. I find that the most important thing is to assess what symptoms are the most prevalent and meaningful to the new mom and start treatment by developing coping strategies that target the symptoms that are most important to her.

When deciding about types of psychotherapy to use, Interpersonal therapy (IPT) appears to be effective with postpartum depression but its impact on generalized anxiety symptoms is still unclear. There is strong evidence that cognitive-behavioral therapy (CBT) works well in treating both depression and anxiety symptoms and I tend to utilize CBT most often unless women are telling me that their relationship with their partner is their biggest concern and in that case we will start with Interpersonal therapy strategies.

4 . I also want people to know that there are different levels of severity of postpartum depression and although moderate and severe PPD definitely need professional treatment, mild depression can improve with self-care strategies and by allowing yourself to ask for what you need to feel better. My self-care suggestions involve both practical and emotional strategies and they are also very helpful to implement in addition to therapy and/or medication if you have moderate or severe PPD.

The most important self-care strategy to start with is to allow yourself to ask and accept help from your partner, family and friends. Ask yourself, “What will help me feel better?” as everyone is different but in general become aware of your own needs outside of the baby’s needs and allow yourself to get:

  • Practical help with chores.
  • Good nutrition and eat every three hours to keep blood sugar levels in balance.
  • Rest and breaks from childcare.
  • Fresh air and movement and getting out of the house.
  • Talking to other women and families who have been through it and recovered.

Emotional self-care is also important, and I think as a mother, it is important to not be hard on yourself. Women can have very high expectations of themselves. We can blame it on societal beliefs, stereotypes and what we see on social media, but often new moms tell me that they believe they should know automatically what to do and they feel like they are failing if they don’t know. Moms often become the default parent where they end up being the one that knows best how to feed the baby, calm the baby, do everything really and they get it right and because the other parent doesn’t get as much practice, they don’t do things the right way! This means they don’t get the breaks and support needed to be able to manage.

Many women also believe they shouldn’t need to ask for help and that other new moms are managing just fine. I think this is because they are comparing themselves to other moms’ social media posts which are of course curated to only show good things and typically don’t show the difficult side of parenting. It is only when women share how isolated and out of their depth they feel that other women open up too. We could all do with support when we have a baby. Our own mothers and families are not always nearby or able to give us support, so we must ask for it from partners, friends, or a babysitter if that is at all possible.

When I work with new moms, I often have them write these messages down and when they feel critical of themselves, say these things to themselves instead:

  • I can’t control everything.
  • I am doing the best I can at this moment and that’s okay.
  • I will try to focus on one thing at a time and stay in the present moment.
  • I will try to be flexible and not focus on how it “should’ be, but rather accept how it is.
  • I love my family and I love me too. Love doesn’t mean I have to sacrifice myself.

5 . The fifth thing that people should know about postpartum depression is that men can get depressed after having a baby too. We typically use the term paternal depression and mounting studies are now showing that becoming a father increases a man’s risk of experiencing anxiety and depression, which in turn can also impact the child’s development. Studies have shown that the prevalence of depression in fathers is considerably higher than in the general adult population. In a comprehensive review of existing studies (Rao et al., 2020) found that 9.76% of dads experienced prenatal depression (depression when their partner is pregnant), with a slight dip to 8.75% experiencing paternal depression postpartum. Paternal depression can also deteriorate marital relationships and cause psychosocial and behavioral problems in offspring (Cui et al., 2020).

It is important to acknowledge the struggles faced by new fathers, as well as supporting mothers who experience PPD, as depression in either parent can put a strain on their relationship and may lead to emotional and behavioral challenges in their children. Research and focus on paternal depression will hopefully increase awareness of paternal mood disorders and therefore reduce the stigma and bring more community resources to fathers too.

My take-away message is if you’re a mom, or a dad, and you are feeling overwhelmed, not your self, sad, angry or worried, please take proactive steps to look up maternal and paternal postpartum depression symptoms and reach out to a counselor who specializes in working with pregnant and new parents as therapy can lead to positive changes for the entire family.

What are some practical strategies for supporting a partner or loved one experiencing postpartum depression?

I have heard many of my clients say that they see needing help as some sort of mom failure. Moms are expected to be able to do this and many women think other moms are coping better than they are. Of course, a lot of moms aren’t coping just fine, they just aren’t telling anyone. Allowing yourself to accept help is one of the first things I work on with new moms. Here are some practical and emotionally supportive ways you can help a loved one who is experiencing postpartum depression.

Practical Support

Be Specific: Don’t leave an offer of help open-ended, be more specific. Perhaps share what help you really appreciated when you had your baby or give her a forced choice; would you like me to sit and hold the baby this afternoon while you do something, or do you want to sit and hold him and chat to me while I fold the baby’s laundry?

Sit With Her: It can be very isolating being at home with a baby and a depressed mom often finds it difficult to get up the effort to socialize so a low-key, one on one chat, can be very supportive. Just having another person there, especially if she is feeling anxious about being alone with the baby can be helpful.

Hang Out With Her Older Child: If this is a second baby, moms don’t get the same opportunity to rest or get things done when the baby naps as they perhaps did with their first baby so offer to take her older child as this is a big help. If you have a similar age child, frame it as helping you out too to have a playmate for your child, as this can help lessen her possible mom guilt.

Give Her Alone Time: Once she feels comfortable leaving her baby for a while, offer to stay with the baby while she does something for herself. Self-care means different things to different people so ask her what she would like to do with a couple of hours to herself.

Emotional Support Is Just As Important

Encourage Her To Talk: Encourage your friend to talk about how she feels without judgement or advice. Women often don’t need a fix but to just be listened to so they can process how they feel about the transition.

Validate The Things She Does Well: When someone is not coping well they tend to focus on all the things they feel they have done badly and tend to ignore the things they are doing well. Validate her efforts and remind her of all the things she accomplished that day in the course of caring for her child. Point out how well the baby is thriving and how he or she just smiled at her. Acknowledge how difficult it is to manage on broken sleep and be responsible for a baby.

Let Her Know She Is Not Alone: Just letting her know you are right there with her and will give her whatever support she needs will be a huge comfort. Next do a little research on her behalf and send her links to websites that talk about how common it is to for new moms to experience postpartum depression.

Help Her Access Professional Support: If she experiences depression for more than two weeks help her find professional help. Women recover more quickly the sooner they access professional help.

Another way to offer support, which I think is both practical and emotional, is to call ahead to all the mental health professionals that are in your area that help women with postpartum mood disorders and do the leg work which many new moms feel too overwhelmed to do.

Get details of location, cost and ask the professionals about their specialist training in postpartum mood disorders, how many years that have been treating women and how many women with PPD they have actually treated. Some therapists say they treat PPD but their experience and training differ widely from some having years of experience and training to others who have only completed a weekend course and only having seen a few women so far. Any therapist who minds you asking about their training and experience isn’t someone you’d want to see.

Offer to drive your friend to her therapy appointment and sit in the waiting area with the baby so she can be near the baby (especially important if she is anxious) but not distracted so she can really talk.

You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

In my capacity as Director of the Postpartum Depression Alliance of Illinois, I have worked with all the State Governors over the past 21 years to proclaim May as Maternal Mental Health Awareness Month. We chose May as it is the month Mother’s Day is celebrated in the USA. We host related events and partner with similar state organizations that work with mothers and babies during that month to foster more awareness about the symptoms of maternal mood disorders, possible impact to the mother, child and other family members, and treatment options.

Other states do similar awareness activities and when a celebrity experiences a postpartum mood disorder, they also generate awareness, albeit fleetingly. It would be my dream that there is a mainstream national awareness campaign during May where popular morning shows, chat shows, newspapers and other media sources highlight postpartum mood disorders, help reduce the stigma and normalize it. I also dream that there is funding for free mental health support for all new mothers and that there is in-depth training for healthcare professionals, so more people have the skills to effectively treat postpartum depression and other maternal and paternal mental health issues.

How can our readers further follow you online?

You can follow me online by subscribing to my blog at www.drsarahallen.com or on these social media accounts:

Facebook https://www.facebook.com/drsfcallen

Instagram https://www.instagram.com/drsarahallen

Youtube https://www.youtube.com/@drsarahallen

Linkedin https://www.linkedin.com/in/drsarahallen

Thank you for the time you spent sharing these fantastic insights. We wish you only continued success in your great work!

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