Why am I experiencing severe irritability and depression after having a baby?

Sarah...years ago I had a similar experience. In an effort to try to get some understanding I happened upon a health book and read that when one breastfeeds the body requires 5 times the normal complement of the B vitamin complex. B vitamins help with many things but also with emotional stability and resilence. In addition, I learned that hormones tend to take quite a while to stabilize in some of us who nurse. I also had some previous anxiety issues though I was so thrilled to have my child. I couldn't figure out why I was feeling so irritable and unhappy. Bottom line is that I started taking a really good stress B complex and began to concentrate on eating ONLY whole and healthy foods; no more junk such as chips, etc. It took about 6 months but I had a tremendous change over time. You're in my prayers.

Hi, Sarah,

Thanks so much for writing to us. I'm with Pat -- I know it must not have been easy to do.

First of all, please know that being a single mom with a 3-year-old and a 2-month-old probably stretches all your coping mechanisms anyway. The stress of parenting two young children, dealing with jobs and the economy, and feeling out of control of your emotions can make it feel like everything is just out of your control. You are NOT crazy. This is real, and it makes perfect sense to me.

The fact that you have a 2-month-old makes me wonder if your depression might be post-partum. Have you considered this? Post-partum hormones can make our moods vary wildly. Yes, it can make us cry all the time, be very irritable, and feel hopeless about the future. And most of the time it starts within the first four weeks after having a baby.

And Sarah, please know that you are not alone. As many as 10 percent of moms experience post-partum depression. That's right -- 1 in 10. That's a lot of women.

It doesn't mean that you aren't a great mom, or that you don't love your baby. Mostly, it means that your brain and body chemistry is off right now.

Here's what the Mayo Clinic says about the causes of PPD:

"There's no single cause for postpartum depression. Physical, emotional and lifestyle factors may all play a role.

■ Physical changes. After childbirth, a dramatic drop in estrogen and progesterone may contribute to postpartum depression. The hormones produced by your thyroid gland also may drop sharply — which can leave you feeling tired, sluggish and depressed. Changes in your blood volume, blood pressure, immune system and metabolism can lead to fatigue and mood swings.

■ Emotional factors. When you're sleep deprived and overwhelmed, you may have trouble handling even minor problems. You may be anxious about your ability to care for a newborn. You may feel less attractive or struggle with your sense of identity. You may feel that you've lost control over your life. Any of these factors can contribute to postpartum depression.

■ Lifestyle influences. Many lifestyle factors can lead to postpartum depression, including a demanding baby or older siblings, difficulty breast-feeding, exhaustion, financial problems, and lack of support from your partner or other loved ones."

Sarah, I see you in all three of these. Your hormones have changed since giving birth. You are most likely sleep-deprived and feeling somewhat overwhelmed. And you have both an older sibling to your baby and a lack of support from a partner. All of these things can contribute to how our brain is doing in processing what is happening in our lives.

Here is the Mayo Clinic's complete page on PPD. Don't miss the blue links down the left side that link to pages about symptoms, diagnosis and treatment:

http://www.mayoclinic.com/health/postpartum-depression/DS00546

You may have heard, a while back, that actress Brooke Shields had post-partum depression. She has worked since then to help take away the stigma that still can surround the diagnosis, and to urge moms to get help if they need it. She wrote a book about her experience called "Down Came the Rain: My Journey Through Post-Partum Depression," and there is an excerpt of that book here:

http://parenting.ivillage.com/newborn/ndepression/0,,7pvl1mhm,00.html

Here's one paragraph:
"I had little time to contemplate such thoughts, because it was time for Rowan to eat again (or snack, I should say). Without the help of a nurse or a lactation specialist, I was in trouble once more. I accepted Chris's help as he guided the baby's mouth onto my nipple; this time I didn't become annoyed or impatient with him or myself. I sat there almost catatonically, staring out into space. Rowan's nursing made me feel drugged and temporarily comforted me. But the moment she was finished and taken from me, I started to sob once more. I sat up with my huge legs stretched out in front of me and, slowly rocking back and forth with my face up toward the ceiling, my arms limp at my sides, I sobbed. I couldn't stop. What was I going to do? Was I ever going to stop feeling like this? Misery enveloped me."

And another:
"After only a couple of days of being home, my crying had increased and no longer occurred only in between feedings but during them as well. At times I even had trouble holding Rowan because of my choking sobs. Why was I crying more than my baby? Here I was, finally the mother of a beautiful baby girl I had worked so hard to have, and I felt like my life was over. Where was the bliss? Where was the happiness that I had expected to feel by becoming a mother? She was my baby; the baby I had wanted for so long. Why didn't I feel remotely comforted by having or holding her? I had always felt that a baby was the one major thing missing from my life, that a child would complete the picture and bring everything into focus. Once I was a mother, the different parts of my world would all converge, and I would experience life as I'd envisioned it and in turn would know what I was meant to be. But having a baby clouded my vision and threatened whatever peace had already existed. Instead of wanting to move forward, all I wanted was for life to return to the way it was before I had Rowan."

Sarah, your situation is different, of course, but I'm sure that some of the emotions Brooke Shields writes about there are familiar to you. Please know that there is, absolutely, help for you.

Therapy can help, and anti-depressants can help. And yes, there are anti-depressants you can take while breast-feeding.

Please make an appointment with your doctor to talk about this. Don't feel shy, just come right out and say it: "I think I may be suffering from post-partum depression." Make a list of your symptoms before you go so that you don't forget any of them. Be specific about your crying, your mood swings, your sleep patterns (or lack of them), your eating patterns (or lack of them), your anxiety level and anything else that comes to mind. Take that list with you to the doctor, and ask whether she or he can refer you to a therapist, whether you should consider anti-depressants, and if so, what the safest ones are for a breast-feeding mom.

Here is the National Institutes of Health's list of symptoms:

"When you are pregnant or after you have a baby, you may be depressed and not know it. Some normal changes during and after pregnancy can cause symptoms similar to those of depression. But if you have any of the following symptoms of depression for more than 2 weeks, call your doctor:

• Feeling restless or moody
• Feeling sad, hopeless, and overwhelmed
• Crying a lot
• Having no energy or motivation
• Eating too little or too much
• Sleeping too little or too much
• Having trouble focusing or making decisions
• Having memory problems
• Feeling worthless and guilty
• Losing interest or pleasure in activities you used to enjoy
• Withdrawing from friends and family
• Having headaches, aches and pains, or stomach problems that don’t go away

Here's that complete page:

http://www.womenshealth.gov/faq/depression-pregnancy.cfm

Sarah, do you think this might be what you are experiencing?

Can you make a doctor's appointment to discuss the possibilities of help?

If for some reason you don't have a regular doctor or can't afford one due to lack of insurance, please let us know what city and state you live in. We can help you find some resources even if you can't afford to pay.

Please write back and update us. You're not alone in this.

Hi Anon - First, thanks for writing. I'm sure it took courage to write this information and to seek help. You mention being depressed, and I'm going to provide you with information about the symptoms, causes and treatment for depression. This is treatable, but you need to see a medical professional who can assess your situation, develop an accurate diagnosis, and work with you on a treatment plan.

You've listed several of the issues you're dealing with, but haven't indicated whether you've sought help from your healthcare provider which is vitally important. Please review the information below, and write back if you have questions or want more information. Let us know if you've sought treatment, or plan to. We're here to help you, you're not going to have to deal with this alone.

Take good care,
Pat

Depression Defined

Depression is not the same as a blue mood. It is a persistent low mood that interferes with the ability to function and appreciate things in life. It may cause a wide range of symptoms, both physical and emotional. It can last for weeks, months, or years. People with depression rarely recover without treatment.

Symptoms

Symptoms of depression are highly variable from person to person. Some people have only a few symptoms, while others have many. Symptoms also vary over time.

Symptoms can change over time and may include:

* Persistent feelings of sadness, anxiety, or emptiness
* Hopelessness
* Feeling guilty, worthless, or helpless
* Loss of interest in hobbies and activities
* Loss of interest in sex
* Feeling tired
* Trouble concentrating, remembering, or making decisions
* Trouble sleeping, waking up too early, or oversleeping
* Eating more or less than usual
* Weight gain or weight loss
* Thoughts of death or suicide with or without suicide attempts
* Restlessness or irritability
* Physical symptoms that defy standard diagnosis and do not respond well to medical treatments

Causes

The precise cause of depression is not known. It is sometimes difficult to determine if something causes depression, or if it instead is a result of being depressed (ie, does substance abuse result from attempts at self-medicating for depression, or does chronic substance abuse result in depression). Examples of possible causes may be mental, physical, or environmental in nature and include:

* Stressful life events (usually in combination with one or more of the following causes)
* Chronic stress
* Low self-esteem
* Imbalances in brain chemicals and hormones
* Lack of control over circumstances (helplessness and hopelessness)
* Negative thought patterns and beliefs
* Chronic pain
* Heart disease and heart surgery
* Genetic predisposition
* Altered brain structure and function, including after a stroke
* Parkinson’s disease
* Postpartum depression occurs after childbirth
* Seasonal affective disorder is a type of depression or a worsening of symptoms thought to be due to the decreased exposure to sunlight that occurs during winter months, especially in northern climates with longer winters.
* Hypothyroidism
* Anemia
* Cancer
* Substance abuse

Diagnosis

There is no blood test or diagnostic test for depression. The doctor will ask about your symptoms and medical history, giving special attention to:

* Alcohol and drug use
* Thoughts of death or suicide
* Family members who have or have had depression
* Sleep patterns
* Previous episodes of depression

The doctor may also perform a mental status examination or neuropsychiatric evaluation to obtain detailed information about your speech, thoughts, memory, and mood. Questionnaires called depression inventories may be administered. A physical examination and other diagnostic tests can help rule out other causes for your symptoms.

Treatment

Treatment usually includes medication, psychotherapy, or a combination of the two. Medicine helps relieve symptoms. Psychotherapy helps you learn more effective ways to deal with problems or to identify and resolve the conflicts contributing to your depression.

There may be a need for hospitalization in some cases of severe depression. Depression with psychotic features usually requires hospitalization and use of antipsychotic drugs, such as olanzapine.

Antidepressant Medications

Up to 70% of depressed patients find relief from their symptoms with antidepressants. These medications can take 2 to 6 weeks to reach their maximum effectiveness.