Lauren Millman, a mental health professional who knew the signs and symptoms of postpartum depression (PPD), didn’t want to believe that it could happen to her.
After brushing off her symptoms for about a year and a half, Millman said an incident that caused her to go “berserk” convinced her that she could no longer ignore them.
In the months that followed the arrival of her first born child, she noticed that she was “terse, unhappy, feeling overwhelmed by little things, sadness for no explained reason,” but it wasn’t until she “went off the deep end” that she started to comprehend the full extent of the issues she was grappling with.
She explained that she took her son to an indoor playground, when he collided with another child on a slide, fell and hit his head.
“It was just that moment where I heard myself and I thought, ‘I don’t sound like myself, I don’t feel like myself. I’m not the best person I can be to my child and … I’m not being the best person to myself,’ ” said the mother of three kids between the ages of 12 and 16.
“This thing had gotten bigger than I could handle and it got the better of me and I needed to seek help.”
Yaneka Jacobs, a modern Orthodox mother of a two-year-old daughter, took a proactive approach to managing PPD, because she knew her history with depression, anxiety and chronic pain stemming from a car accident when she was a teenager would make her more vulnerable.
When she and her husband decided to get pregnant, she conceived right away and didn’t have a chance to consider the physical and mental impact the pregnancy would have on her body and mind.
“It kind of hit me all at once when I found out I was pregnant. I know I have a history of anxiety and depression and so I wanted to seek out some kind of program or psychiatrist who could help me through this period,” Jacobs said.
According to the Canadian Mental Health Association, PPD can start during pregnancy, or develop up to a year after a child’s birth. It can be caused by a number of factors, including family history, biology, life experiences and sleep deprivation.
Millman said there is no evidence to suggest that PPD is more prevalent in the Jewish community compared to the general population.
“It transcends all socio-economic status and no one is immune,” she said.
Studies have found that up to 15 per cent of new mothers are affected by PPD.
A study published in the journal BMC Public Health in 2011 looked at 6,421 Canadian women who had a live birth between 2005 and 2006 and took part in the federal government’s Canadian Maternity Experience Survey. It found that factors including a mother’s stress level during pregnancy, the accessibility of support after birth and a prior depression diagnosis were the strongest predictors of PPD.
“Household income has been negatively associated with the prevalence of PPD in women in cohorts in Vancouver and Calgary. Conversely, the risk for PPD symptomatology increased when the mother was born outside of Canada, even after adjusting for socioeconomic status,” the study concluded.
It kind of hit me all at once when I found out I was pregnant. I know I have a history of anxiety and depression and so I wanted to seek out some kind of program or psychiatrist who could help me through this period
Dr. Beverly Young, who has worked as a psychiatrist in the Perinatal Mental Health Program at Mount Sinai Hospital in Toronto for the past 15 years, said that differentiating between “baby blues,” which are characterized by hormone-driven mood swings that generally last up to a couple weeks, and PPD, is a matter of determining if the symptoms continue weeks and months later and interfere with that person’s functioning and ability to experience happiness.
“They really should be genuinely enjoying motherhood. I understand if they have a colicky baby, or the baby is crying, but if the baby is calm, you should be able to genuinely enjoy the baby,” Young said.
“If a woman is up breastfeeding the baby in the middle of the night, is she able to go back to sleep? If she’s not, is it because her mind is racing? At that point, you should be so exhausted that you fall right back to sleep, but if you’re not sleeping because of worries and racing thoughts, that’s a concern.”
Young added that having suicidal thoughts is an obvious red flag, “Even passive suicidal thoughts, like, ‘This baby would be better off without me.’ I often ask, ‘If you got hit by a bus tomorrow, would that be OK? Sometimes women say ‘yes.’ ”
The good news is that PPD is very responsive to treatment. The bad news is that because of the stigma and shame associated with PPD, there are many sufferers who don’t seek the help they need.
“Asking for help is really difficult and unfortunately society has taught us that asking for help is not OK. It’s stigmatized. It’s a weakness,” Millman said.
“No one wants to be stigmatized. It’s underreported and people who are suffering are underserviced. It’s a real shame.”
She likened asking for help to getting a third cup of coffee to give you a boost. “I need it to function. Will it help? Yes. Will I feel better, happier, stronger? Yes. So the upsides far outweigh the downsides of asking for help and it’s so important to feel empowered to ask for help,” said Millman.
Jacobs said that women are often afraid to ask for support because, as a mother, “they’re supposed to be able to take care of it. On top of that, they feel guilty, or sad, or upset and they are afraid to admit something is wrong because we’re so heavily judged as parents.”
Young said that much of the shame that is placed on PPD sufferers comes from the sufferers themselves.
“Especially women who worked so hard to conceive.… They worked so hard to have this baby and then they have this baby and they’re like, ‘Oh my God, I’m supposed to be loving this. Why am I not loving it?’ ” Young said.
“Women are very hard on themselves, they have problems with perfectionism, not feeling like they’re good enough and equate (PPD) with not being a good enough mother, which is so false.”
Young said the stigma related to mental illness is even more of an issue in certain communities that tend to be more insular, such as the Orthodox Jewish community.
“There is a huge stigma in the religious population, to the point where patients will say, ‘Do not schedule me before or after a religious woman,’ ” to avoid being recognized by someone in the community, Young said.
She said that Mount Sinai partnered with Relief Resources, a non-profit mental health referral agency that caters to the needs of the Jewish community, in order to provide services to women who feel most comfortable speaking with Jewish psychiatrists.
“I’m not religious, but I think just knowing that I know what a mikveh is” makes some Jewish women more comfortable, said Young.
She said that although there is still stigma attached to PPD, perceptions do seem to be changing.
“Women are talking about it more on social media, getting positive feedback for divulging their issues and mental health concerns, but also more Hollywood stars are coming out and saying, ‘I had postpartum depression,’ ” said Young.
In February, a panel discussion meant to address the stigma of PPD in the Jewish community was held in partnership with Sinai Health System, Beth Tzedec Congregation, Shaarei Shomayim, UJA Federation of Greater Toronto, Jewish Family & Child, JACS, Holy Blossom Temple and the Beth Avraham Yoseph of Toronto Congregation.
The program also shed light on the fact that men are not immune from experiencing PPD symptoms, such as depression and anxiety.
Dr. Andrew Howlett – who runs the Fathers Mental Health Program at St. Joseph’s Health Centre in Toronto and co-founded the Fathers Mental Health Network, which allows doctors and patients to find resources, treatment programs and depression screening tools – was one of the panelists.
He said the pressure on a new or expectant father can lead to depression and anxiety in about one in 10 men.
A 2015 McGill University Health Centre study found that about 13 per cent of expectant dads experience depression and anxiety during their partner’s pregnancy.
Ira Weisman, who also sat on the panel, said he developed anxiety during his wife’s first pregnancy and subsequent miscarriage.
“I felt like I had to be her rock and couldn’t address my own issues,” Weisman said. “I couldn’t get it together at work or at home … things were spinning out of control.”
Young said that, in general, men aren’t as likely as women to seek help for mental health issues, but there is a need for programs like the Fathers’ Mental Health Program.
“For the guys, it tends to be more with men who have a history of anxiety and depression and they are struggling with a new identity – and that is similar to women, obviously. But I think with men, if they are the major breadwinner, and the women are on maternity leave and they’re not making a lot of money, they have the guilt and the stress of making money,” Young said.
As the biggest perinatal mental health program in Ontario, and possibly in Canada, Young said that Mount Sinai’s program receives around 1,000 referrals a year.
“Mount Sinai has 7,000 deliveries a year. We’d like to see 15 per cent of those women because we know roughly 15 per cent of women suffer from postpartum depression,” Young explained.
Jacobs said she benefitted from the perinatal program at Mount Sinai, which she started about a month into her pregnancy.
She said the doctors evaluate the patients’ support system for the different phases of pregnancy, as well as the postpartum period, and talk to the patients about their anxieties, fears and concerns.
Jacobs said her psychiatrist offered some holistic suggestions and that she was given access to resources, including meditation and yoga classes, and a support group.
“The Mount Sinai program also has a telemedicine program and so, for the last three months of my pregnancy, and for the whole year postpartum, I was able to see my psychiatrist via telecommunication, so that I didn’t have to go downtown anymore. I think it would have been hard for me to maintain my appointments had I not had that access,” Jacobs said.
Young said the telemedicine program allows her and her colleagues to serve women from all over the province.
“I see women from Orillia, from North Bay and Peterborough and Ottawa. So there is a great continuity of care,” she said.
Although there is no national program dedicated to preventing and treating PPD, there are programs available throughout the country.
Among the various support programs, there is the Pacific Postpartum Support Society in Burnaby, B.C., the Mothers Program at the Women’s Health Clinic in Winnipeg, the Centre Périnatal Le Berceau in Beloeil, Que., and the Families Matter Society in Calgary.
Millman said she successfully used cognitive behavioural therapy to manage her thoughts, feelings and behaviours, and to hone her problem-solving, stress management and relaxation skills.
By the time Millman became pregnant with her second child, “some of those similar feelings came back, but I knew what they were and I knew enough that if I didn’t catch this quickly, it was another round of it getting the better of me and it controlling me and I was not going to let that happen.”
She decided to try antidepressants as an adjunct to counselling and therapy.
“I went on antidepressants for a short period of time and for me, they were a life saver, because very quickly … I was waking up feeling brighter and feeling less down-trodden,” Millman said.
When it comes to something as life-changing as becoming a parent, even in the best of times, people will feel exhausted and out of sorts.
“As a mother, you’ve been physically traumatized.… Whether you’ve had a natural birth with an epidural or a C-section, no matter what, it’s traumatizing. Unfortunately, we live in a society that doesn’t recognize how much of a big deal that is. If you go for minor surgery, they’ll keep you for two days and they’ll make sure you’re OK and send you home. We have a 24-hour policy, where as long as the baby is out and healthy, you’re good to go,” Jacobs said.
“If someone is in a lot of pain or someone hasn’t had a chance to recover properly, that can definitely be a contributing factor.”
The key to getting ahead of PPD is to identify the symptoms early and get the support you need.
“PPD is real and is not a life sentence if you have the right tools to help you,” Millman said.