Inspired by the amazing Hyperbole and a Half

Trigger warning: This post includes descriptions of common postpartum mental health symptoms. If you or a loved one (including men! ~10% of dads experience postpartum depression too) are experiencing some or all of these symptoms in a way that’s interfering with your daily life, PLEASE get help. Talk to your doctor, a licensed mental health professional, or call/text 988.

I’ve been putting off writing this blog post because of all of the topics I could pick to talk about, this is the one that’s associated with the most shame, #momguilt, vulnerability, and is hardest to put my usual humorous spin on. Which probably means it’s the one I need to write the most…so here we are.

First off, some stats, because of all the postpartum topics I plan to write about, this is probably one of the most common challenges and yet the one we still don’t talk about the most, even with other moms who’ve gone through it: 1 in 5 women and 1 in 10 men experience depression or anxiety during the postpartum period; 1-2 in 1000 women experience postpartum psychosis; and many others experience postpartum OCD, PTSD, and/or bipolar disorder.

Postpartum Baby Blues

Let’s start off by talking about the baby blues. While this may have a cutesy name that implies primarily sadness, it is actually one of the most bizarre all over the map mood fluctuations I’ve ever experienced. You will laugh, you will cry, you will be angrier than you’ve ever been at the world, you will feel happier than you ever thought possible while simultaneously feeling like you don’t deserve everything you have all in the span of one minute. The baby blues typically hit a few days postpartum thanks to – yep, you guessed it – our best friend fluctuating hormones again. Not so ironically, this also typically shows up when you are freshly home from the hospital and trying to figure out how to keep a new little human alive on barely any sleep. Super fun times. On a more positive note, I also found that these emotions were very motivating to give back to those less fortunate. I can still barely think about (let alone write about without crying) the fact that our local grocery store keeps the formula locked up because it’s one of the most targeted items for shoplifting by desperate moms who are just trying to feed their baby. I still can’t understand how we can live in one of the wealthiest countries in the world, and there are still families struggling at this level (BRB, going to cry now). All of this is very typical and your emotions will usually “normalize” (read: nothing will really feel “normal” like it used to again) after a few days.

Postpartum Depression

The baby blues differ from postpartum depression (aka PPD) in somewhat subtle ways, but my understanding is that the main difference is the length and strength of your symptoms. Thankfully, I haven’t yet experienced this, but I know a lot of moms have, and thankfully this is something that is readily screened for. Symptoms typically include less interest in your favorite activities, low mood, excessive or uncontrollable crying, intense feelings of shame or inadequacy (this one annoys me cuz really, what new mom hasn’t felt this way), difficulty concentrating, and disturbances to sleep or appetite. As you can tell, the line between standard newborn crap and a diagnosable mental health condition is pretty narrow especially in the early postpartum phase, but one thing I found super helpful was keeping a checklist of the common symptoms on my fridge right above the water dispenser that I basically lived at thanks to breastfeeding (IYKYK) and doing a quick daily self check. It’s still up there to this day because did you know that PPD can develop anytime within the first year after delivery? Stay vigilant and honest with yourself because there are a ton of different resources and treatment options out there that can help, and as we’ve already seen this is SUPER common so there should absolutely be no shame surrounding the need to ask for help.

Postpartum Mania

Unfortunately for me, the postpartum mental health concern that I did end up experiencing is not something that is typically screened for, nor did I have any idea was a thing that I should watch out for. I am fortunate to have been seeing an amazing therapist for the past seven years or so now, and we’ve been through a lot together. She knows me probably better than anyone and is therefore well poised to identify when something’s off. During my pregnancy, she warned me about the typical PPD symptoms to watch out for and helped me understand some of the warning signs for postpartum anxiety and OCD, which is the end of the scale that we both kind of expected me to tip into more than anything else. Color us both surprised when what I actually ended up experiencing about two weeks after giving birth was something we hadn’t discussed at all, is remarkably difficult to find any data or research on, and didn’t appear on any of the postpartum mental health screening checklists I was given by my doctor, my daughter’s pediatrician, and my doula: postpartum mania.

For those that are fortunately not familiar with mania, a simple way of thinking about it is that it’s basically the opposite of depression. Common symptoms include feeling like you don’t need to sleep, having lots of extra energy, racing thoughts, talking fast, elevated mood, heightened levels of activity (especially outside the normal range of what would be expected based on the amount of sleep one is getting), going on spending sprees, paranoia, and engaging in reckless behaviors.

I want you to close your eyes and think about this from the perspective of someone looking at a new mom who is not only keeping her shit together but is feeling great, is optimistic, happy, getting out of the house and doing all the things on very little sleep. Many people would look at this and say “Wow, she’s doing awesome! I was a train wreck at this phase of new parenthood”. I was not, in fact, doing awesome. For me, mania looked like running frantically through TJ Maxx filling up an entire shopping cart in less than an hour under the guise of finishing up my Christmas shopping. It looked like sleeping for less than three hours and having the energy to meal plan, cook, do all the dishes, and organize the pantry/nursery/my closet/whatever else I’d been putting off, all whilst taking care of a newborn. It looked like being terrified of every human who came slightly too close to us while we were waiting for the elevator on the way to a pediatrician appointment and feeling like I needed to carry a weapon in order to protect myself and my child.

The hard thing about all of this is that there’s a very blurry line between symptoms of mania and standard nesting/cherishing all the wonderful moments with your new baby. To this day, I’m still not sure myself or my therapist really knows whether it truly was mania or just standard holiday & newborn prep in a VERY Type A human. That’s how hard it is to recognize, diagnose, and probably treat too, though thankfully in my case, the symptoms largely went away once I got out of the no bottle feeding (therefore no help) phase of establishing breastfeeding and was able to sleep more than a couple of hours at a time.

So how common IS postpartum mania? Unfortunately, this information is nowhere near as readily available as some of the other postpartum mental health stats. I did quite a bit of googling in preparation for this blog post and was only able to find details on postpartum mania in primary research and review articles (like this one) rather than the more typical user friendly resources like those linked above. The information I was able to find suggested that mania and hypomania (basically a subtler form of the symptoms described above) affect between 9 and 19% of women in the early postpartum period, and is substantially higher in those with a history of major depressive disorder. Pretty wild that I, a relatively well educated and therapized scientist who has worked in the field of mental health disorders in the past, had never heard of something this common, but as you may have noticed this tends to be a recurring theme in this phase of life.

If any of this sounds like you or someone you know, there are a few things I want to share that really helped me. The first one was my therapist reassuring me that having symptoms of mania did not mean that I had a diagnosis of bipolar disorder and be resigned to being on lithium the rest of my life (no disrespect to lithium, but I’ve seen some of the side effects of it firsthand and really wanted to avoid going down that road if at all possible). This is not a life sentence. Secondly, it can be really helpful to recruit a few people close to you to keep an eye on your symptoms and make sure they’re not progressing. In some cases, mania can be associated with postpartum psychosis, which is much more scary and can be life-threatening. For me, this was my husband who thankfully had enough paternity leave to take a month off and be home with us in those early days. The main thing we were focused on watching out for was the paranoia I experienced out in public, which for me was the scariest and most obvious symptom and therefore the one I was most interested in tracking to ensure it didn’t progress. Finally, in many cases, simply asking for help (or in my case, actually allowing and receiving it) may be all you need to feel better. You don’t need to actually become superwoman to be the supermom you already are.

In hindsight, probably the hardest thing about all of this was the fact that anytime healthcare providers beyond my therapist would ask me about postpartum mental health symptoms, I had to couch my mania symptoms with “but I’ve never had thoughts of harming myself or my baby”. This is because of the association between mania and postpartum psychosis, and what I now recognize as a general lack of awareness in the healthcare community that one can have mania without full-blown psychosis. This was extremely isolating and probably one of the main sources of the shame I experienced around this challenging time in my life. Remember those postpartum mental health checklists I mentioned putting on my fridge? Zero mention of mania, which is something I think we really need to fix in order to drive awareness of this issue and reduce some of the judgment and shame so moms can get the help they need.

If you’ve made it this far, I have one last request for you: please, please, please help bring awareness to this issue with your friends, partners, siblings, children, random disheveled new mom in the line next to you at the grocery store, whomever. Thank you for sticking around and listening to my TED talk. Until next time!