When Postpartum Depression Doesn’t Go Away

For 38 percent of sufferers, the condition becomes chronic, and mothers who expected it to pass as their children aged can struggle to find effective treatments.

Zoë Jooyeon Bae

After giving birth to her first child, Chelsea Reiswig, like many new mothers, struggled with postpartum depression. But even as her child got older, the condition didn’t go away.

“I knew postpartum depression was a thing,” she says, “but I never really thought about it affecting me. I was not myself. I felt scared all the time.” Reiswig was jarred by the thought that this might be a condition that sticks with her for life. Six years later, Reiswig, 32, is still struggling with depression.

Anxiety and depression are common complications for mothers after childbirth, affecting as many as one in seven new moms, according to the American Psychological Association. For half of those diagnosed, postpartum depression (PPD) is their first depressive episode. But while the majority of PPD cases improve quickly with time and proper treatment, for roughly 38 percent of women diagnosed, PPD becomes a lifelong condition, according to a 2014 report published in the Harvard Review of Psychiatry. “You can absolutely have a postpartum-depression experience that is an isolated event and you never go there again, but it may actually be the first of multiple experiences,” says Carly Snyder, a reproductive and perinatal psychiatrist in New York City. For the women battling chronic postpartum depression, finding treatments that work and doctors who won’t dismiss their concerns can be major struggles.

After she experienced a panic attack when her son was eight months old, Reiswig’s father-in-law—a family-practice doctor—encouraged her to seek help. She was taking one antidepressant for about 10 months until it stopped working and she switched to another.

“I started feeling the depression come back,” Reiswig said, “and I thought, ‘What is wrong with me? This is not normal, he’s like a year and a half [old], why am I still experiencing this? Something is really wrong with me because you don’t hear people talk about postpartum depression starting and then staying like that.’”

The severity and longevity of postpartum depression, says Snyder, hinge on a litany of factors: how quickly it is diagnosed and treated, and a woman’s sensitivity to the hormonal shifts of pregnancy and the postpartum period—as well as environmental stressors like financial hardship, a traumatic birth experience, or lack of a support system. And, of course, some women may be genetically predisposed to depression or other mood disorders.

But one thing is for sure: The longer the condition lasts after giving birth, the more likely it is that the woman will suffer from depression long-term. A study published in March found that most women who experience severe depression at two months and eight months postpartum still report depressive symptoms 11 years later.

Like Reiswig, Jessica, a mother of three who lives in Lee’s Summit, Missouri, had no personal or family history with depression prior to becoming a mom. (Jessica asked to be identified by her first name only because of ongoing legal proceedings with her ex-husband.) Then, after her first two children, twin girls, were born in 2005, Jessica started feeling anxious and overwhelmed—feelings she thought were just part of new motherhood and compounded by the fact that her then-husband was deployed overseas. As the months passed and her depression worsened, she mentioned her concerns to her children’s pediatrician. But the doctor dismissed her, telling her she had twins, so of course she was overwhelmed. Jessica continued to spiral downwards until she hit a breaking point.

“I remember very clearly both of them crying in the middle of the night and just sitting on the floor of their bedroom completely incapable of doing anything,” she says. “I was just like, ‘I can’t do this anymore.’” Her twins were a one and a half years old before she started feeling like herself again.

But the relief for Jessica proved illusory. When she got pregnant again in 2007, her obstetrician urged her to stop taking antidepressants for the health of the fetus—a recommendation that is now less common with more research about how antidepressants affect pregnancy. Jessica obeyed, but then her depression and anxiety returned almost immediately. This time, after her son was born, she didn’t hesitate to go back to her doctor.

“The depression returned during my pregnancy and then when I had my son, it was a big mess, but I knew that time,” Jessica says. “So, when he was six weeks old, I was like, ‘This isn’t a conversation that we are going to have, I need this to be treated.’”

While she knew she needed help managing her depression and anxiety, she also says the older her children got, the more pressure she felt to be recovered. She oscillated on and off her meds for years—stopping when she felt she no longer needed them and then starting again when her symptoms became overwhelming.

“I was thinking, ‘Well, it was postpartum depression, so I should be fine,’ but that’s not how it works, at least not for me,” Jessica says.

After her second pregnancy and the birth of her third child, Jessica was able to recognize the signs of her depression, such as her overwhelming anxiety and difficulty completing daily tasks. But even with that knowledge and experience, it was sometimes difficult to discern what feelings were part of her mental illness and what were normal reactions to the challenges of parenthood.

Jessica’s experience isn’t unique. “It is very difficult for a person, even a trained person, to be able to distinguish between regular frustrations, hormonal fluctuations, and a mood disorder,” says Nicole Washington, a Tulsa-based psychiatrist. Changes in sleep or appetite are typical signs of depression, but with a newborn’s erratic sleep habits, a new mom already has her sleep disrupted.

“The biggest reason PPD might persist would be because it goes untreated,” says Danielle Johnson, a psychiatrist based in Cincinnati, Ohio. “Even though a woman might recognize that she has symptoms she is concerned with or [that] are unusual for her, there is often a stigma about seeking treatment or not knowing it’s something that needs treatment. Women should not be ashamed or embarrassed to let people know they are struggling.”

Once PPD takes hold, the treatment course is similar to that of any other depressive disorder, and can include medication, therapy, or both.

“Now I have accepted this is likely something I will deal with the rest of my life,” says Reiswig, who, like Jessica, still seeks treatment through a combination of medication and therapy. “When I was first told it may never go away it made me feel anxious, like, no, I don’t want to deal with this the rest of my life.”

However, she says learning more about the number of women with PPD who suffer from depression long-term has helped her accept the condition: “It did make me feel a little bit more normal. I didn’t want to have to be living with it, but realizing it is a medical condition like anything else made me feel more normal.”