Depression in Moms Goes Beyond Baby Blues

By Kaumudi Marathé

depression-3“I’m depressed.” How often have we heard a fellow mom say that? We commiserate, give her a hug and move on. After all, the phrase is used quite casually these days. It might indicate sadness – the loss of a job, the death of a loved one or a sense of stagnation – or it might indicate hormonal shifts. Unless that mom says she has been clinically diagnosed with depression, there is a chance we won’t treat her comment with gravitas, ask questions or steer her toward professional help. Experts say we should.

Depression in moms is not always definable, not always evident, not always diagnosed. Women suffer from mood and anxiety disorders at approximately twice the rate of men, and 10-20 percent will experience a clinically significant episode of depressive or anxiety disorder in their lifetime.

“Some of this may be related to physiological distinctions involving hormones and genetics,” says Itai Danovitch, M.D., who chairs the department of psychiatry and behavioral neurosciences at Cedars-Sinai Medical Center. “Additionally, severe stress is a risk factor for depression, and women are much more likely to have a life history of sexual assault or domestic violence.” And some forms of depression, such as postpartum, perinatal and menopausal depression, only affect women.

Living in Los Angeles can make a woman’s struggle with depression more difficult. “It is a wonderful city, but it is also a hard one,” says Danovitch. “The cost of living is high. Schools are plagued with challenges, which require unending parental involvement and support. Commutes are long. Workdays are long, and few workplaces truly adapt to the scheduling and lifestyle needs of mothers. Images of apparent success are everywhere. All of these urban experiences cause stress. And persisting stress is a risk factor for anxiety and depression.”

Unrealistic expectations cause further harm. “There is a circulating fantasy in L.A. that being a good mother means doing it all and doing it all alone,” says Lilit Pogosian, M.D., medical director of the Maternal Wellness Program at Huntington Hospital in Pasadena. This idea inevitably leads to disappointment.

Spotting Symptoms

While studies have shown that one in 10 women of child-bearing age have experienced symptoms of major depression in the past year, these often go unrecognized – and untreated. “It is of utmost importance for mothers to recognize signs and symptoms of depression, as help is available,” says Pogosian.

Karoline Keegan, a 51-year-old L.A. mom of two daughters, has had some form of depression for much of her life. “I think I actually suffered from it, on and off, without knowing what it was,” she says. “Depression is not quantifiable, unlike a toothache that you can identify clearly. If you don’t quite know what something is, you are not sure how to fix it. You muddle through and wait till it passes. Or it could exacerbate till you start hurting yourself or use some coping skills that we practice as women – overeating, shopping, you know – when we just don’t feel good about ourselves.”

Many mothers either do not recognize their symptoms of depression or brush them off as inconsequential. “Less than 50 percent of women who experience depression ever receive treatment for it,” says Danovitch. “When you are preoccupied in caring for others, you are at risk of neglecting your own emotional needs. There is much evidence now that it is vital for caregivers to tend to themselves, and that, in the long run, achieving balance strengthens the ability to care for others.”

Another problem, Elizabeth Hamilton, LCSW, of Kaiser Permanente Panorama City Medical Center says, is that mothers are “very sensitive to possible judgment and criticism and hesitate to bring up negative feelings like worry and sadness,” which are two signs of depression. Other common symptoms include lack of energy and motivation, a sense of hopelessness or helplessness, trouble focusing or sleeping, a disturbed appetite and sometimes suicidal thoughts.

No Super Mom

Recently, Pogosian has noticed mothers in her clinic with more subtle signs: excessive tearfulness, mood irritability, hypersensitivity and social withdrawal. “Mothers stop answering phone calls or texts or they turn down invitations to meet and connect socially,” she says. “They fear being judged for how they experience motherhood and the challenges they face. Such negative thoughts create a sense of rejection, which further feeds the isolation and depression.”

Pogosian says she also sees patients with intense guilt, often triggered by “the constant questioning of oneself and one’s abilities as a mother” and by the belief that “a woman’s role as a mother equals a completely selfless one.” So, moms tend to focus their attention on their loved ones, with not much time or energy left for themselves. This is especially true of mothers raising children as single parents or after a divorce.

Erica Mia Greenberger (name changed) is one of those single moms. “I moved to L.A. when I graduated from college 20 years ago,” she says. “I think I would be the same person anywhere, but L.A. does make you feel that the ideal life is for young people, so you age out at some point.” Greenberger has suffered from depression throughout her life, and is the child of an alcoholic with a family history of depression that has manifested in different ways – anorexia, alcoholism, migraines.

Greenberger believes the pattern continues from one generation to the next. “The only way to break it is to recognize [the] issue,” she says. And though she calls becoming a parent the best thing that could have happened to her, she admits she feels isolated raising a daughter alone. “I am happier with people, and when I am left alone all day through parenting and my work, my head goes to challenging places,” she says. For her, therefore, having a community is healthy and essential.

As it is for most moms. “I tell people to remember that they are not in it alone,” says Hamilton. “The more we support each other, parent to parent and mother to mother, the better off for everyone. Super Mom does not have to go it alone. We exist and thrive in community, and teaching our children that we can reach out to others for help is a valuable lesson.”

Lifestyle Changes

Reaching out for help is the ultimate solution for moms struggling with depression, but there are some lifestyle changes that can help. Pogosian says that moderate exercise and physical activity can help relieve anxiety, as can meditation and yoga.

Mindfulness programs – such as one offered through the UCLA Mindful Awareness Research Center – can also reduce symptoms of anxiety. Headspace, an app available for a small subscription fee, offers a handy and portable resource for mindfulness exercises.

Mothers need to schedule “alone time” for self-care but also need to spend time with friends and fellow moms, even for casual meet-ups, to avoid becoming isolated.

Moms can also work to simplify their parenting, focusing on giving children unstructured free time to play, create and explore. “What they want most is to spend time with us,” Hamilton says. “Take stock. What is most important, most fun? Do these things and cut out the rest. If we feel less hectic and more calm in mothering, this passes on to our children and partners, and can result in improved well-being for everyone.”

Getting Help

Whatever lifestyle changes they try, Pogosian recommends that mothers who believe they are dealing with depression connect with practitioners who specialize in women’s mental health. This will ensure a thorough evaluation and treatment planning to best address the challenges and vulnerabilities today’s mothers face.

Danovitch stresses that clinical depression is treatable, and encourages moms to seek help early.

He recommends:

  • A medical evaluation, because nutrient and hormone deficiencies such as anemia, low thyroid function and vitamin D deficiency can cause depression.
  • Talk therapies such as Cognitive Behavioral Therapy (CBT) or Interpersonal Therapy (IPT), which are designed to be delivered in 10 sessions or less so they don’t require an open-ended commitment.
  • Lifestyle interventions including aerobic exercise and boosting essential fatty acids in the diet.
  • Antidepressants, particularly for moderate to severe depression, but only when combined with therapy and lifestyle changes.

Hamilton advises anyone dealing with ongoing sadness, hopelessness, crying spells, worry, stress, insomnia and physical pain such as stomach aches, headaches or body aches to seek help from a qualified mental health professional. “Oftentimes, speaking with a professional therapist is enough to gain the knowledge and positive coping skills needed to feel better,” she says.

Kaiser offers telephone and video visits, email communication with doctors, podcasts on topics such as relaxation and guided imagery, and an array of support groups including groups dedicated to women experiencing depression.

Moms struggling with depression can also seek support from partners, friends and family members. “Mothers are so often busy doing for everyone else. Take the time to exercise, eat healthy foods, be mindful in your approach to everyday tasks and live in the moment,” Hamilton urges.

So, if you notice a friend who is continually gloomy, sad or not socializing much, give her more than a hug. Ask pointed questions, listen for clues in the answers and offer practical suggestions so she can get help. You might be just the push she needs.

Kaumudi Marathé is a journalist and chef, but her favorite job is being a mom. When she isn’t driving to and from ballet class, volunteering at school events or walking her puppy, Kaumudi teaches cooking, writes freelance and runs long distances in Glendale.

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