By Dr. David Woo - April 8, 2024

Postpartum depression (PPD) is a prevalent mental health condition that affects many new mothers worldwide. According to the CDC, it affects about 1 in 8 new mothers in the US (1).

While the postpartum, or after birth period, is often portrayed as a time of joy and bonding, it can also bring about significant emotional challenges for some women. In severe cases, postpartum depression can escalate to a condition known as psychotic postpartum depression, posing additional risks to both the mother and her infant. In this article, we delve into the symptoms that distinguish postpartum depression and psychotic postpartum depression, potential treatments, and the promising role of transcranial magnetic stimulation (TMS) in offering a drug-free therapy for both conditions.

Understanding Postpartum Depression 

Postpartum depression, sometimes known as maternity depression, is a type of mood disorder that affects women after childbirth.

How long does postpartum depression last?

In the majority of cases, postpartum depression typically occurs within the first few weeks or months after the birth. However, if untreated, symptoms can even persist for years (2).

Why does postpartum depression happen?

There is no single cause understood to be responsible for postpartum depression. However, genetics, hormonal changes, stress and emotional issues, and disturbed sleep patterns can all play a role. As with other forms of depression, the individual’s particular situation must be considered when looking at ways to overcome it.

Postpartum Depression Symptoms

Depression and postpartum depression share many symptoms, but in the case of PPD, negative feelings can center around the baby and the patient’s role as a mother. Symptoms can vary in severity and may include:

• Prolonged feelings of sadness, hopelessness, or emptiness.
• Frequent crying episodes without apparent reason.
• Irritability or anger, especially towards the baby or other family members.
• Losing interest in previously enjoyable activities.
• Fatigue or lack of energy, even after adequate rest.
• Weight changes, loss of appetite, or binge eating.
• Difficulty bonding with the baby.
• Thoughts of harming oneself or the baby.

Psychotic postpartum depression, a severe form of PPD, involves additional, more acute symptoms, such as hallucinations, delusions, paranoia, and disorganized thinking. This condition requires immediate medical attention due to the heightened risk of harm to both the mother and the infant.

Stigma Surrounding Postpartum Depression

Mothers with postpartum depression can also be subject to additional stressors due to pressure from social expectations regarding gender roles, family, and motherhood (3). For example, a woman with PPD may feel unable to express her feelings or reach out for help because she is “not supposed” to feel that way about her baby or being a parent. It’s important to note that depression, including PPD, can affect anyone and is by no means an indicator that someone does not love their child or won’t be a good parent. 

Open communication with loved ones about one’s feelings and needs is crucial to good mental health, and this is also true for mothers struggling with PPD. Don’t be afraid to lean on your support network and seek professional help for your symptoms.

How To Help Someone With Postpartum Depression

If you notice someone in your life expressing the symptoms of postpartum depression, there are some things you can do to help them, including:

• Offer non-judgmental emotional support: As explained below, it can postpartum depression can be difficult to discuss because of the associated stigma. Listen to your loved one’s feelings and needs and be supportive. Remember, and remind them, that it’s okay sometimes to focus on their needs, not just the baby’s.
• Help with practical tasks: Such as errands, childcare, or other tasks to help ease the pressure on the new parent.
• Encourage them to seek professional help: Postpartum depression is a medical condition that is most effectively overcome through treatment by a healthcare provider. The following sections recommend proven treatments to find relief from postpartum depression.

Recommended Treatment for Postpartum Depression

Effective management of postpartum depression typically involves a combination of therapies tailored to the individual’s needs. Some recommended treatments include:

• Psychotherapy: Counseling sessions with a mental health professional can help mothers cope with the challenges of PPD, develop coping strategies, and improve communication with loved ones.
• Medication: Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs), may be prescribed to alleviate symptoms of postpartum depression. However, medication choices must be made carefully, considering their potential impact on breastfeeding and the health of the mother and infant.

Transcranial Magnetic Stimulation (TMS) For Postpartum Depression

In recent years, TMS has emerged as a promising alternative treatment for individuals with treatment-resistant depression, including postpartum depression. TMS therapy involves the non-invasive stimulation of the brain using magnetic pulses that target the specific brain areas involved in mood regulation. By modulating neural activity in the prefrontal cortex, TMS can restore the brain’s chemical balance and alleviate symptoms of depression, including those associated with psychotic postpartum depression.

Several studies have demonstrated the efficacy of TMS in reducing depressive symptoms and improving overall functioning in patients with postpartum depression without undesired side effects on lactation or other concerns (4,5,6,7). TMS reviews in 2023 show it to be effective and well-tolerated for many patients, including pregnant women, with few or minimal side effects and long-lasting results.

Don’t Suffer In Silence – Contact Madison Avenue TMS & Psychiatry

Postpartum depression, including psychotic postpartum depression, is a serious mental health condition that requires a prompt diagnosis and appropriate intervention. If you or someone you know is struggling with postpartum depression or psychotic postpartum depression, the best thing to do is seek professional help.

Madison Avenue TMS & Psychiatry offers comprehensive psychiatric services, including TMS, for individuals experiencing treatment-resistant depression, including postpartum depression. For many major health plans, TMS is covered by insurance, and in other cases, we may be able to arrange an out-of-network agreement with your insurer to cover TMS costs.

Contact us online today or call (212) 731-2033 to schedule a consultation and learn more about how TMS therapy can help you find relief from postpartum depression and reclaim your mental health and well-being.

Additional resources on depression and women’s health:

• What is TMS?: https://www.madisonavetms.com/what-is-tms/
• TMS for Anxious Depression: https://www.madisonavetms.com/blog/tms-for-anxious-depression/
• Women and Mental Health: Understanding the Gender Depression Gap: https://www.madisonavetms.com/blog/women-and-mental-health-understanding-the-gender-depression-gap/
• Depression Treatments that are safe for Pregnant Women: https://www.madisonavetms.com/blog/depression-treatments-that-are-safe-for-pregnant-women/

Resources:

1. Center for Disease Control. Depression Among Women. Link. Accessed March 18, 2024.
2. Vliegen, Nicole PhD*; Casalin, Sara PhD*; Luyten, Patrick PhD. The Course of Postpartum Depression: A Review of Longitudinal Studies. Harvard Review of Psychiatry.  2014;22(1):p 1-22. Link. Accessed March 26, 2024.
3. Hyde, Janet S. PhD; Mezulis, Amy H. PhD. Gender Differences in Depression: Biological, Affective, Cognitive, and Sociocultural Factors. Harvard Review of Psychiatry. 2020;28(1):p 4-13. Link. Accessed March 18, 2024.
4. Peng, L., Fu, C. Xiong, F., Zhang, Q., Liang, Z., Chen, L., He, C., Wei, Q., Effects of repetitive transcranial magnetic stimulation on depression symptoms and cognitive function in treating patients with postpartum depression: A systematic review and meta-analysis of randomized controlled trials. Psychiatry Research. 2020;290. Link. Accessed March 18, 2024.
5. E.Q. Cox, S. Killenberg, R. Frische, R. McClure, M. Hill, J. Jenson, B. Pearson, S.E. Meltzer-Brody. Repetitive transcranial magnetic stimulation for the treatment of postpartum depression. Journal of Affective Disorders. 2020;264,193-200. Link. Accessed March 18, 2024.
6. Garcia, KS., Flynn, P., Pierce, KJ., Caudle, M. Repetitive transcranial magnetic stimulation treats postpartum depression. Brain Stimulation. 2010;3,1, 36-41. Link. Accessed March 18, 2024.
7. Ganho-Ávila, A., Poleszczyk, A. Mohamed, M., Osório, A. Efficacy of rTMS in decreasing postnatal depression symptoms: A systematic review. Psychiatry Research.2019;279, 315-322. Link. Accessed March 18, 2024.

Dr. David Woo

Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.