Cultural and societal factors certainly play a role in postpartum depression, specifically in the expectations that are placed upon a new mother and her child. It would be helpful to provide educational materials, and references to any number of postpartum depression organizations- many of which provide support in dozens of languages across the world. As previously mentioned, there may be minimization or complete denial of symptoms. Additionally, seeking out any type of mental health support may be frowned upon or even a point of contention. It is crucial to provide psychoeducation in these situations, as extensive research studies have indicated the benefit of timely interventions. Working in a framework that allows family and friends to support recovery is the best way to ensure that recovery is successful.
Postpartum depression affects millions of women worldwide, yet it remains a topic that is often misunderstood and stigmatized. Through this series, we aim to shed light on the various aspects of postpartum depression, including its symptoms, causes, treatment options, and the impact it has on individuals and families. As part of this series, we had the pleasure of interviewing Dr. Tzvi Furer.
Dr. Tzvi Furer is a seasoned child & adult psychiatrist and owner of his concierge private practice, Palm Tree Psychiatry located in Jupiter, FL. Dr. Furer has extensive mental health treatment experience- Dr. Furer is a former Unit Chief of Adolescent Inpatient Psychiatry at New York City’s Bellevue Hospital, former Associate Program Director for New York University Langone Health’s Child & Adolescent Psychiatry Fellowship, and former undergraduate professor at New York University in class topics including narrative medicine, sleep, and love. Dr. Furer has also been awarded the status of Fellow through the American Psychiatric Association and Distinguished Fellow by the American Academy of Child & Adolescent Psychiatry, given for significant contributions in the field of psychiatry.
Thank you so much for joining us in this interview series. Before we begin, our readers would love to “get to know you” a bit better. Can you tell us a little about yourself?
It’s a pleasure to be here! My name is Dr. Tzvi Furer, and I have always been fascinated with the human brain. In fact, I knew I wanted to be a doctor since I was four years old! After finishing college and medical school, I completed Adult Psychiatry Residency at SUNY Downstate Medical Center/ Kings County Hospital Center in Brooklyn NY where I served as Chief Resident. I then completed a Child Psychiatry Fellowship at NYU Medical Center / Bellevue Hospital Center in Manhattan NY, where I stayed on as faculty for several years after graduation. I previously served as Unit Chief for Inpatient Adolescent Psychiatry for several years, and previously served as the Associate Program Director for NYU’s Child Psychiatry Fellowship. I now live in Florida with my wife, children, and dog. I own and operate my own concierge private psychiatry practice, Palm Tree Psychiatry, in Jupiter FL that services both FL & NY with treatment for children, adolescent, and adults.
Ok, thank you for that. Let’s now jump to the primary focus of our interview, about postpartum depression. Let’s start with a basic definition so that all of us are on the same page. Can you please tell us what postpartum depression is?
Postpartum depression is a known medical condition relating to mood and behavioral changes that develop in women during the postpartum period. Most definitions of postpartum refer to the twelve-month period after a delivery, however, it can describe any period following three months after a birth. These symptoms most closely resemble the condition known as major depressive disorder (“depression”) including feelings of sadness, poor concentration, loss of interest in previous activities, difficulties with appetite or sleep, and even onset of self-harm or suicidal thoughts. These thoughts can range from mild (known as “postpartum blues”), to more severe symptoms that are known as postpartum depression. Definitions of postpartum depression can also vary, including the formal DSM-5 diagnosis of Major Depressive Disorder with Peripartum Onset, “Depressive Episodes Associated with the Puerperium,” or the more straightforward ICD-10 diagnosis of “postpartum depression.” The exact classification depends on the part of the world where you are receiving the diagnosis.
Can you discuss some common misconceptions about postpartum depression and why they are harmful?
As a provider that has detected and treated postpartum depression, misconceptions about the condition are rampant. Working with mothers and their partners, I have occasionally seen individuals who have been in denial about having associated symptoms, or state that it is “normal” to feel sad or upset following the birth of their child. And while a condition of “postpartum blues” can be frequent, this may create some misconception that it is “normal” to feel excessively sad or have mood swings following pregnancy. Most people do not know there is differentiation based on severity of symptoms, or how to approach treatment and support of the condition. The range of symptoms of postpartum depression can span time-limited reactions to debilitating impairments that can affect functioning and potentially lead to thoughts of self-harm / suicide. There is also a similar postpartum condition known as “postpartum psychosis” that is often mistaken for postpartum depression but can be extremely dangerous as it can include hallucinations, disturbing thoughts, delusions, and paranoia directed against other people.
Additionally, misunderstanding about postpartum depression can instill blame on the pregnant individual as being “responsible” for these symptoms. There is no connection between postpartum depression and the ability to function as a parent. In clinical practice, I have seen first-hand accusations related to quality of parenting- even towards a parent that had a child only days prior! Blame has no role in the treatment of mental illness, and postpartum depression is no different.
Can you explain the role of hormonal changes in postpartum depression, and how does this influence treatment approaches?
Among the many elements that contribute to the postpartum period, a change in the level of hormones in the body is one of the more striking physiological changes to occur. More specifically, hormones such as estrogen and progesterone decrease in the body, both typically associated with emotional processing. Decreases in these two hormones lead to low mood, decreased energy levels, and general amotivation. Oxytocin, another hormone that has been labeled as the “bonding” or “cuddle” chemical, has levels that highly correlate with adaptations to stress responses. There is also speculation that the post pregnancy period may affect thyroid levels as well, and the thyroid is directly associated with energy levels, mood, and overall feelings of well-being.
How does postpartum depression impact the bonding between a mother and her baby, and what interventions are available to address this?
Postpartum depression impacts numerous things in the postpartum period, and affects the mother-child bond itself. A novel period in the life of both parent and child, symptoms of postpartum depression may cause a mother to feel isolated, withdrawn, and impact the mother’s mood. Understandably, these resulting symptoms may be devastating, and affect activities related to mother-child attachment such as nursing and non-verbal / verbal communication. Because the symptoms of depression are pervasive, the level of one’s own insight into their condition may be highly affected. Specifically, this means that individuals may not recognize there is an issue entirely and may be more likely to minimize or downplay any of the symptoms they are experiencing. Besides the direct manifestations of postpartum depression, further exacerbations occur by a parent’s own perception of what is happening. It is not uncommon for mothers to feel guilt, shame, irritable, or embarrassment that they are unable to connect fully with their own child. These external feelings can further aggravate their already existing low mood, difficulty with sleep or appetite, poor concentration, or other symptoms of depression.
Helpful interventions include individual therapy or counseling, and the use of psychopharmacological medications such as antidepressants. An important aspect of therapeutic treatment includes fostering and building upon the relationship between a mother and their child, and creating opportunity to connect without feelings of guilt, shame, anxiety, or sadness.
What are some of the best ways to treat postpartum depression?
Postpartum depression is treatable, with assessment and detection being crucial in providing interventions. As with most typical associated depressive conditions, individual psychotherapy (or “talk therapy”) is important in recognizing mental patterns, automatic negative thoughts, and cognitive processes that are occurring. There are specific forms of therapy that may be useful including cognitive behavioral therapy (CBT), interpersonal therapy (IPT), psychodynamic therapy, and dialectical behavior therapy (DBT) among many others.
For individuals with more severe symptoms or looking to benefit beyond therapy, psychopharmacological medications may be helpful in alleviating these symptoms. The most frequently used medications are antidepressants of the Selective Serotonin Reuptake Inhibitor agent class, including medications such as sertraline, fluoxetine, and escitalopram. Medications should always be closely monitored by a medical professional to monitor progress, potential side effects, and adjust the dose as needed. There are other types of antidepressants and agents for mood symptoms that may be effective.
It should be noted that postpartum depression can also be comorbid with other mental health conditions and symptoms such as anxiety and insomnia, and that ongoing treatment may target these limitations directly.
Ok super. Here is the main question of our interview. Based on your experience and research, can you please share “5 Things Everyone Should Know About Postpartum Depression?” Please share a story or an example with each one.
1 . Having postpartum depression does not mean that you are a “bad” mother: The recognition, assessment, and treatment of various mental disorders can vary drastically across different cultures, societies, geographic location, and different expectations assigned to individuals. While there currently is increased awareness of postpartum depression, there are still numerous cultures that would assign any form of mental illness as being exaggerated or not existing entirely. While a thorough clinician will diagnose and treat in a culturally appropriate framework, it is possible that symptoms of mental illness may reflect poorly on the mother. Overall treatment outcomes depend on appropriate support, and the presence of symptoms is used to label perceived deficiencies in the parent, reflecting inaccuracies. It is crucial to correct these negative thought patterns immediately, as an unsupportive environment may create hostilities that will exacerbate existing symptoms, and further feelings of frustration, anger, and low self-esteem.
2 . Postpartum depression IS treatable:
Amidst symptoms that may feel overwhelming, it is easy to believe that no treatment exists for postpartum depression. While several symptoms of mild depression, known as “postpartum blues,” has been normalized and to an extent minimized, it creates the false impression that symptoms will pass or do not require treatment. Research has demonstrated that the combination of therapy and medication treatment can be vastly helpful in alleviating symptoms of depression. Early detection and treatment allow to improve symptoms and prevent the condition from becoming further exacerbated. Further support and treatment can come from support groups, or networks that can be extremely supportive in managing the array of symptoms that may occur.
3 . You shouldn’t be embarrassed to have postpartum depression:
Besides the stigma placed by society or cultural expectations, there is substantial guilt that results in feeling embarrassed or shame to have postpartum depression. The presence of this condition is no reflection on the ability to be a parent or indicates that something was done incorrectly during pregnancy. Because of the frequency of postpartum depression and associated automatic negative thoughts, support groups and organizations may substantially helpful. The appropriate support and treatment can mark the difference between a rapid recovery and sustained symptoms that may worsen over time.
4 . There are several types of postpartum depression, but not officially:
Postpartum depression is often distilled and lumped in with a general set of symptoms, when the truth is that postpartum depression has been differentiated in both society and in scientific literature under the terms of “postpartum blues,” “postpartum depression”, and more concerningly, “postpartum psychosis.”
Complicating this further is that the Diagnostic and Statistical Manual (DSM), the diagnostic manual from which mental health professionals derive diagnoses, has combined both postpartum depression and postpartum psychosis, previously distinguished, as one combined diagnosis known as “depressive disorders with peripartum onset.” This, combined with colloquial discussion about postpartum depression as one condition with different presentations, has created confusion in differentiating and distinguishing appropriate treatment interventions.
To be more specific, the differentiation of postpartum depression depends heavily on the symptom profile and severity of symptoms seen in the individual. Previously, the distinction made included:
-Postpartum Blues: A constellation of low mood with mild or few depressive symptoms that is time limited in nature. These symptoms of depression may include tearfulness, tiredness/fatigue, irritability, anxiety, impaired concentration, and mood swings. Generally, postpartum blues are described as a temporary mood shift that improves quickly, with the person returning quickly to their previous baseline.
-Postpartum Depression: This is defined as a more severe set of depressive symptoms in the postpartum period, specifically including low mood, poor concentration, impaired sleep or appetite, loss of interest in previous activities, and guilt. Occasionally, this syndrome may be associated with thoughts of self-harm or even of suicidal ideations as well. These symptoms may be more pervasive in nature and may not quickly resolve.
-Postpartum Psychosis: This is the most severe form of postpartum-associated depressive disorders and includes the involvement of significant symptoms of disorganization & psychosis. Typically presenting anytime within days after birth up through six weeks after birth, symptoms involved can include paranoia, delusions or sustained false beliefs, loss of touch with reality, hallucinations or misperceptions, and prominent confusion. Postpartum psychosis can interfere with the ability to detect reality and can be associated with severe thoughts of harm to oneself or others. This is considered a severe psychiatric emergency and requires urgent evaluation & treatment.
5 . Postpartum depression doesn’t always look like “depression”:
Postpartum depression may not always appear as “depression”, and this relates to multiple factors.
To begin, as with many depressive disorders, the expectation for a diagnosis that the person will appear sad or withdrawn all the time. Individuals with depression, especially postpartum depression, may be overwhelmed and stressed, with depressive symptoms appearing more functionally related to symptoms of anxiety or irritable mood. Mothers with postpartum depression may be severely on edge, easily frustrated, and may not present as the more stereotyped tearful or sad presentation of depression.
Another consideration is that as mentioned previously, a severe form of postpartum “depression” is that more closely related with psychotic symptoms resembling disorders such as bipolar disorder or schizophrenia. Recent shifts in diagnosis with the DSM 5 place this presentation as technically diagnosable as “postpartum depression” but require urgent evaluation and treatment as these individuals are substantial risks to themselves or others.
What are some practical strategies for supporting a partner or loved one experiencing postpartum depression?
While it may seem straightforward, one of the absolute best ways to support a partner or a loved one experiencing postpartum depression IS to support them in a non-judgmental manner. Mothers with postpartum depression may be highly critical of themselves, including their feelings or even their decision to have a child altogether. It is important to normalize occasional feelings or frustrations, but also gently guiding those with postpartum depression towards seeking out support. This can be an overwhelming time on top of having a newborn child, which is already a time that can be prone to poor sleep, difficulty maintaining a routine, and substantial stress. Strategies that may be helpful initially would be to provide a break for the mother, including encouragement of previously enjoyed activities. This includes leaving the home environment, which can be massively helpful in preventing feelings of being “trapped.” If this Is not helpful, a suggestion could be made about attending any number of support groups for postpartum depression which can be helpful in assuaging feelings that one is “alone.”
What are some cultural or societal factors that may contribute to the prevalence and experience of postpartum depression, and how can we address these effectively?
Cultural and societal factors certainly play a role in postpartum depression, specifically in the expectations that are placed upon a new mother and her child. It would be helpful to provide educational materials, and references to any number of postpartum depression organizations- many of which provide support in dozens of languages across the world. As previously mentioned, there may be minimization or complete denial of symptoms. Additionally, seeking out any type of mental health support may be frowned upon or even a point of contention. It is crucial to provide psychoeducation in these situations, as extensive research studies have indicated the benefit of timely interventions. Working in a framework that allows family and friends to support recovery is the best way to ensure that recovery is successful.
You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
While several great strides have been made in creating recognition and support for postpartum depression, I think the greater movement may be to provide broader education about Postpartum Depression. More materials, and perhaps hospital trainings for family members at the bedside, could be extremely crucial in recognition and referral to treatment. Often, family members are the first to notice possible symptoms, and depending on how seriously this is taken, it could make a large difference between quick action and procrastination. Targeted interventions that involve the entire family system may help to support better overall outcomes, and provide validation to the individual suffering from symptoms of postpartum depression.
How can our readers further follow you online?
Please visit my website at www.palmtreepsychiatry.com! I am also available on various social media platforms including Facebook, X, Instagram, LinkedIn, and Threads- @palmtreepsychiatry.
Thank you for the time you spent sharing these fantastic insights. We wish you only continued success in your great work!
It was my pleasure, thank you for the opportunity.
Tzvi Furer of Palm Tree Psychiatry: 5 Things Everyone Should Know About Postpartum Depression was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.