** This post was originally published at themamanotes.com by its author, Caitlin Kruse. The following is a repost of my interview with Caitlin, the first part of three on our perinatal depression series together. **

{CK} I think every mother can agree, the postpartum period is hard. You’re faced with new challenges every day in regards to caring for a newborn, not getting much sleep, your hormones are soaring, you may not feel an immediate bond with your baby – and then there’s the physical component of your healing and changing body.

The list really goes on, and it’s something many new moms haven’t thought about or know much about. And to be honest its not something that we talk about much or enough.

Lately it seems like more and more women are sharing their stories and struggles through this time and through this platform it’s very important to me to help educate expectant and new moms about postpartum depression.

Since I’m not expert in this field, today I’m excited to welcome back my friend, Kelly Newsome Georges of Ritual Care. In short, Kelly’s a postpartum care educator for new parents and Ritual Care offers a ton of incredible resources for mothers. Today Kelly’s giving us a basic overview about PPD and in the coming weeks we’ll be tapping into more specific topics.

{CK} There’s no doubt the postpartum period is challenging on a mother and her partner, but how does one know what’s normal and what’s not when it comes to feeling anxious or sad?

{KNG} First off, know that all mothers go through emotional ups and downs as a new mom. That, in itself, is absolutely normal. Remember, you’re adjusting to huge changes: a new sleep pattern due to newborn night wakings, the stress of keeping your fresh little miracle alive and, of course, the hormonal shift that occurs after delivery (particularly when you deliver your placenta, the pregnancy hormone powerhouse).

Second of all, it’s really important to note that you can’t diagnose yourself for, say, Perinatal Depression (aka Postpartum Depression or “PPD”). Only a professional, licensed health professional can do that, so just make sure you keep someone — your doctor/midwife, therapist, or pediatrician — on your contact list.

That said, an easy way to think about what’s normal or not is to ask yourself two short questions: How long (duration)? + How strong (intensity)?

Duration :: How long have you been feeling this way? When did it begin? Has it been ongoing or stop-and-go?

Intensity :: How strong are your anxious/sad feelings? Is it super-intense? Ongoing throughout the day? Disrupting your daily functioning? Have you stopped caring for yourself and/or baby?

And the short answers are: If it hasn’t been very long, isn’t ongoing, and you get relief from time to time, it’s probably closer to the normal side of things. But if it’s felt more like a never-ending-crying-fear-fest — even if you’re pretending on the outside like everything is okay — that may be closer to the “let’s call someone” side.

Let’s take an example and look at the difference between 2 of the most well-known perinatal mood experiences: Baby blues and Perinatal depression (aka Postpartum Depression or “PPD”).

Baby blues is super-common, affecting at least 4 in 5 of new moms and resolving on its own within 2 weeks. Thus, it is the “normal” of the two. PPD, on the other hand, affects closer to 1 in 5 new moms. It requires extra support, and can start anytime during the first postpartum year (when i had PPD for the first time, for instance, it didn’t peak until my daughter was 6 months old!). Mild cases of PPD might resolve on their own, but i always recommend receiving help.

When in doubt, chat with someone about it. A trusted friend, family member, doula, breastfeeding expert, or an anonymous call to a postpartum help hotline. The most important thing is to not self-isolate. Whether you’re going through “normal” or not, there’s no reason to go through it alone.

{CK} What are the most common postpartum mood disorders?

{KNG} First, there’s Baby Blues — a highly common emotional experience of ups and downs that nearly every mom goes though.

Then, there are official perinatal mood and anxiety disorders. I call them the “Big 6”: Perinatal Depression, Perinatal Anxiety, Obsessive-Compusive Disorder (OCD), Post-Traumatic Stress Disorder (PTSD), Bipolar Disorder, and Postpartum Psychosis.

(Pro tip: “Perinatal” is just a fancy term that means before and/or after birth, covering pregnancy and/or postpartum. Science has shown that Postpartum Depression, for instance, can begin during pregnancy. So, the clinical language is finally changing to better represent what mom’s going through.)

{CK} What are major warning signs to look for? *

{KNG} Postpartum Psychosis can be the most dangerous, because it has a sudden onset of psychotic symptoms. This is the disorder that the media often incorrectly labels “postpartum depression,” but it’s not.

Postpartum Psychosis is much more severe than Postpartum Depression. At .001-.002% of the new mom population, it’s also extremely rare. Look for paranoid behavior, refusal to eat, severe insomnia, confusion. Mom might also have dangerous delusions that feel so real to her, she believes them (e.g., She must hurt her children to save them from evil spirits, etc.).

For other disorders, some key signs include:

Depression ::

Excess crying, sadness, worry, stress, trouble sleeping, feeling hopeless, lack of eating, overeating, disinterest in caring for baby.

Anxiety ::

Extreme fear, insomnia, panic attacks, trouble breathing, excessive worry, extreme guilt.

Obsessive-compulsive ::

Disruptive, and sometimes scary, thoughts that don’t make sense to mom. She can feel that they aren’t true, yet can’t stop herself from the ritual/compulsion that follows the obsession. Mom might have constant thoughts of baby being harmed (or even harming baby), though she has absolutely no intention to do so. Moms are often scared to talk to anyone about this, but it’s actually more common than they may realize.

Post-traumatic stress ::

Flashbacks, nightmares, and hyper vigilance after a traumatic event (including birth).

Bipolar ::

Extreme behavioral “lows” (depression) and “highs” (optimism, fast speech, insomnia).

*Remember, you cannot diagnose yourself! You must talk to, and be evaluated by a health care professional.

{CK} What is the first thing a mom experiencing PPD should do?

{KNG} Talk to someone — a dear friend, therapist, doctor (even her pediatrician. In the United States, at least, they’re the ones who see mom frequently in the first year.).

{CK} What does treatment look like for someone with PPD or another mood disorder?

{KNG} It varies depending on severity. If it’s a mild case, treatment can often be an increase in self-care — for instance, hiring a postpartum doula or childcare help so that mom and dad can sleep. If it’s more moderate, then professional help — like a supportive therapist — is key. And if it’s severe, along the lines of Postpartum Psychosis, then mom must get immediate professional psychiatric treatment. As in, right now.

{CK} What are some resources for help?

{KNG} Some of my favorite online resources are Postpartum Support International (PSI), Postpartum Progress and the Edinburg Postpartum Depression Scale.

For books, I recommend Postpartum Depression For Dummies by Shoshana Bennett, and Anything by Karen Kleiman.

For immediate live professional help, call the National Suicide Prevention Hotline at 800-273-8255 (available 24/7), or leave a message with PSI at 800-944-4773 and someone will get back to you.

I also have a ton of resources in my PPD Care Kit, available in the Free PPD 101 Course online at RitualCare.com.