Neha Pathak, MD, FACP, DipABLM: Welcome to the WebMD Health Discovered Podcast. I'm Dr Neha Pathak, WebMD's Chief Physician Editor for Health and Lifestyle Medicine. Today we're exploring a topic that too many families weather in silence: postpartum­­ depression, or PPD. Postpartum depression is a condition that affects up to one in five new parents and can touch anyone regardless of age, background, or number of children. We'll unpack the rampant myths and misinformation to talk about what postpartum depression really looks like — everything from irritability or rage, intrusive worries, guilt, numbness, and trouble sleeping — and how to tell when it's time to reach out for support. Experiences with postpartum depression can be isolating, but they're also treatable, and recovery is possible. Together, we'll take a step-by-step approach to the questions you've probably been carrying in silence: Who should I talk to first if I'm concerned about postpartum depression? How can partners, friends, and family really help? How is postpartum depression diagnosed? What do effective treatments look like? Whether you're a new parent, a partner, or a friend, the goal of this episode is to leave you feeling informed, supported, and safe. You are not broken, you haven't done anything wrong, and you're not alone.

First, let me introduce my guest, Dr Megan Spence. Dr Megan Spence is a licensed clinical psychologist with more than 15 years of experience. She has expertise in trauma, anxiety, depression, life transitions, and work stress. She's certified in perinatal — meaning pregnancy and postpartum — mental health. Her approach is trauma- and multiculturally-informed, evidence-based, and empowering. Welcome to the WebMD Health Discovered Podcast.

Megan Spence, PsyD, PMH-C: Thank you. Thank you so much for having me.

Pathak: Well, I am really looking forward to our conversation today, but before we start exploring the topic, I'd love to ask about your own health discovery — either through your research or in working with patients. What were some of the questions and issues that helped frame how you changed your practice or the work that you're doing?

Spence: Yeah, so I came to perinatal work through the lens initially of trauma work and women's health. What I came to love about perinatal work and just this time in people's lives is that I really learned and heard from parents how much they wanted to do better than past generations for their families. And so I find this to be such an important time in terms of intervening, where the impact of treating and working with people at this time in their lives can affect multiple branches of the family tree — past generations and future ones. And so I found that really powerful.

Pathak: That is really beautifully said, and I'd love to then shift us to our topic today of postpartum depression. Can you start by helping us define what postpartum depression is? What is the definition?

Spence: When we think of postpartum depression from a clinical lens — meaning we're diagnosing this condition — we're looking at beyond the first two weeks postpartum through the first year postpartum. So in this time, are people experiencing classic symptoms of depression — low mood, crying spells, guilt, worthlessness, changes to sleep and appetite, and, in really severe situations, potentially thoughts about harming themselves or harming the baby. So after the first two weeks, through the first year postpartum.

Pathak: And so if these emotions, these feelings, this sort of mood disorder continues past a year, is that still postpartum?

Spence: Yes, potentially, if the beginning was within the first two weeks through the first year.

Pathak: And how long can postpartum depression last?

Spence: It can last for years if left untreated. So we really want to try to identify the symptoms and treat as early as possible. And the good news is we have very effective treatments that work.

Pathak: So then talk to us a little bit about how you might identify it, because as you're saying, it really can go on if not intervened on — it can go on for the early years of your child's life. What are some of the red flags? You mentioned some of the emotional, mental, and physical changes, but can you help us dissect some of those a little bit more?

Spence: I'd say more specifically, what I hear a lot in terms of the guilt piece or worthlessness is that I'll hear cognitions like, "I am a failure," "I'm not a great parent," "I'm not the right parent for my child." A lot of irritability or even rage — typically that's directed at a partner, but not always. There could be stressors happening, maybe issues with extended family members or work. Impairments to sleep — another big one I see is people so concerned about the health of the baby or even the health and safety of family members that they're staying up and really not able to rest even when they're given the opportunity.

Of course, sleep is compromised for anyone with an infant, but this is beyond that. It's like, "I had two hours to nap, and I wasn’t able to sleep at all because I was watching the monitor to make sure the baby was breathing." Those are sort of more nuanced ways. Oftentimes, the person who's experiencing these symptoms isn’t always able to detect them in themselves, so frequently it can be a loved one who’s noticing — "Hey, you’re getting really angry about things that don’t seem like a huge deal," or "You’re so worried, I’m concerned about you." So frequently, it’s a loved one who’s the first person to spot it.

Pathak: So I can imagine that as you’re talking about how long postpartum depression can potentially last without intervention, you might have one pregnancy, and then another pregnancy kind of stacked on a year or two later. How does that play out with symptoms?

Spence: Yeah, so having postpartum depression in any pregnancy becomes a risk factor for potentially having it in a subsequent pregnancy or postpartum period. So it's a risk factor — not a guarantee. And what we know about this condition is that it’s multifaceted. There’s a biological component to it, there are social components to it — so multifaceted — which means that there is hope to then potentially mitigate those risk factors in subsequent pregnancies. Again, if we can detect it, we know about it. Then the hope is that while it could be a risk for future pregnancies, there are things we can do proactively to try to prevent that.

Pathak: Let’s think about some of the factors that might influence the duration of postpartum depression. So I’m talking about maybe the patient before they’ve even identified it in themselves — or, as you said, a loved one has identified it in them. What are some of the factors that influence how long postpartum depression can go on for?

Spence: Yeah, so detection and access to treatment — which can be impacted by things like financial stress. COVID certainly impacted access to treatment in many cases. What the support system is like — is there care for the child? Right? If someone can’t attend an appointment because they are the solo parent of this baby, how do they get the care they need? And then accessing the treatment and being sort of what we call "compliant," or taking the recommendation. So if you’re prescribed medication, taking that on a regular basis, attending therapy consistently so that the treatments will work. And other big ones are life stressors — so again, that support system, financial situation, job factors, other stressors that are happening around this person.

Pathak: And are there experiences that are connected to the pregnancy or the postpartum period that might exacerbate your postpartum mood experience? So I’m thinking of things like breastfeeding challenges, a difficult birth, medical complications that happen during your pregnancy or afterwards. Does that play a role in how severe postpartum depression can get?

Spence: Yeah. So again, when we're thinking about risk factors, there are some that we know about — personal or family history of mental health challenges, sensitivity to hormone fluctuation. So if there’s a history of postpartum or PMDD or even severe PMS, that could be a risk factor for PPD. Medical challenges during the pregnancy — so potentially diabetes, thyroid issues, traumatic birth could be a risk factor. Having a child in the NICU, having multiples. And then also what we call high-stress parenting groups — these are groups like solo parents, teenage parents, military parents, parents who face systems of oppression, queer parents — certain high-stress groups. That’s an additional risk factor because it creates more stress in the body in general, which can exacerbate symptoms too.

Pathak: So for someone who’s listening who might have a loved one or has experienced this themselves — if they’re pinging with some of these risk factors that you’re discussing, some of the symptoms that you talked about — now they’re ready to seek care. What is it that someone like you would do on that first encounter? Where should they go first to start the path toward a diagnosis?

Spence: So really any medical provider they trust — it could be a primary care doctor, it could be an OB-GYN, they might have a therapist already or a psychiatrist they’ve seen in the past. Postpartum Support International is this amazing organization that offers free support groups daily. There are multiple — it’s very robust — there are all kinds of specialty groups in there. There’s also a directory there and a hotline that you can call to get help and get connected. There are statewide coordinators who will help find perinatal-certified therapists and psychiatrists. So any of those options are good ones.

I would also note here that when someone’s really depressed or feeling low, it’s hard to rally to find the energy to navigate all of that. So this is where loved ones can step in and be amazing allies. If you’ve got a partner or even a friend, or even just another mom that you know who’s been through this — having that person accompany the person who’s suffering to an appointment, making those calls — that can be a great support.

Pathak: I’m so glad you mentioned how hard it is to take any of these actions when you are in the midst of it, and I can give my own example here. I had a COVID baby, and I remember so vividly — I can still see myself doing this — where I was in the room with the baby, and I am lucky enough to live in a neighborhood where a lot of families were able to work from home. So people were walking around the streets, they were enjoying themselves, and I remember looking through the blinds and peeking out and just seeing smiling people and thinking, I don’t really understand how people are smiling. I can’t imagine myself being one of these people at all. And I think the few appointments that I went to, without fail, were the appointments for the baby — but it was really hard to rally to go to appointments for myself or OB-GYN follow-ups. So what are some of the options there if you can kind of rally yourself to get to your child’s pediatric appointments? Are there ways to sort of talk about this in those settings?

Spence: Thank you, first of all, for sharing that experience. It makes me think of a couple of things I haven't mentioned. One is that oftentimes, when women get to me, they say to me, “I just don't feel like myself. I feel outta my body, disconnected. I just really…” And when I hear, “I don't feel like myself,” it's a huge flag for me, regardless of symptom reporting and all of that, right? So I just want to make note of that.

And then the other piece is how important it is that we have integrated medical systems. So I was an integrated psychologist in an OB-GYN unit. When the OB would see people postpartum, they could refer them to me. Not every hospital system has this, right? But we've made strides in terms of attempting to screen people at postpartum appointments and throughout pregnancy. Pediatric departments should be doing this too — and some do — where you go into your pediatrician appointment, they'll give you a screener that looks at symptoms of depression. That might catch some folks.

But going back to this “I don’t feel like myself,” that is also something you can share with a pediatrician. If you're at your kid’s appointment and they say, “How are things going? How’s the baby feeding? How are you sleeping?” you can say, “You know, baby's doing fine. Baby's gaining weight. I don't feel like myself. I feel really disconnected. I'm raging at my husband.” And no one should be judging you for that — they should be helping connect people to care.

Pathak: I'd love to kind of shift to some of the social-emotional barriers. So, in your experience, what are some of the fears that keep new moms, and even potentially their caregivers or loved ones in that family unit, from saying or suggesting that this might be postpartum, or that you might need help?

Spence: You know, I think we've made a lot of progress, and I think there is just still so much stigma around this topic, right? There's sort of this expectation that particularly mothers — but also men suffer from this condition too, and people who don’t identify on the gender binary — so there's a stigma around sort of “pulling it together” postpartum. Like coming back together physically, having it all together, being super mom, super employee, looking great, you know?

And so all of that can create barriers in terms of even just admitting that something is wrong, that you need help. For a lot of people, this may be the first time they've experienced clinical depression to a degree where they need medication or regular therapy. And there's a lot of fear about that. There are fears about, “What does this mean for my breast milk? Is my baby gonna be affected if I take a medication?” For some folks, there’s medical mistrust related to the birth or otherwise — historical medical mistrust, cultural medical mistrust — and so going into a medical system to get support can be really scary.

So there are many, many barriers that can prevent somebody from getting that care. And I think the antidote to that is just continuing to educate the public about this — really giving informed consent to people who do seek care. So explaining thoroughly, taking more time than normal to explain what some of the options are, what they look like, risks and benefits — all of that can be very helpful to reducing some of that stigma.

Pathak: And I can also imagine some of the stigma happening because you may not only have thoughts of hurting yourself, but thoughts of hurting your baby — which can be really traumatizing to acknowledge, and I think scary to tell someone, because you don't know what that means for how the system is gonna then interact with you. So can you share a little bit about how you approach those fears?

Spence: Thank you for bringing that up. Another huge fear is that CPS will be called and the baby’s gonna be taken away. It is a huge, huge fear. First of all, I think we know in the psychology field that suicidal ideation — thoughts about hurting yourself — is a symptom of depression.

And when we look at that symptom, we consider: does this person have a plan and intention? Like, are they really at risk of harming themself? Same with the baby, right? Is this person actually planning to hurt their child? Is this something they really — what we call ego-dystonic or ego-syntonic — kind of psychological jargon for “Does this thought align with what this person actually wants to do?” Or does this thought feel like it's not themselves?

So common intrusive thoughts can be anger toward the baby, like, “This baby is crying again — can you just please sleep?” That is not thinking about hurting your baby in a way that is congruent with a belief system, right? We also know these things can be rather rare — like homicidal ideation toward the baby is really quite rare.

So I guess what I would offer is that you can seek help, and even with these symptoms, be assured that unless there is an immediate danger to yourself or the baby, no one’s taking the baby away, right?

Pathak: I'd love to then kind of pull on a point you made earlier around some of the cultural expectations to pull it all back together afterwards. That can also be a barrier. And I’m kind of thinking about the flip side where — okay, so the COVID baby was my third kid, and no one expected me to pull it all together. They were just like, “Yes, of course you’re laying around. Of course you can’t get yourself out of bed. Yeah, we absolutely understand why you wouldn’t even wanna feed yourself.”

How do you think about that, and what do you tell people — or especially folks that are the loved ones of someone that may be suffering with that — around when you need to actually intervene?

Spence: I actually kind of hold some personal acquaintances of mine about this. One of them shared that there was a postpartum depression experience, second baby, around COVID time, and it was hard to locate those symptoms in herself. But also, she wasn’t seeing support systems, right? Because of COVID, because of fear of getting sick, there weren’t a lot of people around to, again, kind of bear witness and reflect back that, “You’re not acting like yourself,” right?

So I think that adds additional challenges when there aren’t multiple touchpoints with multiple people. I think this piece is about educating — again, I go back to education. How can we bring spouses and partners into appointments to educate them about the symptoms as well? When people are pregnant, even if they’re not experiencing these symptoms, how can we educate them — give handouts, literally say, “Share this with your partner. Share this with your best friend. Share this with your mother, whoever is gonna be around this person.”

So that there are multiple people — and I’ll say, people who aren’t trained in mental health can’t really assess severity, don’t always detect it. And I think that was also a big part of why, during COVID, we saw rates really go up — because again, that village was sort of taken away, right? People were so isolated in that time.

So I think that’s why if we can disseminate this information — these podcasts, right? — sending these podcasts out to loved ones to give a sense of this, then we can catch it more regularly.

Pathak: So I’d like to shift us then to the recovery, or what is expected from you postpartum, with regard to things like returning to work, figuring out childcare for the baby you’ve just had and potentially other children that you already have, and difficulty finding community support. How do things like that impact postpartum depression?

Spence: This can be another time where we see a surge, right? So sometimes I see people who are doing great the first couple of months, and then they go back to work, and they come back to me, and that's when the symptoms begin because maybe there's stress about inadequate childcare access, or they just don't want to be back at work that early postpartum. So again, these are more of additional life stressors that can be risk factors. Not in every situation, but certainly can be. And I think overall, you know, the U.S. isn't as supportive to working parents as maybe other parts of the world, and so that adds a layer of stress for people who are returning to work.

Pathak: Yeah, I mean, I'm just kind of reflecting again, thinking about with my first two pregnancies, there was no COVID, so it was sort of like at the 12-week mark, that was it. That was all of the leave that I had. And then with COVID, there was some ability to work from home, and that was really helpful in some ways, but also created such a difficulty for me to get back into any sort of routine that was, I think, somewhat protective for me in my earlier pregnancies. So can you talk a little bit about how some of these lifestyle interventions can help as well with regard to things that aren’t necessarily medication related?

Spence: So I'll caveat this with, we always want to be holistic in thinking about what is realistic and achievable for this person, given multiple life circumstances, right? Ideally, we really want to hone in on sleep specifically. There's research that five hours of continuous sleep can be protective from a mental health standpoint. So sometimes I'm talking to people about what's going on with the feeding — is there a possibility to give the baby a bottle at this point so that you get this longer stretch? But sleep is so, so imperative, and we have to tailor that work around whatever is happening for this person's schedule, the support that they have, the multiple kids in the home, even the house layout.

Like I'm frequently asking people, what's your layout in your home? Sometimes it's using earplugs to block noise if there's a partner who's on shift, because the mother might be really sensitive to crying and have a biological response. So we want to try to reduce the stimulation there. Exercise is another big one. Again, caveat — we need to get creative. And also, I'm often talking to women about reducing expectations around what that means, right? So I'm not talking about exercise to get in your most fit body, like going to Orange Theory multiple times a week. I'm talking about, can you get out and walk for 15 or 20 minutes a day?

Like, what is actually realistic? I've had working moms who put little foldable treadmills in their homes, and they're walking on the treadmill during meetings. People walking around schools if they're teachers or, you know, the block — things like that. So being really creative. Nutrition is huge. So when you're breastfeeding, you're burning 500 extra calories a day. You really need to eat a lot of protein and just fuel your body in general. A lot of times when people are struggling with depression, they forget to eat or they don’t feel hungry. So again, getting creative — like, do you have a pump? Where’s your pumping station? Can you get a wheeled cart full of snacks that are high in protein, say granola bars or something like that? Can you have snacks in your car for yourself? Having partners bring water when women are feeding.

So nutrition, sleep, and exercise. And then social support is another big lifestyle factor, right? So depending on how robust the system is and also how helpful it is — wanting to have people who are cheering this person on, who are providing positive words, who are supporting their parenting choices, who may be sharing collective experiences to decrease isolation and stigma. So if they don't have a robust system, trying to get them connected maybe to local parent groups or postpartum support international groups or local support groups. All of those things can be really impactful.

Pathak: This is really, really helpful, and I'd love to then kind of shift to a group of people who may be suffering from postpartum, but it may be invisible to others and maybe even to themselves, because their experience with postpartum comes after a stillbirth, a miscarriage, abortion, surrogacy. I'd love to have you help us talk through what postpartum looks like in those other types of settings, and then we'll talk a little bit about treatment.

Spence: So each of these situations is very distinct. What I would say is that many of these situations where there is a loss can feel very isolating. So providing that support — like, if this is your loved one, checking in on how they're doing, encouraging them to get professional support, because again, they may not see the symptoms in themselves, or it may be just so crushing that it's really hard to rally, right? So checking in for an extended period of time, not just immediately after a loss. Providing support rather than any kind of judgment around reproductive choices that people are making.

And tailoring our treatments, right? So it’s not really appropriate to give certain screeners to people who maybe experienced a stillbirth, for example, versus someone who did not. We might offer in-home therapy for people who are suffering and are bedridden because they're having a really hard time. And then encouraging folks to talk to other people again, to find supportive places. And there are actually tailored groups in these different niche areas, right? Where people can find others who’ve experienced this — who can kind of hold these experiences so that they don’t feel invisible, so they feel really real.

And then really honoring the physical recovery here too, and recognizing that hormones can be at play in some of these situations as well. The grief experiences, providing people an opportunity to honor these losses ongoing, and just giving space to be able to talk about it because maybe people in their lives don't know what to say, don't say the right thing, or they just feel like they can't talk about it because they're worried about burdening other people.

Another really big thing here is guilt and shame. So oftentimes with loss, women — or the birthing person — are carrying a sense of guilt and shame related to, “I did this. I caused this.” So we really, as loved ones and as professionals, want to send the message: this is not your fault. You did not do this.

Spence: That's the message we want to send. I think there's also ways individually to get support, whether that's a friend you really trust, whether that's a therapist, whether that's a religious community — wherever that is for an individual. It’s really just about having positive, non-judgmental support and love around that person.

Pathak: I want to move us then to really just understanding more about treatment — evidence-based treatments. We've talked a bit about support groups, but talk to us a little bit about what evidence-based treatment looks like.

Spence: Yes. So we often look at severity level when we're thinking about different options. Psychotherapy can be very effective for any level of severity. But when we're thinking about moderate to severe symptoms, we're really looking at the combination of medication and therapy.

There are medications that have been well researched and are widely used. And then in terms of psychotherapies, we have a number of evidence-based treatments. We can also integrate treatments and tailor them to the person.

When I'm working with people in this postpartum period, I'm really honing in on those lifestyle factors first and foremost — specifically sleep, eating, even showering — I mean, really basic self-care — and then the support piece. And then yes, groups are available as well. Sometimes we're thinking about the physical recovery. So there’s pelvic floor physical therapy, ways to address injuries that might be related to the birth. Also sometimes coordinating with the medical team to help address any pain that people are experiencing or injuries.

I don’t prescribe as a psychologist, but what I can say anecdotally, from working with hundreds of people postpartum, is that medications are tailored depending on symptoms. We didn’t talk about anxiety as much today, but anxiety is also very common postpartum. So if someone’s highly anxious, that might be a different type of medication than someone who’s suffering from depression. Also, if someone’s got postpartum PTSD or trauma, those treatment options in terms of medication may be different as well, or OCD. The dosing might be different.

And psychosis — also different. So it really does depend on the symptoms. There are certain meds that are known to be really great at targeting intrusive thoughts versus meds that might help someone sleep and eat better or have more energy. So all of that is kind of looked at and can be tailored depending on the person’s personal history, family history, and also whatever they’re presenting with in the moment.

Pathak: I think that’s really so helpful and so critical for people to recognize that postpartum depression isn’t necessarily just a monolith — that there’s a variety of ways that you individually are experiencing it, and all of that information is critical to share with your team. So I’d love to end our time together with — if you could just speak directly to a person who’s listening who might feel like, “I’m having a lot of these symptoms.” What is the best way that they can bring this to someone’s attention? What kind of information would be helpful to bring to you or the healthcare team?

Spence: Yeah. I mean, I think unburdening themselves with needing to diagnose, but more just telling us honestly what is happening, right, in their own words. So like, “I’m not feeling myself. I am so worried about my husband every time he goes out that he’s going to get in a car accident, that I can’t focus on my kid. I’m feeling really detached from my child. I don’t feel bonded. I’m not loving this. I’m feeling really guilty that I’m not loving this. I feel like I’m a bad mom.” Like whatever it sounds like and feels like — as best as you can, just trying to share that with us. And it’s on us as the medical team, the professionals, to help sort out what that is and give some education about that and give options for care.

Pathak: And then what about the loved one who is supporting someone who’s recently given birth — partner, sibling, friends, parents — how can they best support someone who they see seems to be experiencing postpartum depression or has some of the symptoms that we described today?

Spence: Checking in on a regular basis, if you’re close by physically, providing relief and support to try to get this person some rest — so holding the baby, letting them shower, bringing them food, bringing them water, encouraging people to reach out for support, offering to accompany them to do that. Literally getting on the phone, going into appointments with people. Educating yourself on symptoms and taking care of yourself. Oftentimes spouses also may be traumatized or experiencing things mood-wise, so also getting care there. And being that really positive mirror — it can’t be said enough — you cannot say enough to someone who’s suffering from postpartum depression that “You are a good mom. You are the right mom for your child. This will get better.” They may not believe you for a long time, but it can’t be said enough, and eventually those kinds of messages can be internalized. So it’s super important to just reiterate that.

Pathak: Wow, that is really powerful. I want to thank you so much for your time.

Spence: Thank you.

Pathak: Before we close our episode today, I'd like to leave you with my three key takeaways. First, postpartum depression is real. It's really common, and it's treatable. If you are struggling, please know that you're not alone. It's not your fault or a sign of weakness. Up to one in five new parents experience postpartum depression, and with the right treatment and support, most people recover fully. You don't have to suffer through this alone.

Second, the very simple thought of “I don’t feel like myself” is reason enough to seek help. Many of us are programmed to hold off on finding resources or asking for help until things feel unbearable. But if you're feeling disconnected, constantly on edge, unable to rest — those are signs that you may need to talk with a trusted healthcare provider, whether that's your OB-GYN, your primary care doctor, or a therapist. Talk to someone. Postpartum Support International also offers free daily support groups and a helpline at 1-800-944-4773. We’ll include these resources and more in our show notes.

Finally, healing can begin with communication, connection, and taking small steps. Getting adequate sleep, nourishment, gentle movement, and honest emotional support can make a real difference. Ask loved ones to help you get rest, prepare meals, or come with you to appointments — because you deserve care, compassion, and relief.

Thank you so much for being with us today. To find out more information about Dr Megan Spence and postpartum depression, make sure to check out our show notes. Please take a moment to follow, rate, and review this podcast on your favorite listening platform. If you'd like to send me an email about topics you are interested in or questions for future guests, please send me a note at [email protected].

This is Dr Neha Pathak for the WebMD Health Discovered Podcast.