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Singer Alanis Morissette has had postpartum depression with the birth of each of her three children. Getty Images
  • Singer Alanis Morissette is talking about the postpartum depression she has had after the birth of each of her three children.
  • About 1 in 9 women in the United States will experience postpartum depression.
  • Symptoms usually appear a week to a month after childbirth.
  • Experts say women should develop a personalized self-care plan before they get pregnant.

Not once, not twice, but three times it has happened to singer Alanis Morissette.

She has worked her way through postpartum depression with the birth of each of her three children.

The Grammy award winner has now opened up about her recurring experience with the post-birth condition.

In a personal essay, she writes, “I have been here before. I know there is another side. And the other side is greater than my PPD-riddled-temporarily-adjusted-brain could have ever imagined: as a mom, as an artist, as a wife, as a friend, as a collaborator, as a leader, as a boss, as an activist.”

Morissette shares a reminder for herself and others that postpartum symptoms as well as life itself does improve with time.

“I saw how things got richer after I came through it the last two times,” she writes.

And this time, Morissette says, she was prepared.

“I knew better so I set it up to win as much as I could beforehand. Support. Food. Friends. Sun. Bio-identical hormones and SSRI’s at the ready… but for all this preparation, PPD is still a sneaky monkey with a machete — working its way through my psyche and body and days and thoughts and bloodwork levels,” she writes.

Experts say 1 in 9 women in the United States will experience postpartum depression.

Symptoms commonly appear a week to a month after childbirth but can also develop before birth and months after delivery.

“The postpartum period is the most frequent time that women experience their first major depressive episode,” said Helen L. Coons, PhD, ABPP, clinical health psychologist, visiting associate professor, and clinical director at the Women’s Behavioral Health and Wellness Service Line at the University of Colorado School of Medicine.

Moreover, up to 80 percent of women will experience some form of perinatal depression or “baby blues.” Knowing what to watch for can prevent further problems.

Signs and symptoms of depressive episodes are varied and include excessive crying, inability to concentrate or retain new information, feelings of worthlessness and guilt, and a desire to escape.

“Depression, in and of itself, is a recurrent disorder,” Coons told Healthline. “When a woman has had an initial episode of perinatal or postpartum depression, in other words, during or after pregnancy, they are at risk for another episode.”

While Coons notes that many pregnancies in the United States are unplanned, she says that ideally, if a woman has experienced depression at any time in her life, or postpartum depression, she should have an evaluation with a perinatal mental health specialist before trying to conceive.

The following questions, says Coons, can help a woman determine if she is ready to think about conceiving.

  • Is your mood stable or are you feeling anxious or depressed?
  • How is your sleep quality and quantity?
  • Are you practicing good self-care?
  • Do you feel ready to handle the joys and the stress of having an infant in your life?
  • Do you have an established patient care plan for your mental health?

“Clinically, I like to see a year of stable sleep and mood,” said Coons.

Coons adds that good mood and self-care are particularly important to monitor because depression diminishes a woman’s quality of life and “is one of the major predictors of nonadherence to health recommendations.”

She explains that when you’re pregnant, you are encouraged to “take prenatal vitamins, exercise, eat well, avoid alcohol and other drugs.”

Every woman thinking about conceiving who has ever experienced an episode of depression can benefit from a pregnancy self-care plan.

According to Coons, the benefits of implementing a personalized plan early on has several advantages for a woman’s overall health.

  • You minimize the risk for recurrence of another depressive episode.
  • You learn multiple strategies to reduce that risk.
  • You learn to identify signs and symptoms so you can raise a red flag early and seek help to treat your depression.
  • You educate yourself and can review the plan with loved ones who may detect signs sooner and support you.
  • You have an established relationship with a mental health provider who can ideally see you if you do become depressed.

“When I work with a woman who has a past history of depression or anxiety, any time, and certainly in a prior pregnancy or postpartum, if there are more than 2 days of disturbed sleep, I encourage them to call and we get a plan going to decide what they should do,” Coons said.

She recommends consulting a psychologist or psychiatrist who specializes in perinatal mental health. Ideally, one would do this before conception or “very early” in the first trimester for a personalized self-care pregnancy plan, especially if there is a history of depression or postpartum depression.

This way, if you become symptomatic, you’re already established with a history taken by the provider. They can get you in more quickly and get a collaboration going to get you treated early during pregnancy.

Medication can have a lifesaving effect for people experiencing severe depressive episodes.

Coons said if women have questions about medications during pregnancy or postpartum while they’re breastfeeding, she advises them “to give themselves the benefit of a high-level consult with a psychiatrist who specialized in perinatal mental health.”

For those who fear taking medication while nursing, Deborah Roth Ledley, PhD, a licensed psychologist in Pennsylvania who has written the book “Becoming a Calm Mom,” said “This concern must be balanced against the very significant concern of untreated depression.”

“There are some medications that are safe to take while nursing and other moms might decide, while weighing the costs and benefits with family and trusted doctors, that it is better to discontinue nursing and treat the depression properly,” Ledley told Healthline.

“Nursing is only one component of motherhood,” she said. “If a new mom is having trouble getting out of bed or interacting with their newborn, it is much more important to treat the depression since babies can be fed with formula and be perfectly healthy.”

Still, there are many other options for women experiencing postpartum depression.

“There’s a broad range of pharmacological and non-pharmacological strategies we recommend,” Coons said. “In fact, cognitive behavioral techniques are often recommended as a first line to stabilize sleep and treat depression. In addition, aerobic exercise and mindfulness techniques can be very helpful for the treatment of mild depression.”

Your postpartum support team can include:

“Therapists can educate women about how their mood or anxiety disorder could present once the baby arrives,” Ledley said.

For example, if a woman has harm-related obsessive-compulsive disorder, a therapist can normalize the type of intrusive thoughts they might experience (e.g., What if I drop the baby down the stairs?) and teach strategies for how to get past these thoughts (e.g., walking up and down the stairs with the baby even if the anxiety is telling you not to).

“Being told you might have these experiences and that other people have these experiences, and that there are ways to deal with them, is half the battle,” Ledley said.