Postpartum Depression: How to Tell, and How to Get Help in Colorado

Postpartum depression affects roughly one in seven new parents. It is one of the most common complications of having a baby and one of the most treatable. It is also one of the most often missed, largely because the people living with it work hard to look fine.

This is an overview of what it is, how it differs from the other things the months after birth can bring, and what getting help looks like here.

If you are having thoughts of harming yourself or your baby, or you feel you are losing touch with what is real, you need help today rather than an article. Call or text 988, the Suicide & Crisis Lifeline — free, confidential, 24/7. Our safety and crisis resources page lists Denver-area options, and if you are in immediate danger, or showing the signs of postpartum psychosis described below, call 911 or go to an emergency room.

What postpartum depression is

Postpartum depression is depression that begins during pregnancy or in the year after birth. It can look like persistent sadness or emptiness, but just as often it looks like something else: flatness where you expected joy, irritability, guilt that never lets up, exhaustion that sleep does not fix, or being unable to sleep even when the baby does. Many parents describe feeling disconnected from the baby, or going through the motions of care without feeling anything.

It is a medical condition. It is not a sign that you did something wrong, that you do not love your child, or that you are not cut out for this.

The postpartum spectrum

The months after birth can bring several distinct things, and they need different responses.

The baby blues. Tearfulness, mood swings and overwhelm in the first days after birth are very common, and they pass on their own within about two weeks. If they do not pass, that is the signal.

Postpartum depression. Low mood, loss of interest, hopelessness or numbness that lasts past two weeks, or begins later in the first year.

Postpartum anxiety and intrusive thoughts. Racing worry, panic, and frightening unwanted thoughts — often about harm coming to the baby — are at least as common as depression and frequently occur with it. They are covered in detail in postpartum anxiety and intrusive thoughts, including why those thoughts are so distressing and why they are not a sign of danger.

Birth trauma. A frightening or medically complicated delivery can leave symptoms of post-traumatic stress — flashbacks, avoidance, being constantly on alert — that are easy to mistake for depression and respond to trauma-focused treatment.

Postpartum psychosis. Rare, usually in the first weeks after birth, and a medical emergency: confusion, seeing or hearing things that are not there, beliefs that do not fit reality, or very little sleep with unusual energy. It is treatable, and it needs care the same day — call 911 or go to an emergency room. The same urgency applies to any thoughts of harming yourself or your baby, or that your family would be better off without you (988, as above).

Why so many parents wait

Most parents with postpartum depression do not ask for help for months, if they ask at all. The reasons are consistent.

It is supposed to be the happiest time. Everyone around you expects joy, and so do you. When it does not arrive, the natural conclusion is that something is wrong with you rather than that something is wrong with your mood.

Everything gets attributed to the baby. Exhaustion, irritability, poor concentration and appetite changes all have an obvious explanation in a newborn, so the depression hides behind it.

Fear of what saying it out loud will mean. Many parents worry that admitting they are struggling will be read as being unfit. Clinicians who work with new parents hear this constantly; telling one that you are not okay is how care starts, not how scrutiny starts.

It does not look like the picture. Postpartum depression that shows up as rage, numbness or relentless anxiety does not match the image of a parent crying all day, so people rule themselves out.

Partners get it too

Depression in the year after a baby arrives is well documented in fathers and non-birthing parents, and it is less likely to be noticed, because screening is aimed at the person who gave birth. It often shows up as withdrawal, irritability, working longer hours or drinking more rather than sadness. A household where both parents are struggling is common, and both can be treated.

What getting care looks like

Start with whoever you already see. OBs, midwives and pediatricians routinely screen for postpartum depression, often with a short questionnaire called the Edinburgh Postnatal Depression Scale, and pediatric well visits in the first months are one of the places it is asked about. You do not have to wait to be asked. Saying “I don’t feel like myself and it’s been more than two weeks” is enough.

Therapy. The first-line therapies are CBT and interpersonal therapy (IPT). CBT works on the guilt-heavy, all-or-nothing patterns postpartum depression runs on and, through behavioral activation, on rebuilding small sources of rest, contact and accomplishment into days that have narrowed to survival. IPT focuses on the role change of new parenthood and the support you are or are not getting. Both are non-medication options, which matters to many pregnant and breastfeeding parents.

Medication. Antidepressants are widely used after birth, and there are now medications approved specifically for postpartum depression. Whether medication fits, and what is compatible with breastfeeding, is a conversation for a prescriber — often your OB. Therapy and medication are not competing choices; many people use both.

Make it possible to show up. New parents have very little time and less sleep. Online sessions remove the commute and the childcare problem, and for many people they are the difference between getting care and not.

Getting help in the Denver area

Our postpartum depression therapy in Denver uses CBT and IPT, paced for people who are exhausted and short on time, in person at our Greenwood Village office in the Denver Tech Center or by secure video anywhere in Colorado. Partners are welcome in the work.

We accept Colorado Medicaid through Colorado Access and Rocky Mountain Health Plans (RMHP). For commercial plans we are out-of-network and provide superbills for potential reimbursement, and HSA and FSA funds are accepted. The billing page has the details.

You do not have to be sure it is postpartum depression to reach out, and you do not have to wait until it is unbearable. Send us a message and we will talk through what you are experiencing and what would help.

This article discusses postpartum depression, including thoughts of self-harm, and is intended as general education, not medical advice or a substitute for an individual assessment. If you or someone you know is struggling, call or text 988 in the U.S. to reach the Suicide & Crisis Lifeline.