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When Bri Ramos was pregnant with her second child, she was already worried about the symptoms she experienced with her first. The lack of motivation or excitement. The severe anxiety that, up until having her first child, she never dealt with before.
Then, she started having panic attacks in her second pregnancy.
"I was like, 'Oh, here it goes again,'" Ramos, 36, told Business Insider. Her doctor saw Ramos "walking right into some bad postpartum" and took a proactive approach: prescribing Ramos Zoloft shortly after she gave birth.
Ramos is one of the many mothers diagnosed with postpartum depression. A new study from JAMA found that postpartum depression diagnoses have doubled in the last decade.
Dr. Nehaa Khadka, a maternal and child health epidemiologist at Kaiser Permanente Southern California and lead researcher on the study, told Business Insider her team was surprised by how high the rise was.
While it could be partly due to increased awareness and screening, there seems to be more at play.
Rates of depression and loneliness are on the rise, and were turbocharged during the pandemic. Emerging cultural pressures to return to work quickly or to be the perfect parent can play a role too, therapists say.
Behind the research, many mothers with PPD say they still feel misunderstood, left in the dark, and lacking resources.
Ramos, the founder and creative director of an ad agency, said one of the hardest postpartum adjustments for her was accepting a "new season" of her life.
"So many women go through an identity crisis because it's like, 'I've been this high-achieving career woman, and now I am at home for the next six or 12 months taking care of a child,'" she said. She had to take time to figure out who she was as a mother, separate from her usual work routine.
Not every working mom has the ability to take time off and transition into motherhood. There is no national paid maternity leave in the US; full-time working moms have to rely on their employers' individual policies. This puts mothers in a precarious position: if they can't take more time off to recover, their depressive symptoms can impact their productivity, putting their jobs on the line.
When Stephanie Fornaro had her second child at 33, she had "just an overwhelming feeling of doom and sadness." She also felt resentment toward her husband when he went to work, leaving her fully in charge of their son.
Because her symptoms were physically debilitating, she quit her software sales job for two years. Not working contributed to her depression, too.
"When you're accustomed to a demanding job and 'performing' and then you go to a slower pace, and solitude, it's a major adjustment that I think many underestimate," Fornaro, 39, said.
Plowing ahead, potentially ignoring postpartum depression symptoms, can lead to quicker burnout — and leaving a career entirely.
Justine Sterling Converse runs a women-owned event strategy and management company in Texas. She remembers many of her close friends in the industry jumping back into full-time work after taking three months of maternity leave. They all quit shortly after, unable to balance motherhood with working long hours and weekends.
Once she started having children of her own, Converse realized how hard it was to return to full-time work so soon. "12 weeks is just when you're starting to have a routine with your baby," Converse, 40, and a mother of four, told BI.
It was harder with postpartum symptoms. Converse was diagnosed with postpartum OCD, something she hadn't heard of before. In her office of 10 full-time workers, she said about 75% of them have experienced postpartum depression, anxiety, or OCD.
It's partly why her company policy includes 16 weeks of maternity leave and a 50% "transition" month for mothers to ease back into working full-time. Converse, who recently gave birth, is in a transition month herself and said it's been a huge help.
"I willed myself to not go through postpartum again," Converse said. "And I still did."
Symptoms of postpartum depression range from intense mood swings to thoughts of harming your baby. While it's common to feel "baby blues" when you first give birth, PPD is much more severe and can last for weeks or months.
Still, it's one thing to know about postpartum depression. It's another thing to identify it in yourself when you experience new symptoms.
"As a new mom, you're in survival mode," Fornaro said. She knew something was off, but didn't have the space and time to take stock of it all and see it for what it was. "Now, I can reflect and go, 'Wow, I really was struggling.'"
Fear of judgment has kept some new parents from reporting their PPD, said Dr. Clayton Shuman, who led a 2022 study on how the pandemic influenced a rise in postpartum depression rates. He said patients might hold back on sharing their symptoms like being unable to bond with their baby, "to avoid the stigma and guilt."
Ramos believes more openness around the subject is helping.
Out of her tight-knit friend group, four out of five women have had kids. All of them have had postpartum depression or anxiety, and openly discuss their symptoms. While Ramos experienced a lack of joy, a friend had intrusive thoughts about her newborn's health.
In contrast, when Ramos' older sisters experienced PPD nearly two decades ago, one of them "just sat in her closet and cried." She thought her depressive symptoms were normal and, at the time, told no one.
Postpartum symptoms can last for years, much longer than the three to four months of maternity leave many US full-time employees get.
In contrast, European countries like Greece and Iceland offer 26 weeks of leave or more. Some, like North Macedonia, allow parents to take additional leave if they need to, without fearing for their job security.
For American mothers without as many federal safety nets, extra help makes all the difference. Fornaro's husband worried about her postpartum depression and offered to pay for a nanny, which she initially refused. "It took a lot of convincing and setting aside my pride," she said.
Looking back, she said hiring extra help was the "best decision" for her family. Her nanny not only made every day more manageable, she offered crucial emotional support and helped Fornaro bounce back.
In Ramos' experience, even the smallest interventions can radically change postpartum symptoms. She said she is grateful her doctor was so quick to diagnose her and prescribe medication; it made for a much smoother experience with her second child.
"I'm just so thankful that I got to enjoy him being a baby and having fun with him," she said, remembering how overwhelmed she was when she had her daughter four years earlier. "I was just in a completely different state of mind."
