Navigating Postpartum Depression After Miscarriage

Some women feel sad or depressed after having a baby. This is a well-known disorder called postpartum depression. What a lot of people do not realize is it can also happen after a miscarriage. A miscarriage is when a pregnancy ends on its own before the baby is born, and it can lead to feelings of sadness. One in five women who miscarry experience symptoms of a depressive disorder. We spoke to clinical psychologist Dr. Jenny Yip about why this type of depression happens and how women can get help.

How can women recognize if they are suffering from PPD, or if their symptoms are part of the grieving process after a miscarriage?

Grief after a miscarriage is an expected emotional response. This kind of grief is a natural response that is episodic and situational. These feelings are tied to the immediate loss of pregnancy. Grief comes and goes. However, postpartum depression (PPD) after a miscarriage is different. A woman feels a lingering and persistent emotional struggle. But if you are experiencing deep sadness and grief that lasts for more than two weeks after the miscarriage, you may have postpartum depression.

Do the changes a woman’s body goes through explain the source of PPD?

You’re right. A woman’s body and mind go through a lot of changes during pregnancy and the postpartum period. These changes can be grouped into three key categories: physiological, psychological, and psychosocial. These changes explain why some women are at higher risk for postpartum depression, anxiety, OCD and even psychosis. It is important to remember that PPD and other disorders can happen after any type of birth, whether it is a miscarriage, live birth, or stillbirth.

Can you elaborate on these three categories further, please?

Sure. First is obviously physiological.

After a birth, a woman experiences a hormonal shift. There is a significant drop in estrogen and progesterone levels. When that happens, it impacts our brain’s neurotransmitters such as serotonin, dopamine, and GABA. These are mood-related neurochemicals that affect our feelings of joy and pleasure. This dysregulation can cause anxiety, depression, and loss of interest.

Now, during pregnancy, a woman’s body goes into protective mode because it’s under physical and emotional stress. As part of this, the body becomes more tolerant of higher cortisol (stress hormone) levels. So, when we lose the pregnancy, hormone levels—including cortisol—shift dramatically, which impacts our mood, energy, and anxiety. Also, during pregnancy, your immune system changes to protect the developing baby. So again, when you lose the pregnancy, your body reacts with an inflammatory response. This response disrupts our brain function, and inflammation has been linked to depression.

Then we have a psychological impact.

Of course, losing a child will lead to grief and trauma, but women who have experienced previous pregnancy loss or fertility treatments are impacted more often. Then, women who are perfectionists with high expectations for pregnancy and motherhood are also at higher risk. Also, women who are impacted by genetic factors such as anxiety and depression running in their family will feel the grief of loss much more deeply.

And lastly, we have psychosocial which includes emotional and social factors.

You see, women face a huge stigma around miscarriage and maternal mental health that can lead to PPD. Cultural values and belief systems are a big contributor. So, the stronger a woman’s support system is, the less likely they are to suffer from PPD.

Are there any signs and symptoms of such PPD to look out for?

After a miscarriage, it is normal to feel sadness, grief, or even numbness. But when these feelings do not fade and begin to interfere with your daily life, it could be a sign of postpartum depression.

Some common symptoms would be withdrawing socially and isolating yourself, losing interest in previously enjoyed activities and family time, loss of appetite and low energy, constant rumination over the loss and your future, and in general, hopelessness, deep sadness, guilt, shame, and criticism of yourself. You could be having trouble sleeping because of both hormones and mental ruminations. This can lead to irritability, anger, anxiety, panic attacks, racing thoughts, and in extreme cases, intrusive thoughts of harming yourself. You may find it difficult concentrating or making decisions, or crying frequently.

If your symptoms last longer than 2 weeks, it’s considered persistent. That’s when it is important to seek help.

And what can we do to feel better?

If you are suffering, it is very important to look for mental health resources that provide perinatal information. From these organizations you can find a mental healthcare provider with relevant experience treating PPD or anxiety after miscarriage.

The first line of evidence-based treatment is cognitive behavioral therapy (CBT). It will help you recognize the unhelpful thought patterns you have to build more flexible thinking. It will teach you ways to reduce your anxiety, manage your depression, and give you coping skills. Acceptance and commitment therapy (ACT) will also help.

How can we raise awareness about this and help more people?

There is a lot of shame in our society about miscarriage. We are encouraged to keep our pregnancies a secret until the second trimester, and this creates a layer of judgment. We live in a society and culture that adds so much stigma and shame around miscarriage and loss of pregnancy. If we keep silent, then how can we raise awareness if women will not talk about it?

In order to raise awareness, we need to encourage women to be more open and tell their stories. We need to use language that genuinely asks how a woman is doing, and we need to remind women that their loss is valid; it indeed must be difficult. And this can only be achieved when we expand the vocabulary for PPD to include every outcome of pregnancy and not just livebirths. Afterall, women experiencing miscarriages, abortions, and stillbirths must be included in the conversation as well.

Postpartum depression after miscarriage is more common than people think. If you are feeling sad or lost after a miscarriage, talk to your doctor. You deserve help and support. Remember, You Are Not Alone!