When famous people talk about their postpartum depression (PPD), the world pays attention. Serena Williams, who gave birth to her daughter Alexis Olympia in September 2017, has used her voice yet again to raise awareness of the serious mental health condition that, according to statistics from the Centers for Disease Control and Prevention (CDC), affects one in nine women after they give birth.
Williams first revealed her experience with PPD in an Instagram post back in August, but she used the phrase "postpartum emotions" rather than "postpartum depression."
Now, in a new episode of the Mamamia No Filter podcast, Williams explained her careful choice of words. She "felt like it was important to say something that a lot of people could relate to and understand," Williams explained. "I felt like it was really important to talk about because a lot of people feel like the word 'depression' is bad, and just because you’re going through things doesn’t necessarily mean it’s depression."
Williams’s perspective could be helpful for new moms who are reluctant to label themselves as having mental health issues. A meta-analysis published in 2017 in the BMJ looked at 24 previous studies of women's decision to seek help for psychological distress after giving birth. According to the study results, the stigma attached to mental illness was one of the main reasons women didn’t get help, highlighting that the fear of being seen as a "bad mother" caused many of them to stay silent.
"Stigma is unfortunately highly prevalent in our society, and people shy away from labeling their intense emotions as 'depression' or 'anxiety,' which is understandable," Tamar L. Gur, M.D., Ph.D., assistant professor of psychiatry, neuroscience, and obstetrics and gynecology and associate director of the Medical Scientist Training Program at Ohio State University Wexner College of Medicine, tells SELF.
"Women are so afraid of being anything less than a perfect mother that they ignore that they have lost their appetite, have trouble sleeping, spend hours worrying, are unable to enjoy anything, have trouble concentrating, and even may feel like life is not worth living," Dr. Gur continues. "More important than the label of 'depression' is whether women are able to identify that something is wrong and seek the support—and in some cases the treatment—they need and deserve."
Postpartum depression is also often used as a blanket term to cover a wide range of postpartum emotional experiences that might include depression as well as anxiety, irritability, OCD, and in severe cases, psychosis.
“From the clinical standpoint, research has shown that postpartum mood change is likely composed of several different psychiatric disorders, many of which do not share the same pathogenesis,” Michael E. Silverman, Ph.D., associate clinical professor at Icahn School of Medicine at Mount Sinai, tells SELF. “As Williams points out, the emotional struggles of early motherhood can be multifaceted.”
For instance, Silverman says he's treated a number of women with postpartum OCD who don’t always identify with postpartum depression, and as such felt misunderstood by their family, friends, and clinicians.
Another issue is that the colloquial use of "depression" doesn't capture the range of emotions people with clinical depression experience. “Sadness is only one aspect of depression, and most people who are depressed are not always ‘sad’,” Silverman says. “In fact, persons diagnosed with depression can still experience moments of joy, interest, and excitement. But most people assume that if you can feel these ‘happier’ ways, than you’re not really depressed. This is simply not clinically accurate.”
Having a more general term to refer to the many types of mood changes that could occur after pregnancy might make it easier for a wider variety of people to realize when they need and deserve extra support.
"We can view it as an opportunity to broaden our orientation to mental health issues so that the message is, 'If you feel in distress, not yourself, getting help can make a difference,'" Catherine Monk, Ph.D., professor of medical psychology and director of research at The Women’s Program at Columbia University Medical Center, tells SELF. “Williams’s position may help us move towards more preventative, inclusive mental health care such that people do not view mental health issues as black or white.”
Ultimately, what's most important is referring to your own experiences in terms that make sense to you, so that you can identify when something feels off and get the help you need. Of course, this goes for anyone experiencing mental health issues, not just postpartum moms.
"Williams’s decision to avoid using the term 'postpartum depression,' and instead to describe in vivid terms what she felt, may enable others to self-reflect on their own experiences, find their words for what feels 'not right' in them—independent of a medical term that can be intimidating—and get help," Monk says. "We as professionals need to help people deal with what is troubling them, not just symptoms in a narrowly defined diagnostic category.”