It is summer, the sky is high and blue, and everything and everyone around you seems touched with a smile. Everyone except you. Of course, you are trying to put one on, maybe even practice it in front of the mirror, because a smile, after all, is what one would expect from a new mother. Especially since it took so long (and so much effort, resources, struggle) to get here, so long to have your rainbow baby. But the smile feels fake and alien and the only thing real, you secretly confess, is that you feel depressed.

One in five new mothers in the US experiences postpartum depression. According to studies on the effect of assisted reproductive technology (ART) treatment on maternal mental health, this number may be even higher, especially if giving birth to multiple babies.

Researchers in Australia reported that conceiving a child after undergoing infertility treatment was four times more likely to result in mild to moderate depression, anxiety issues and other emotional problems than having a child without such treatments. Other studies, however, conclude that women who conceived with ART are no more likely to experience postpartum depression compared to women who conceived naturally.

But whether you are at higher risk or not, it is a good idea to pay attention to your mood after you have your baby. Postpartum depression is a hidden illness, not only to society but also to the individual. Looks can be deceiving, including how new mothers feel about themselves. Many new mothers appear normal to the outside and are deeply depressed at the same time, often without realizing it. Our culture’s expectation of mothers is to be loving, functional and 100% dedicated. This expectation is often deeply internalized, and reinforced by guilt and shame. Experiences that fall outside these expectations might be missed entirely by a tired new mother filled with huge, often brand new feelings. Here are some things to look out for:

*you have no interest in being around other people, including your baby or partner
*you feel irritable, resentful and impatient
*you experience changes in appetite and weight
*you feel exhausted but have trouble sleeping or sleep too much
*you evade questions about your own well-being
*you cry frequently and easily
*you are unusually tired
*you have physical complaints unrelated to pregnancy or new motherhood
*you are concerned about the appearance of your self (body, weight) or your baby

Depression takes many forms and often masks as, and co-occurs with, anxiety. If this is the case, you may notice any of the following:

*you have a hard time relaxing
*you worry excessively about your own health or the health of your baby
*you feel overwhelmed with tasks and paralyzed to do anything
*you are concerned about not being a good mother
*you are overly friendly and smile a lot when you are with others
*you make excessive attempts to be social (start moms group, social media etc)
*you are frequently angry with your partner
*you experience unusual discomfort handling or responding to your baby (including eye contact)
*you are reluctant to let others care for your baby
*you apply rigid or obsessive standards regarding baby care

Postpartum depression is very treatable, and mothers who experience depression need not suffer silently. Balanced nutrition, regular exercise (other than carrying baby), therapy, acupuncture and, in some cases, medication can make a difference. Adequate sleep is also important but often not easy with a new baby. Consider hiring a postpartum doula (some offer over-night services) and spending long stretches of time unplugged from screens.

There are many theories about the causes of depression, including sleep deprivation, thyroid dysfunction, past trauma, environmental changes and biological predisposition. Evolutionary-based theories propose that depression has an adaptive function. Low mood slows and restrains behaviors that may otherwise incur further losses.

Neurologically speaking, depression puts mental “breaks” on, forcing the organism to do less, to feel less and to anticipate less. It gives the organism a chance to mull over present situations/choices/life more slowly and carefully, thus increasing survival and longevity.

Consider this: When your brain is depressed it is in need of deep-rest. Caring for yourself during this time in ways that allow for rest and restoration will be vital for your healing. This is not to say that rest alone will cure depression. But it’s an important piece.