You Are Not Alone With Postpartum Depression

Summary

Stuff You Should Know — "You Are Not Alone With Postpartum Depression"

iHeartPodcasts | Hosts: Josh & Chuck | Released: July 14, 2026

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Episode Overview

This special episode of Stuff You Should Know is a “Public Service Announcement”-style deep dive into the world of maternal mental health, focusing on postpartum depression (PPD) and related disorders. In their trademark empathetic yet informative tone, Josh and Chuck demystify not only postpartum depression but the whole spectrum of perinatal and maternal mental health challenges. They aim to reduce stigma, share modern understanding of causes and treatments, highlight racial disparities, and remind listeners: "You are not alone."
(1:13–1:28; 2:02–4:42)

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Key Discussion Points and Insights

1. Why This Episode Matters

• Maternal mental health issues like PPD impact up to 12% of mothers—but are still under-discussed and burdened with stigma.
• The pressure on new mothers to be “perfect” right away makes seeking help harder, and many cases go undiagnosed.
• The US is in a maternal mental health crisis, with suicide and overdose now the leading causes of postpartum maternal deaths.
  "The US keeps getting worse and worse, and I mean like a lot worse..." — Josh (5:29–6:49)

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2. Definitions and Scope

• Postpartum Depression (PPD): Not limited to after birth—can begin during pregnancy and up to a year post-delivery. Symptoms include persistent sadness, anxiety, loss of appetite, sleep problems, and difficulty bonding.
• Other Disorders:
  • Postpartum Psychosis: Severe, rare (1 in 1,000), with delusions, paranoia, and significant danger—requires immediate ER visit.
  • Postpartum Anxiety & OCD: Intrusive thoughts, compulsive checking, irrational fears, sometimes including disturbing or taboo thoughts.
  • Postnatal Mood and Anxiety Disorders: Feedback loops that worsen both parent and baby’s distress.
• The “baby blues” (short-term mood swings, mild sadness) are common but distinct: if symptoms persist beyond 2 weeks, it’s likely PPD.
  (2:02–4:42; 7:57–9:34; 10:20–18:27)

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3. Stigma and Underdiagnosis

• Half of PPD cases may go undiagnosed due to cultural norms, family pushback, and inadequate medical screening.
• Tools like the Edinburgh Postnatal Depression Scale exist, but not all symptoms or communities fit its model. "Even doctors sometimes are like, you'll be fine. Just get over, just get back in there." — Josh (7:29–7:57)

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4. Risk Factors

• For PPD and related issues:
  • History of depression/anxiety or family history (especially bipolar for psychosis)
  • Childhood trauma, infertility treatment, unplanned or high-stress pregnancy
  • Poverty and lack of social support—low-income mothers have twice the rate, and Black/Latina mothers are disproportionately affected
    "Single Black mothers are six times more likely than the general population to experience it." — Chuck (22:07–22:50)
• Biology: Anemia, hypothyroidism, and genetic predisposition (up to 30%).
• Sleep deprivation: Key trigger—especially dangerous when mania is induced (often a precursor for psychosis).

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5. Symptoms and Complications Across Disorders

• PPD: Persistent sadness, irritability, guilt, difficulty bonding, loss of interest
• Postpartum psychosis: Delusions, paranoia, disassociation—emergency situation
• Postpartum OCD: Intrusive, sometimes taboo thoughts (including sexualized images), compulsions for baby safety
• Danger: Sufferers afraid to seek help often internalize guilt and isolation
  "If you're having thoughts like this, you're not alone. It's actually more common than you would think." — Josh (16:46–17:16)

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6. Racial Disparities

• Rates up to 40% in Black and Latina mothers; yet these groups are up to 57% less likely to receive treatment
• Classic symptoms used in standard screening may be different across cultures (e.g., higher irritability or fatigue in Black mothers), so specialized tools like the Jackson Hogue Phillips Contextualized Stress Measure are being developed
  "They came up with a different scale just for black mothers, right?" — Chuck (23:36–23:44)

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7. Causes: The Hormonal and Environmental Storm

• Sudden drop in pregnancy hormones (progesterone, estrogen, oxytocin, relaxin) can trigger depression
  • Allopregnanolone: Especially implicated—natural brain steroid drops abruptly after birth, similar to quitting an antidepressant cold turkey (32:31–33:48)
• Environmental factors include isolation, workload, sleep loss, and the overwhelming responsibility of infant care
  • Partner or family support is vital; sleep disruptions impact the whole family
  • "Sleep when the baby sleeps" and asking for help are recommended

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8. Outcomes for Infants

• Untreated maternal mental health issues increase risk for preterm birth and low birthweight, especially in communities already at risk
  "Pregnant women with PPD are far more likely to deliver a preterm baby or a baby with low birth weight." — Chuck (34:22–34:56)

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9. Treatment: Good News

• Maternal mental health conditions are highly treatable
  • Therapy: Cognitive Behavioral Therapy (CBT) is very effective; focuses on challenging unhealthy patterns and triggers
  • Medication:
    • Classic SSRIs (e.g., Paroxetine, Sertraline) are safe while breastfeeding, with low to undetectable transfer to breast milk
    • New drugs like brexanolone and zuranolone target the hormone allopregnanolone—potential gamechangers, but shockingly expensive in the U.S. without insurance ($15k–$34k per course)
  • Support: Peer groups, podcasts (e.g., recommended: "One Bad Mother"), and partner/family support are invaluable
• Key is recognition and outreach—seek help early and know you’re not at fault
  "Treatment is quite viable." — Josh (38:26–38:41) "Shame, shame, shame ... Capital S H A M E" — Chuck, on the high price of new drugs (42:09–42:30)

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10. What About Fathers?

• Up to 10% of new dads may experience postpartum depression and/or anxiety—similar symptoms, sometimes delayed onset
• Male hormonal changes (lower testosterone) may play a role, and financial or relationship strain is often a factor
• Stigma and lack of awareness mean many men suffer in silence
  "So can men get postpartum depression? The answer is yes..." — Chuck (42:42–43:27)
• Treatment for fathers is also effective and important

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11. Societal Barriers & Policy

• U.S. lack of parental leave and subsidized childcare compounds strain—leading many families into financial and emotional crisis
• Josh and Chuck urge listeners to vote for candidates who support childcare and parental leave reforms
  "Use your voice at the voting booth..." — Chuck (45:53–46:21)

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Notable Quotes & Moments

• “Nobody’s perfect. But the idea that you’re just supposed to immediately click with your kid and now you’re a perfect mom…that is not how it plays out very often.” — Josh (4:42)
• “The leading cause of death [among new mothers] is suicide and drug overdoses…that’s crazy!” — Chuck & Josh (6:36)
• “This is not you. It is your hormones. You do…you have not suddenly developed a sexual attraction to infants or children. Like, it’s not you.” — Josh (16:46)
• “It’s just mean of evolution, really, to be like, ‘Here’s all this stuff you need to have a baby. Now you don’t have a baby anymore—who cares about you?’” — Josh (27:03)
• “If you have postpartum depression, it doesn’t mean that you don’t want to bond with your baby…It’s not you, it’s your biology and your environment.” — Josh (35:28)
• “God bless Dr. Aaron T. Beck, the creator of CBT.” — Josh (39:19)
• (On the cost of medication): “Shame, shame, shame. Capital S H A M E.” — Chuck (42:11, 42:23)
• Lighthearted moment: Chuck and his wife joking at home about “beta cucks” and “soy boys,” poking fun at toxic masculinity narratives (47:16–48:15)

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Timestamps for Key Segments

• 01:13–04:42: Why maternal mental health matters; introduction and framing of stigma
• 06:03–07:57: The US maternal mental health crisis & mortality
• 10:20–11:57: What is postpartum psychosis; urgency and rarity
• 14:13–15:07: OCD and anxiety after birth
• 16:35–17:47: Taboos and intrusive thoughts—breaking the silence
• 22:07–24:30: Racial disparities—higher rates and lower treatment for women of color
• 27:03–30:21: The hormonal rollercoaster—progesterone, estrogen, oxytocin, and “evolutionary meanness”
• 32:31–33:48: The role of allopregnanolone and sudden drop post-birth
• 34:22–35:25: Effects on infants—birthweight, prematurity, and feedback loops
• 38:26–40:52: Treatment: CBT, medication, reassurance on antidepressant safety
• 42:09–42:30: New medications—cost barriers
• 43:27–48:26: PPD in fathers—symptoms, risk factors, societal pressure, and the call for policy change

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Concluding Takeaways

• You are not alone.
• Postpartum depression and related disorders are highly treatable.
• Help is available for both moms and dads—no shame, no blame.
• Policies and social change matter: demand support for parents and maternal mental health.
• If you or someone you know is struggling, it’s not your fault—reach out, speak up, and support one another.

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“If you’re a new mom or an old mom or even never had kids, it doesn’t matter. We would love to hear from you about this episode.” — Josh (49:02)

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If you or someone you know is struggling with postpartum depression, please seek help from your health provider or a mental health professional. You are not alone. There is hope, and there is help.

Transcript

[Podcast Host]

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[Josh]

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[Ben Nadif Haffrey]

Thirty years ago, an island off Manhattan almost brought down New York City.

[Narrator]

Who will you trust? Your friends and neighbors? Who will you trust? The people five miles overseas.

[Ben Nadif Haffrey]

This is a story about neighbors turning on each other and what happens when a forgotten place decides it's had enough.

[Chuck]

But we're not stopping, are we?

[Ben Nadif Haffrey]

Listen to Revisionist, the Staten island problem on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

[Podcast Host]

Welcome to Stuff youf Should Know, a production of iHeartradio.

[Josh]

Hey, and welcome to the podcast. I'm Josh, and there's Chuck. And Jerry's here too. And this is stuff you should know. The kind of bummer edition. But we're hoping to shine a light on something to help people out.

[Chuck]

That's right. You know how we do these playlists once a quarter now, which by the way, I hope people are enjoying those sort of collecting things in groups and releasing them once a quarter in groups of 10 or 12. I thought it was kind of a fun idea and we've been enjoying it. But maybe one day something we can Bucket is just really sad joke free episodes that we feel like are almost like a public service announcement.

[Josh]

For sure.

[Chuck]

We just call them Bummer episodes you need to hear.

[Josh]

Right? I think that's a great title. Let's do that. We have enough for sure.

[Chuck]

Yeah. I mean this would definitely be one of them because we're talking about postpartum depression and sort of the general bucket of post and even prenatal and during natal troubles that women go through. Because there are several subcategories that they kind of place under postpartum depression. But it is a real serious thing that affects. I saw 10 to 15%. I think Dave helped us with this and he said one in eight, which is about 12% of women experience this. And it's one of those things that is not talked about enough to where it seems like the numbers could be higher because people are still ashamed to admit this kind of thing happens.

[Josh]

Yeah. There is a definite stigma on this to varying degrees depending on your culture or ethnic group. But basically, across the board, you're going to find a stigma against a new mother who can't get it together for her baby. That's kind of like what people sometimes look at it as. And if you are basically being looked at like that and you're already down on yourself because you're not performing perfectly to your own standards or whatever that heaped on top of it, you're. You're probably not going to be like, everybody, I need help. You're going to just kind of dig in and just keep trying to go. And that is the exact opposite of what you're supposed to do with any of what are called maternal mental health issues. There's a whole umbrella term. It's not just postpartum depression or perinatal depression. There's a bunch of other ones we'll talk about a little bit too. But all of them add up to, you got to ask for help. You also have to be on the lookout for needing to offer help to the new mother, too, if you're the father or a family member or a friend or something.

[Chuck]

Yeah. It's a brutal situation where, I mean, giving birth is, you know, it can be a very wonderful, joyous thing, but no matter how you slice it, it's a very big sort of. And traumatic. Doesn't always necessarily, I think, mean something awful, but just such a big life event that then you're then expected, like, and now it's supposed to be the best thing ever. And you're gonna be the happiest you've ever been immediately, despite these huge hormonal swings. And you're gonna be a perfect mom. You're gonna be such a great mom. You're gonna be a perfect mom. It's just so much pressure. And so, yeah, this is a bit of a psa for sure.

[Josh]

For sure. And you hit something on the nose. Being perfect immediately. I mean, being perfect is too high an expectation anyway. Nobody's perfect. But the idea that you're just supposed to immediately click with your kid and just now you're a perfect mom or a great mom. Like, that is not how it plays out very often. I would guess most of the time it's a process. Exactly. So like I said, postpartum depression or perinatal, I'm just going to call it postpartum. I basically don't know anybody who's ever called it perinatal depression.

[Chuck]

Yeah.

[Josh]

So we're just going to call it postpartum depression with the caveat that it doesn't just happen after birth, it can happen while during the pregnancy as well. Right?

[Chuck]

Yeah. And up to a year following birth as well.

[Josh]

For sure. So again, this falls under the umbrella term of maternal mental health. There's also some others. Postpartum anxiety, postpartum obsessive compulsive disorder. We'll talk about those a little bit later. But when you put all of these things together, you get a really bleak picture of mothers in the United States. Whereas the rest of the world is doing better and better with maternal mental health, the US Keeps getting worse and worse, and I mean like a lot worse.

[Chuck]

Yeah. There was a CDC study that found that rates of postpartum depression were seven times higher in 2015 than they were in 2000. And between 2016 and 2023, new moms reported nearly 65% increase of fair to poor mental health. It is, oh man. It is the leading cause of death among new mothers now in the United States with suicide and drug overdose accounting for 22% of all postpartum maternal deaths in the United States.

[Josh]

That's crazy.

[Chuck]

Maternal death rates, you usually look at it as like something tragic happened in the birth, like physically or biologically. And in the United States, the leading cause of death is, is suicide and drug overdoses.

[Josh]

Yeah. I mean, and this is the highest in the developed world by far. And that, that increases the highest in the developed world. Right. So it's, it's a crisis in the United States, it's a crisis worldwide. But in the United States it's like a five alarm fire, apparently.

[Chuck]

Yeah.

[Josh]

I'd be really interested to know what the problem is. Like what, what's behind those figures or underneath those figures.

[Chuck]

Same.

[Josh]

You think it's a, the, the, the United States transition toward the. Becoming the society from a Handmaid's tale.

[Chuck]

Yeah, that might have something to do with it.

[Josh]

So one of the other things about the postpartum depression too, that's really problematic is, and you kind of touched on this early on, I think something like half of cases just go undiagnosed in part because even doctors sometimes are like, you'll be fine, just get over, just get back in there. You know, give it the old college try. And families too. And I think that self inflicted stigma too, that new mothers have.

[Chuck]

Yeah. And you know, it's one of the reasons is because, and you know, they have screening tools now. There's one called the Edinburgh Postnatal Depression Scale to determine when that line is crossed. Because the baby blues or the postpartum blues are something that happens a lot, like maybe even most pregnancies. You end up for up to a week or two having these hormonal swings where there's overlapping symptoms with what ends up being ppd. So that's why a lot of reason it becomes undiagnosed is cause people think like, well, this is just the baby blues. I'm suffering from some sadness and crying and feeling overwhelmed, certainly because this is maybe my first time. Although I should point out that postpartum is not limited to first birth at all. It can happen with any, like their third birth, the third kid, fourth kid, whatever. But the overlap is so great that a lot of times I think people are like, well, it'll pass, it'll pass. It's just the baby blues. But if it goes on for more than a week or two, you're probably in PPD territory.

[Josh]

Yeah. It's not that the postpartum depression is a, like a different thing than the baby blues. It's the severity of the symptoms, the same symptoms and the duration of those same symptoms that really differentiate it and make it something that like you, you need help for. Like you need to get professional help. It's not just going to go away on its own, or if it does, it's going to, you're going to grind through years of it totally unnecessarily. Because we didn't say this yet. It's very highly treatable.

[Chuck]

Yeah, for sure. That's the good news. And we'll get to that. But you know, some of those symptoms we should list are loss of appetite, difficulty sleeping, feeling worthlessness, or maybe even guilt or shame, anxiety, panic, irritability, anger, big time mood swings, difficulty with bonding with your baby. And again, these are, these can be the baby blues, or if they're super severe and go on long enough like you said, it develops into ppd. And it's the kind of thing that can also start several weeks to a month later. So you gotta keep an eye out. Like if those first couple of weeks are like, you're like, oh man, I managed to dodge this. It also might start later. And that's okay. You just need to be aware.

[Josh]

Right. I said that there's other disorders under the umbrella of maternal mental health issues and another one is postpartum psychosis. And it's essentially what it sounds like. The mental health disorder can become so pronounced after birth that you may suffer from delusions, you may become paranoid, you may be disoriented, you may feel disassociated from the people around you or the world itself or reality. And that is considered. So postpartum depression is something you need to seek help for. Postpartum psychosis is considered a. You immediately take a trip to the er when you or the people around you figure out that you are suffering from postpartum psychosis, it's like, get in the car, maybe you can throw on a robe and just go to the ER.

[Chuck]

Yeah. And it's very rare. We should say it's one out of every 1,000 births. But they say that because very sadly, about 4.5% of the cases of that psychosis result in harm to the baby and 5% result in suicide. And if you've ever seen some terrible news report about a mom that said, God told me to drown my baby, that's what we're talking about here. Because delusions of grandeur, a lot of times, religious in nature, obsessive thoughts about harming you or harming your baby, extreme paranoia, like that kind of thing. That's what falls under the postpartum psychosis banner.

[Josh]

Yeah. And from researching postpartum psychosis, they found that there are some additional risk factors. Seems like the number one risk factor for developing it is if you have a history, whether personal or familial, of bipolar disorder. And that if you start having sleep loss, that triggers bouts of mania, that is a really big red flag that you are at a great risk of going on to develop postpartum psychosis, meaning. So sleep loss, which you already are getting from just having a new baby, but if that triggers mania, that's a, that's a big red flag. And that's probably what kicks the whole thing off, is that loss of sleep. It's like crazy important. And it's nuts that evolution didn't take that into account. Like, oh, yeah, we need to make sure everybody sleeps after this, not stays awake for the next two years because it'll drive people crazy. That can trigger all of these maternal mental health issues.

[Chuck]

Yeah, I mean, that can be rough on a family. We got very, very lucky with Ruby in that she was a pretty good sleeper from early on. But I've heard some nightmare stories and it's really tough. Sleep is so, so important. I think another thing we didn't point out was for the postpartum psychosis, it's almost always a first time pregnancy too. Which differentiates it from postpartum general postpartum depression. But some similar risk factors for regular ppd, if you have a history of depression or anxiety you're more likely if you had a childhood trauma that you experienced if you underwent infertility treatment. You may be more likely to. If it's an unplanned pregnancy or if you're a low income mother, especially if you're like literally living in poverty. They experience PPD at twice the rate of higher income moms. And there are also a couple of biological factors. If you suffer from anemia or hypothyroidism. And then it can be genetic. I think depending on what study you've seen. I've seen anywhere from 14 to 30% have potentially a genetic factor like inheritable.

[Josh]

Oh, really? I hadn't seen that at all. Let's talk about postpartum or perinatal OCD and perinatal mood and anxiety disorder real quick too. Okay.

[Chuck]

Yeah.

[Josh]

So pocd, this is. This to me sounds like the hardest to deal with because I think you're probably the least likely to step forward and say, I need some help, everybody. But it's obsessive compulsive disorder that develops way more quickly than typical obsessive compulsive disorder, usually very shortly after birth or after the baby's born. And it's, you know, like ritual behaviors like checking on the baby incessantly, worrying that the baby's gonna get contaminated with germs, and lots of intrusive thoughts that can be super disturbing.

[Chuck]

Yeah, for sure. I mean, I think it's a natural tendency if you've, especially for a first time parent, to have this new, seemingly very fragile, tender thing that you're in charge of keeping alive. It's a pretty natural instinct, I think, to maybe think like they're so small and so fragile. So my dumb advice just as a parent is like, they're more robust than you think and they're made to survive and they're made to live, generally speaking. So you have that on your side. But I can see how it's pretty easy for maybe someone to go down this road of worrying about germs or checking on the baby every like 10 minutes in the middle of the night and to become sort of obsessive. This, the pocd, can cross the line into some even unwanted sexual obsessions. Like a mother apparently can have sexualized images flashing through their mind while they're changing a diaper, which is just sort of creates a cycle of you thinking, like, what's wrong with me? What's going on? I'm having this weird thing flash through my head. And in reality that's all it is, is just lack of sleep or your hormones or something just really unusual that flashed through your head. And as an intrusive thought, it does not mean that that's who you are or you're leading to some awful outcome.

[Josh]

Right. And I think that's kind of worth saying again, Chuck, because this is the kind of thing that you would not. Who you gonna tell that to? Oh, I'm having sexualized thoughts about our baby.

[Chuck]

Yeah, right.

[Josh]

You're not gon going to tell that to anybody. It's going to be so tough to admit that. So you have to know that is not you. It is your hormones. It is not you. You do. You have not suddenly developed a sexual attraction to infants or children. Like, it's not you. So if you're having thoughts like this, you're not alone. It's actually more common than you would think. And, like, you can get treatment for this, and you should get treatment for it because you're probably really being hard on yourself right now.

[Chuck]

Yeah. And, you know, and if you give in to that thought, then that's when you're maybe avoiding bathing your baby or avoiding caring and holding for your baby. So it's a tough thing to come forward and talk to people. So that's why it's really great to have a great support system of other moms, friends, and families to people to lean on. Because I guarantee you, if you. If you say the weirdest thought you've had out loud in a group of moms, there will be a couple of them that are like, I had the same thoughts. It's okay, right?

[Josh]

Yeah. Yeah. Hopefully you have a group like that or can find one, you know?

[Chuck]

Yeah.

[Josh]

Then there's postnatal mood and anxiety disorder, which essentially is a really terrible positive feedback loop to where you feel like you're not bonding with your baby well enough or fast enough. And so you start to become anxious, which the baby picks up on, and the baby becomes distressed or less likely to connect with you or pay attention to you, which makes it harder for you to read the baby, which makes it less likely for you to bond in any kind of quick fashion. And it just keeps going in this cycle.

[Chuck]

Yeah, for sure. And you know what? I want to recommend a podcast, because if you maybe you're a little more isolated and you don't feel like you have this, or if you just don't have this sort of support system around you. Our old buddy Jesse Thorne, who runs the Maximum Fund Network and co hosts with judge John Hodgman, with our pal, his wonderful wife, Teresa. She's just the best. And I don't think they do it anymore. But Teresa and Biz Ellis had a show called One Bad Mother. Oh, yeah, I remember that for a long time. And I'm pretty sure they stopped doing, but they did it for many, many years. And One Bad Mother was just a great outlet and support system for just this kind of stuff. The message was always like, you're doing just fine. You're doing okay. You think you're the worst, and you're really the best. And, like, you know, if you're having a hard time and you feel like you're alone in this, like, turn on that podcast. Like, do something like that to know that you're not alone out there.

[Josh]

Right. And pour yourself a megapint of wine and treat yourself to the Bad Moms trilogy in one sitting.

[Chuck]

That's right.

[Josh]

So you want to take a break?

[Chuck]

Yeah, let's take a break, and we'll get into some statistics about other communities and how they deal with this.

[Ben Nadif Haffrey]

Thirty years ago, an island off Manhattan almost brought down New York City.

[Narrator]

Who will you trust, your friends and neighbors, or will you trust the people five miles overseas?

[Ben Nadif Haffrey]

This is a story about neighbors turning on each other and what happens when a forgotten place decides it's had enough.

[Chuck]

We reached for a feeling that exists in in this city. But we're not stopping, are we?

[Ben Nadif Haffrey]

I'm Ben Nadif Haffrey, and for my new series on revisionist history, I took a deep dive into Staten Island's attempt to secede from New York city in the 1990s and what it all has to do with the politics of resentment that dominate America today. Listen to revisionist history, the Staten island problem on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

[Rebecca Nagle]

The Declaration, which is full of these beautifully rendered, you know, sentences and paragraphs about enlightenment ideals, does also have this darker history to it.

[Podcast Host]

Why is it important for the darker part of the Declaration of Independence and the American Revolution, why is it important that Americans know about it?

[Rebecca Nagle]

Well, if we don't understand the full context in which our nation was founded, we won't understand the full context in which our nation now finds itself.

[Podcast Host]

I'm Rebecca Nagle. Gohin Tawadon Jalekayetli. Que la citizen of Cherokee Nation.

[Josh]

Are you guys big Chiefs fans?

[Chuck]

Hell, yeah.

[Podcast Host]

This is First America, the true story of how the United States came to be and how we got to this present moment. Listen to First America on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

[Chuck]

All right, everyone, we're back. We promise. Talk about statistics. And in this case, there are some pretty stark racial disparities when it comes to PPD as far as the incidence of occurrence and very sadly, treatment. Up to 40% of Black and Latina moms suffer from PPD, which is about twice the rate of non Hispanic white moms. And single black mothers are six times more likely than the general population to experience it. Really? Sadly, Latina women and Black women are 57% and 41%, respectively, less likely to start treatment for PPD than white women.

[Josh]

Right. And there's a lot of reasons for why they're less likely to start treatment. In part, there's a stigma, just like with any culture. I think in Latino culture, that stigma can be even stronger than white or black culture culture. But for, say, black women in particular, it can often go undiagnosed because it doesn't present as the classic symptoms that the EMBRA scale is designed to detect. Rather than depressive symptoms, black mom might have. Irritability, self criticism, deep fatigue, insomnia. These are not all necessarily shared by all new mothers. And so it just. The doctor just might miss it. They might be like, hey, you're just aggro. Stop being aggro.

[Chuck]

Right.

[Josh]

You know?

[Chuck]

Yeah. I think they came up with a different scale just for black mothers. Right?

[Josh]

Yeah. The Jackson Hogue Phillips Contextualized Stress Measure, which, next time you have a party, give that out as a party favor for guests.

[Chuck]

Yeah, for sure. But that's great that they were like, hey, we have a. We have a hole in our treatment plan here as far as even diagnosing this in black women. So they came up with their own scale, which is awesome. Basically, everybody, the American College of Obstetricians and Gynecologists, the ama, the American Academy of Pediatrics, everyone recommends that everybody should be screened for prenatal or, I'm sorry, perinatal depression. But very sadly, less than 20% of all women are screened for these mental health disorders, and those numbers are a lot lower for women of color.

[Josh]

Right. So those are reasons why they might not actually go seek out treatment for ppd. There's also reasons why they're more likely to suffer from PPD in the first place. And those seem to center on social determinants of health, which is like your environment, your income level, the amount of free time. You might even have to go see the doctor. All of these things tend to be less than what a white mother would experience. And all of them help Increase the likelihood of experiencing postpartum depression.

[Chuck]

Yeah, for sure.

[Josh]

So regardless, Chuck, of whatever your ethnic or racial group, there are essentially the same causes. I mean, ppd, even though it might manifest itself differently, even though access to help for PPD is. Is different. Those are all human made obstacles.

[Chuck]

Yeah.

[Josh]

The biological basis for it is the same in every case. And essentially it's a combination of hormones and the stark raving horror that is becoming a new parent.

[Chuck]

Yeah, for sure. Like we were saying, you're thrown into this brand new thing where your first charge is like, all right, keep this baby alive.

[Josh]

Oh, man, I cannot imagine.

[Chuck]

I mean, I remember and this is like, I imagine it's the same with adoption as with it just, you know, a regular birth. But, you know, all of a sudden, someone just hands you a baby and the nurses see the look on your face. And hopefully the nurses are all as great as ours were. They're just like, you're doing fine. They told us. What I said was like, hey, these babies are meant to stay alive. You're gonna be just fine. Just feed them this way and you're on the right track by just getting food into their body. And so, like I said, evolution has happened in such a way where they want these babies to live. So you've already got a bit of a head start. But being bombarded by hormones and a change in hormones is definitely something that's hard to deal with because your body's bombarded with hormones because you're pregnant, to help you be successfully pregnant and to stay pregnant. And then immediately after, within 72 hours, most of these hormones go back to their previous state. And that's just a big break to throw on.

[Josh]

Yeah, it's pretty mean of evolution, really, to just be like, here's all the stuff that you need to have a baby. Now you don't have a baby anymore, who cares about you? And your baby's like, thanks for the ride, lady.

[Chuck]

Right? They could have been like, well, let's just tap these down very slowly over the course of six months. Yeah.

[Josh]

What the hey, you know, I know I'm a childless man, CIS even, and I am offended by that. I'm mad at natural selection for that. It's just totally unfair. It's just unfair.

[Chuck]

Well, what are some of these hormones? Let's talk about them.

[Josh]

Well, you got good old progesterone. Everybody knows that one. That one won the. The super bowl last year.

[Chuck]

That's right.

[Josh]

It helps you create your placenta that the baby's going to, I guess, attach to I remember, if I remember my health class from eighth grade correctly, okay. It also stimulates blood vessel growth, which helps get nutrients and oxygen to the womb. Progesterone, like any hormone, it's actually quite clever. But we have a finite number of hormones. Not that many, actually. I'm not sure how many, but they do so many different things, and they do so many different things in combinations. It's just elegant and beautiful. The human body can be. Except when the hormone levels drop too quickly.

[Chuck]

Yeah, for sure. There's also, of course, estrogen that's gonna help the uterus grow, contribute to fetal development. As far as organs and things go, it's gonna stimulate that milk duct development. Relaxin is another one that's the most chill of all. That's gonna inhibit uterine contractions until you need them to avoid premature birth. And then it's gonna do double duty and relax and soften the pelvic joints when you're preparing for birth. And then finally, we have oxytocin. They really shoot through the roof at the beginning of labor to stimulate uterine contractions.

[Josh]

Yeah.

[Chuck]

And then again, like we said, within about 72 hours of birth, at least estrogen and progesterone that had increased tenfold just goes back to normal. And these huge hormonal swings are just tough to deal with. You know, it's tough to know which way is up.

[Josh]

Okay. That's just the hormonal, the biological aspect of it. There's also the environmental aspect of it, the. The nurture version that was nature. This is the nurture part. And having a new baby comes along with. All of a sudden you have to stay at home with your new baby and can't do anything. You aren't sleeping. I think that that is, like, kind of overlooked by people who've never had kids or underestimated, I think, maybe, or who haven't had kids that. That don't sleep very well. And then you also have to nurse. You have been physically gone through the wringer, taken through the ringer. Like, there's all sorts of different things that come that are specific exclusively to just having had a baby that combined with the hormones, they just come together. And at the very least, give almost all new mothers the baby blues. And then some moms. Postpartum depression, postpartum mood and anxiety disorder, postpartum psychosis, postpartum ocd.

[Chuck]

Yeah. And, you know, as far as the sleep thing goes, even if you have, like, a great sleeper like we did, you're still gonna have disrupted sleep for a while because you have to get up and feed that baby in the middle of the night. And some people have a really hard time going back to bed. So this is when partners need to really, really, really, really, really step up. If you have a partner when you're having a baby, I can't imagine how tough this is on your own. But yeah, step up, take middle of the night feedings, let that mom get as much sleep as possible. And then they also say sleep when the baby sleeps. So embrace those naps all day long. If like your baby has a great nap in the afternoon, so should you.

[Josh]

Right. Don't like your mother in law. Well, if she's willing to come over and watch the baby overnight, fake it.

[Rebecca Nagle]

Yeah.

[Chuck]

Oh man. And we had a lot of help, so like. Cause you know, my mom and Emily's mom were both living here at the time. And so I just really feel for people that don't have that kind of help and feel like they're trapped at home. So my other advice as a CIS dad is to get out in the world. You might think that your baby is just a walking sickness bomb waiting to happen if they go and breathe the world's air. But there's nothing better that you can do for yourself and your baby than to get out in the world as much as possible as soon as possible. Yeah, they'll be just fine.

[Josh]

Great advice, Chuck. You are just rolling with it today.

[Chuck]

Well, I hope I've learned something.

[Josh]

I think you've learned a lot. Yeah. So yes, you have your hormone levels plummeting. That seems like a pretty good answer to where postpartum depression comes from, right?

[Chuck]

Yeah.

[Josh]

But it turns out that they've zoomed in, they've gotten even more granular. If you're like a C suite type and have figured out that there's this one hormone in particular that really seems to be largely responsible. It's not the only one responsible for it, but it's a pretty. It got caught red handed with like a bag with the dollar sign on it, wearing a black mask, kind of skulking away.

[Chuck]

That's right.

[Josh]

So what is it, Chuck?

[Chuck]

It is allopregnanolone. It's funny, Dave wrote this and he was like, good luck pronouncing that. And Dave, buddy, that one's pretty easy compared to a lot of the stuff that we see for sure. But that is a steroid. That's a steroid naturally produced in the brain. And it plays a couple of key roles during pregnancy in that it inhibits the release of oxytocin which we already talked about to avoid premature labor, which you don't want. It also protects the developing fetal brain from all those stress hormones that mom has.

[Josh]

Right. Okay, so this is pretty great stuff. Unfortunately, just like all the other hormones, it says, so long I've done my thing, like, within a couple of days of having given birth. So all of a sudden, not only is this a hormonal change, this natural antidepressant has suddenly just vanished on you. And this can really seem to trigger postpartum depression in a lot of women.

[Chuck]

Yeah, for sure. So it's gonna lower their anxiety for a while while they're pregnant and boost a mother's mood. And then after that baby is born, when it crashes out, it probably feels akin to going off an SSRI or something.

[Josh]

But quickly, whenever you go off a medication like that, you're supposed to step it down, slowly, taper it off. This is like, again, nature just being a total bee ripping that stuff away from you. And all of a sudden, you're just going cold turkey off of this antidepressant. You got used to over nine months.

[Chuck]

Yeah, for sure.

[Josh]

So, Chuck, one thing that we've really been focusing on is the mom. And the mom definitely suffers from post apartum depression, but so can the baby as well.

[Chuck]

Yeah, for sure. Pregnant women with PPD are far more likely to deliver a preterm baby or a baby with low birth weight. So there can be a literal physical outcome of postpartum depression for the baby. And we talked earlier about black and Latina women experiencing PPD at higher rates. So that also is gonna correlate over to birth outcomes, because Black women are 50% more likely to give preterm. To give birth preterm than white women and more than twice as likely to have a baby with a low birth weight.

[Josh]

Right. This, of course, makes it even more pressure laden for you to get it just right. Right. So that also can affect your ability to bond with your baby. And again, as we saw with postpartum mood and anxiety disorder, that can create a feedback cycle where you get more and more anxious about it, more and more depressed about it, and that that affects your bonding even further, which you get more and more depressed and anxious about, and that affects your baby as well.

[Chuck]

Yeah, for sure. Should we take a break?

[Josh]

Yeah. There is one other thing I think before we break to point out, and that is that if you have postpartum depression, it doesn't mean that you don't want to bond with your baby like you are incapable of bonding with Your baby in the healthiest possible way. It's not you. It's your biology and your environment.

[Chuck]

Yeah, Yeah. I thought you were about to say it's not you, it's them. It's the baby.

[Josh]

It's the baby's fault.

[Chuck]

Yeah, he's just not that into you. All right. I'm glad we could make a sort of a light joke. I hope it came across that way. And we will be back right after this with treatment options, because there's great, great news on the horizon.

[Ben Nadif Haffrey]

Thirty years ago, an island off Manhattan almost brought down New York City.

[Narrator]

Who will you trust? Your friends and neighbors? Or will you trust the people five miles overseas?

[Ben Nadif Haffrey]

This is a story about neighbors turning on each other and what happens when a forgotten place decides it's had enough.

[Chuck]

We reached for a feeling that exists in this city, but we're not stopping, are we?

[Ben Nadif Haffrey]

I'm Ben Nadif Haffrey, and for my new series on revisionist history, I took a deep dive into Staten Island's attempt to secede from New York city in the 1990s and what it all has to do with with the politics of resentment that dominate America today. Listen to revisionist the Staten island problem on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

[Rebecca Nagle]

The Declaration, which is full of these beautifully rendered, you know, sentences and paragraphs about enlightenment ideals, does also have this darker history to it.

[Podcast Host]

Why is it important for the darker part of the Declaration of Independence and the American Revolution? Why is it important that Americans know about it?

[Rebecca Nagle]

Well, if we don't understand the full context in which our nation was founded, we won't understand the full context in which our nation now finds itself.

[Podcast Host]

I'm Rebecca Nagle. Gohin Tawadon Jalecayetli Gay la citizen of Cherokee Nation.

[Josh]

Are you guys big Chiefs fans?

[Chuck]

Hell, yeah.

[Podcast Host]

This is First America, the true story of how the United States came to be and how we got to this present moment. Listen to First America on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

[Josh]

Okay, Chuck, so you said there's great news on the horizon, and we're about to lay it on them. All the moms who are bawling and yelling and doing all the things while they're listening to this episode. Treatment is quite viable.

[Chuck]

That's right. Standard treatment is what you might think. It's therapy, perhaps antidepressant medication. Certainly cbt. Cognitive behavioral therapy. We've talked about a lot. That has been proven to be pretty effective for PPD and postpartum anxiety and everything. Yeah, and everything in general. But in the case of cbt, you're identifying these triggers that seem very automatic, these thought patterns that you think you can't help and coach you through that and how to develop a healthier way of responding to those things when they do happen.

[Josh]

Right. God bless Dr. Aaron T. Beck, the creator of CBT.

[Chuck]

Yeah, for sure.

[Josh]

There's also medication. We talked about allopregnanolone being discovered as like a main culprit for postpartum depression that led to some drugs being expressly targeted to basically help that transition. So you don't just go cold turkey, you kind of taper off of that stuff.

[Chuck]

Yeah.

[Josh]

And then there's also long been SSRIs prescribed for it, like a standard antidepressant. And that, of course, gives moms pause. Like any kind of medication can give a lot of moms pause because they're like, I'm nursing, so what's that going to do to the baby?

[Chuck]

Yeah, for sure. They've studied this. The current sort of wisdom on this is that they have been detected in very, very low levels, sometimes even undetectable levels in breast milk. There are rare reports of adverse effects on infants or in infants. So that's where the science currently stands.

[Josh]

Yes. I also saw that Paroxetine and Sertraline, which is Ciroxat and Zoloft.

[Chuck]

Okay.

[Josh]

They seem to be the preferred antidepressants for nursing mothers because they have a shorter half life than other SSRIs and they pass to breast milk in smaller amounts than other SSRIs. So if SSRIs in general are okay, these two are super okay, according to the medical establishment. Not me, because I'm not a doctor.

[Chuck]

That's right. And by the way, we did, I think, two pretty good episodes on breastfeeding back in the day. That was a two parter. Right.

[Josh]

We did one on bottle feeding and one on breastfeeding.

[Chuck]

Right. Yeah. So feeding your baby and, you know, I recommend you do those. And we got, you know, it's always when it's two dudes podcasting about this stuff, about lady stuff, we're always a little nervous. And we always get really good feedback from women that say, like, you guys did a really good job. And it's good that you guys are out there sort of not feeling like it has to come from a woman's perspective. So I hope we're doing this all justice, you know?

[Josh]

God, I hope so too.

[Chuck]

I think you're doing fine.

[Josh]

I think you're doing great, but I'm

[Chuck]

just another CIS dude.

[Josh]

So if you want to target allopregnanolone, there's a drug called brexanolone. Yeah. There's another one called zuronolone. Yeah. And those are the generic terms for them. The problem is, as it stands right now, if you're paying out of pocket with zero insurance, you're going to pay 34 grand for one in the United States. I'm sure it's like 10 bucks in Canada or 15 grand for the other.

[Chuck]

Shame, shame, shame.

[Josh]

Yeah. Hopefully if you have even passingly decent insurance in the United States, like you're not going to pay anything even remotely like that. But yes, I think you should say it again, Chuck. Yeah.

[Chuck]

Still, even if insurance is covering it. Shame, shame, shame, shame. Capital S H A M E. Good for you, buddy.

[Josh]

And now here's an ad for Saran alone.

[Chuck]

Oh, man, you're managing to squeeze in some jokes. I like that.

[Josh]

I like you.

[Chuck]

So can men get postpartum depression? The answer is yes, that can happen. Apparently between 8 and 10% of new dads suffer from some kind of anxiety or depression after the birth of a job. And it also may be connected to hormones. In some cases, it's usually later than women might experience it, between three and six months later, maybe up to a year later. But a lot of the same issues, sleep issues, loss of appetite, feeling overwhelmed, tired, sad, anxious, and also the same people at risk. If you're a younger dad, if you have a history of depression, if you are struggling financially, or if you're just having trouble in your marriage or relationship. You don't have to be married to have a baby. We all know that.

[Josh]

Right.

[Chuck]

Although those same kind of risk factors.

[Josh]

Right? And there's also additional risk factors that dads customarily have that new moms don't necessarily. That's a. That's like the new mom is expected to be a great mom and raise a great, healthy, well adjusted baby right out of the box. The dad is expected to really step it up and provide for his new family. And that can often mean like, well, you're stuck here in this job and you're now beholden to this employer. And like you may this, that might not be the greatest feeling in the world for you right then. And at the very least, it's additional pressure. So that can also kick off postpartum depression in dads, which was, I think, best expressed in the Wham song Everything she Wants.

[Chuck]

That's right. And I hope this is Clear. But to be clear, we're not obviously talking about the old days where like the man's got the job and the woman doesn't work and isn't expected to. But you know, in two income families, a lot of times when a mom has a baby, they at the very least hopefully have a great maternity leave kind of situation. If not, sometimes they have to leave whatever job and just not get paid for a while. So there may be more pressure on the second income earner to kind of make up for that loss or at least keep the ship afloat till mom can get back to work.

[Josh]

Yeah, and one of the, I guess, quirks of the United States economy, I guess, is that especially if you, if you have a two income house and there, there is not great maternal leave or paternal leave, both parents have to go to work very soon after the birth. They will have to put their kid in childcare. The United States, unlike some other countries, does not have free child care. It is a paid private business industry. And some couples figure out that the cost of daycare is more than say, the mom or the dad would actually bring home. And so in that sense, it makes sense to just for, for the mom or the dad to stay home, whoever has the lower income that daycare would exceed. That's nuts that that happens to anybody and it happens to a decent amount, at least anecdotally.

[Chuck]

Yeah, for sure. Daycare is really, really expensive. And it's a real shame because that helps the family, that helps for outcomes for the kid and their development. So my recommendation is to use your voice at the voting booth. And if there are candidates in your local city or state or nationwide that believe in the idea of free childcare, then speak with your vote. That's all I'm going to say on that.

[Josh]

Okay. One other thing too, Chuck. It's not just environment. Just like with postpartum depression in women. Postpartum depression in men also seems to have to do with hormones because men's hormones or the balance of hormones change during pregnancy as well, which is pretty neat.

[Chuck]

Yeah, for sure. Your testosterone is gonna probably drop during the pregnancy and continues to get lower after the birth happens. And people think, you know, researchers think that that's basically to keep tuk tuk at bay and to reduce aggressive tendencies while father infant bonding is happening. Like, chill out, dad. You need to be gentler right now. So we're gonna lower your T. Right.

[Josh]

And also stick around and help raise the kid rather than go look for your next conquest.

[Chuck]

Yeah, man, I wonder if I should Say this on the air.

[Josh]

Oh, we can edit it out.

[Chuck]

All right, we'll see. One of the funny things that Emily has done lately is, you know, all the in the stupid manosphere world, like, you know, low T, beta male soy. That's another one. Like, your soy. Like, because you eat soy instead of meat like a man does. She will. Anytime I'm like, I don't know, just being wishy washy about something or what if she feels like she just wants to kind of poke fun at me, she'll call me like a beta cuck or ask me if I have low T. Or like, hey, soy, come over here and help me with this thing.

[Josh]

Oh, my gosh.

[Chuck]

I mean, it always just brings the house down between the two of us. Cause it's just such a dumb thing anyway. I like that she's taken something from the manosphere and kind of twisted it to use it in our own marriage as a comedy.

[Josh]

I would love to be sitting on the couch someday and her do that to you because, yes, I would lose. So funny.

[Chuck]

Yeah. I'm waiting for Ruby to be like, what's a beta cuck?

[Narrator]

Right.

[Josh]

Let's see. Oh, yeah. Postpartum depression is also treatable in dad. So if you think you have it, seek help, because it's very treatable, too.

[Chuck]

That's right.

[Josh]

You got anything else?

[Chuck]

I got nothing else, man. I always feel like we're on ice skates with these episodes.

[Josh]

I didn't feel like that about this one.

[Chuck]

I always get a little nervous in how I speak about this stuff, so I hope you did okay.

[Josh]

You did great, man. You did great.

[Chuck]

You did great.

[Josh]

Well, then it sounds like we both did great.

[Chuck]

But I want moms to write in and say, you did great. I don't care what I think about you and what you think about me anymore. We know we love each other.

[Josh]

All right, fair enough. Okay. Yeah. If you're a new mom or an old mom or even never had kids, it doesn't matter. We would love to hear from you about this episode.

[Chuck]

Yeah. And not just saying we're great. Like, if we fell short, let us know and we'll try and do better and correct it.

[Josh]

Well put, man. I'm glad you said that, too, because, yeah, we sounded like a couple of.

[Chuck]

I know. Like, please make us feel better.

[Josh]

Right? Couple of cucks.

[Chuck]

Beta cucks. Yeah.

[Josh]

Since Chuck just laughed about beta cucks again.

[Chuck]

So funny.

[Josh]

That means it's time for listener mail. Soy is the one that really gets. Well, you know what's crazy is soy Actually does raise your estrogen levels and can give men mini boobs.

[Chuck]

Oh, well, great. Give it to me. I love it. All right. This is from Adam in Michigan. Hey, guys. I'm a little more than disappointed that in the Three Mile island episode, you failed to mention professional wrestler Adam Bomb. He was a popular wrestler in the 1980s in the WWF. He was billed as being from 33 Mile island and was an imposing 66290. He had yellow contact lenses and his finishing move was called the Atom Smasher. This is so great. He was a rather imposing figure with a very creepy theme song, and he made quite an impact. His real name is Brian Clark. He's still alive and looks almost like he did in the 1980s. Adam from Michigan.

[Josh]

Nice. Hi. Never heard of him. So thank you for letting us know, Adam.

[Chuck]

Yeah, it was fun.

[Josh]

You hadn't heard of him?

[Chuck]

No. I mean, I didn't keep up with wrestling much.

[Josh]

No, I didn't either, but sounds like we were missing out on a lot.

[Chuck]

But, you know, we're just soy loving beta cucks.

[Josh]

So what do we know if you want to be like Adam and let us know. Wait, is this from Adam Baum himself?

[Chuck]

No, this is a D A M. Oh, okay.

[Josh]

Well, there was an Adam Baum who was a DJ at album 88 for a while. He had like, the Soul Something show.

[Chuck]

Oh, wow. I bet. I listened to it.

[Josh]

It was really good. Well, anyway, thanks a lot, Adam from Michigan, for letting us know about Atom Bomb. We love that. And if you want to get in touch with us like Adam did, you can send us an email to send it off to Stuff podcastheartradio.com

[Podcast Host]

Stuff youf Should Know is a production of iHeartRadio. For more podcasts My Heart Radio, visit the iHeartRadio app. Apple Podcasts are wherever you listen to your favorite shows.

[Jacob Goldstein]

This is Jacob Goldstein from what's yous Problem? When you think about discovering small brands, what store pops into your mind? Well, it should be Walmart. Seriously. Walmart has thousands of small brands and they're all in one place. Just go online or in store, discover and shop. It could not be easier. Every one of these brands has a real story and real people behind it. They're true American success stories. And you can find them all at Walmart. Discover thousands of small [e-mail] today.

[Chuck]

He's dribbling the ball with everything on the line. He's driving down the pitch.

[Narrator]

He's facing price hikes and cuts past him. Carrier contracts, tries to block him.

[Chuck]

Oh, he leaves him in the dust.

[Narrator]

He's at the edge of the box. He cuts past the nonstop group chat, trash talk. He clears on goal. He shoots.

[Chuck]

Go unlimited data for $25 a month forever. Visit your local Boost Mobile store today to get unlimited data with a price that never changes. Boost mobile after 30gb, customers may experience lower speeds. Customers will pay $25 a month as long as they remain active on the Boost $25 unlimited plan.

[Ben Nadif Haffrey]

Thirty years ago, an island off Manhattan almost brought down New York City.

[Narrator]

Who will you trust? Your friends and neighbors? Or will you trust the people five miles overseas?

[Ben Nadif Haffrey]

This is a story about neighbors turning on each other and what happens when a forgotten place decides it's had enough.

[Chuck]

But we're not stopping, are we?

[Ben Nadif Haffrey]

Listen to Revisionist the Staten island problem on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

[Podcast Host]

This is an iHeart podcast.

[Chuck]

Guaranteed Human.