Recently, celebrities like Hayden Panettiere and Drew Barrymore have opened up about their struggles with postpartum depression. Of course, this awareness is a good thing, but many moms are still being undiagnosed for another type of depression: maternal depression.

Postpartum depression affects up to 16 percent of mothers and can occur up to a year after giving birth, or even months later. Maternal depression, which is equally serious yet receives less attention, often goes undiagnosed. In fact, a study in the journal BJOG suggests that depression is actually more common four years after giving birth than at any other time during the first year.

Cris Evert Ruffolo, 29, was diagnosed with postpartum depression after having her twins, but she continued to suffer with depression after they turned a year old. After uprooting her family from the Philippines to China and more recently to Kalispell, Montana, Chris said the lack of family and social support has left her feeling overwhelmed, irritable and angry.

“There are feelings of despair and hopelessness that always crop up from time to time [too],” she said.

Although her husband supports her, lets her sleep in late and does a lot of the household chores, she craves time alone to read, get a coffee or do activities that she used to enjoy before having her children.

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“I love seeing my kids but I can’t wait to be away from them,” she said.

All women are at risk for maternal depression, but some are more likely than others to suffer.

“You can have people who get sick and remain sick even though their children are 2 or 3 because they haven’t had adequate treatment,” said Dr. Samantha Meltzer-Brody, an associate professor and director of the perinatal psychiatry program at the University of North Carolina’s Center for Women’s Mood Disorders in Chapel Hill.

For some women, depression can start during pregnancy and persist. In fact, a study authored by Meltzer-Brody in the Lancet Psychiatry found that women with severe symptoms like worsening anxiety and suicidal thoughts developed depression during pregnancy.

Women who have previously had postpartum depression, a depressive episode at another time during their lives or a family history of depression are all at risk, too. Although it’s rare, women who have none of the risk factors and are seemingly happy can also develop maternal depression, said Karen Kleiman, founder of the Postpartum Stress Center in Rosemont, Penn.

What are the causes?
When it comes to maternal depression, there are several factors that can play a role.

For starters, lack of sleep and physical and mental exhaustion even during the toddler and preschool years can affect a mom’s ability to produce “feel-good hormones,” said Dr. Jessica Michaelson, a psychologist and early parenthood coach based in Oakland, Calif.

The transition to motherhood, along with feelings of low self-esteem, changes in a woman’s sense of sexuality and self-identity, life stressors such as financial problems or caring for a child with special needs, and a lack of social support can all have an impact.

“It amazes me how surprised we are and in some ways how naïve we are to think in our culture that women should just do this automatically and well when we have a culture that doesn’t support them,” Kleiman said.

Often times, moms can also feel disconnected and unsupported by their partners—especially if moms take on most of the household chores and parenting responsibilities.

Some moms may struggle during the toddler years as their children learn how to handle intense emotions and parents try to figure out how to discipline.

“You go from having these sweet interactions with a baby to a lot of pushing against, feeling separate and conflict,” Michaelson said. “The grief of stepping into this more negative phase with your child can be really depressing and exhausting.”

Another reason moms may suffer from depression is because of their own early childhood experiences. If they grew up in a home where they were constantly yelled at, punished and put down, and now they’re falling into the same pattern with their own children, they can have feelings of guilt, shame and hopelessness.

Facebook and social media only make depressed moms feel worse because the perception is that every other mom is having happy moment after happy moment while they’re somehow stuck in the drudgery of motherhood.  

“People who are more likely to look to all that idealized, fake stuff are also likely to have more negative early childhood experiences themselves,” Michaelson said.

How to find help
The good news is that moms don’t have to suffer in silence, but taking the first step is key. Although moms are usually screened by their OB/GYN or their child’s pediatrician for postpartum depression, they can fall under the radar later on if it doesn’t come up at their regular doctor’s appointment.

If you think you may have maternal depression, trust your instincts. Don’t try to deal with your feelings alone because you’re too busy caring for little ones.

“Understand that self-compassion can have healing properties,” Kleiman said.

Ask your primary care physician for a referral or contact organizations such as Postpartum Support International http://www.postpartum.net/ and Postpartum Progress, http://www.postpartumprogress.com/the-symptoms-of-postpartum-depression-anxiety-in-plain-mama-english who can help you find a provider.

Also, do your best to eat healthy foods, exercise, get enough sleep and do activities that fulfill you, like meditation, yoga or meeting friends for lunch.  

“If you don’t take care of yourself, you’re not able to do as good a job as you would like to of taking care of everyone else,” Meltzer-Brody said.

Julie Revelant is a health journalist and a consultant who provides content marketing and copywriting services for the healthcare industry. She's also a mom of two. Learn more about Julie at revelantwriting.com.