Postpartum Depression

Postpartum depression is a serious mental health condition that may occur during pregnancy or shortly after giving birth. It can cause a mother to fail to bond with her baby, to have characteristic symptoms of major depression, and even to have thoughts of harming herself or her baby. Postpartum depression can make it very difficult to function or to properly care for a baby. All women who have given birth should be screened for signs of depression, as this is a devastating condition, but it is also treatable.

What Is Postpartum Depression?

New mothers commonly experience low levels of depression, moodiness, anxiety, and sadness after giving birth. Known as the “baby blues,” this is normal and usually doesn’t last long. However, some women experience much more serious symptoms that persist for a longer period of time. This is a real, diagnosable condition known as postpartum depression. It is a type of depression and it requires diagnosis and treatment.

It is important for women to understand that this is not a failing of maternal instinct, rather an actual medical complication of childbirth. It is easy to feel ashamed and guilty, but postpartum depression is treatable and can be managed if it is diagnosed. With treatment and time a new mother can get relief and overcome depression, and she can start to bond with and enjoy her new baby.

Types of Postpartum Depression

The so-called “baby blues” is a recognizable condition and while it is not considered to actually be postpartum depression, it is worth noting. Many new mothers will experience mood swings, sadness, irritability, excessive crying, a feeling of being overwhelmed, difficulty concentrating, and changes in appetite and sleep. When these symptoms persist for just a few days or a couple of weeks and are not severe, it is not likely postpartum depression. A new mom who has more serious symptoms or symptoms that persist for more than two weeks should be evaluated for postpartum depression.

A rare but very serious type of postpartum depression is depression with psychotic symptoms. This is more common during pregnancy and less so after delivering. The symptoms may include hallucinations, severe mood swings, extreme confusion, and having thoughts of harming the baby or oneself.

Psychotic postpartum depression is not common. It may occur in any woman who is pregnant, but those with a past history of psychosis, specifically schizoaffective disorder or bipolar disorder, are at a greater risk. Although rare, this kind of psychosis should be considered a medical emergency as it can lead to serious injury, harm, or death in the baby or mother.

Facts and Statistics

Postpartum depression carries a big stigma. New mothers struggling with depression often feel as if they have failed because they are not overwhelmed with joy at giving birth. The truth is that this is a real and serious psychiatric condition that is more common than many women realize.

  • About one in seven women across the U.S. will experience postpartum depression after having a baby.
  • Postpartum depression is the most common complication of childbirth.
  • The condition most often begins between one and three weeks after giving birth.
  • Postpartum depression makes it difficult or impossible for a woman to care for her baby.
  • Any woman having a baby may struggle with postpartum depression, regardless of race, age, socioeconomic status, number of pregnancies, or difficulty of pregnancy.
  • Fifty percent of cases of postpartum depression actually begin during pregnancy.

Symptoms and Diagnosis of Postpartum Depression

The Diagnostic and Statistical Manual of Mental Disorders lists postpartum depression as major depressive disorder with peripartum onset. In other words, it is essentially the same condition as major depression, but it is triggered by pregnancy or childbirth. A common myth about postpartum depression is that it always occurs after a baby is born. The term peripartum refers to the fact that it can begin during pregnancy, before delivery, or after delivery.

The U.S. Prevention Services Task Force recommends that depression screening for adults should include all women during and after pregnancy. The importance of screening is to diagnose women early so that they can be treated. Diagnosis is done by psychiatric evaluation using the criteria for major depressive disorder. The symptoms of postpartum depression may include:

  • A persistent depressed mood
  • Severe mood swings
  • Crying more than normal
  • Struggling to bond with or take interest in the new baby
  • Withdrawal from friends and family
  • Feeling disconnected from others
  • Difficulty sleeping or oversleeping
  • Intense periods of anger or irritability
  • Loss of interest in normal or previously enjoyed activities
  • Fatigue and low energy
  • Feeling worthless or ashamed
  • Feeling like a bad mother
  • Difficulty thinking, concentrating, and making decisions
  • Anxiety or panic attacks
  • Thoughts of harming the baby or of self-harm
  • Thoughts of death and suicide

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Causes and Risk Factors

It is impossible to pinpoint an exact cause of postpartum depression in any one individual. But, there do seem to be some factors that are likely to trigger this condition. There are physical and biological changes, for instance, that may contribute to depression. The drop in hormones, in particular, has been implicated in the development of postpartum depression. In addition to the drop in estrogen and progesterone, during this time the hormones produced by the thyroid also drop. This can cause fatigue and sluggishness.

Another set of contributing factors to postpartum depression are emotional. A woman may experience anxiety, worry, fear, and stress during pregnancy. After giving birth she may experience emotional turmoil and mood changes because of being overwhelmed with being a new mother, not getting enough sleep, changes in appearance and in the body, and ongoing anxiety, worry and stress.

All women go through these changes during and after pregnancy but not all will develop postpartum depression. There are some well-known risk factors that may help explain why some women are affected and others are not, including:

  • Any history of depression or another mood disorder
  • A family history of depression or mood disorders
  • Difficult and stressful events leading up to childbirth, such as health complications or divorce
  • Health complications in the mother or baby
  • Difficulty breastfeeding
  • Relationship problems with a partner, spouse, or father of the baby
  • Lack of a strong or positive support system or lack of help in taking care of the baby
  • Financial or housing difficulties or instability
  • A pregnancy that was unwanted
  • Being a young mother
  • Substance abuse

Co-Occurring Disorders

Any type of mental illness may commonly co-occur with another mental illness because they have common risk factors and because one may trigger symptoms of another, especially when it goes untreated. Postpartum depression may co-occur with anxiety, it may be related to earlier or ongoing major depression, or it may co-occur with eating disorders.

Postpartum depression may also co-occur with substance abuse or substance use disorders. Drinking or using drugs during pregnancy is very risky for the baby, but it may also play a role in triggering or worsening symptoms of depression, both during and after pregnancy. After giving birth a new mother may turn to substance abuse as a way of coping with the feelings of depression. Anyone being treated for postpartum depression should also be screened for any co-occurring disorder. Addressing all mental health issues is crucial for healing and recovery.

Treatment and Prognosis of Postpartum Depression

Many women ask how long postpartum depression will last, which is an important question. Without treatment it can go on for months. With treatment symptoms are likely to resolve much sooner. The prognosis is very good for most women who seek out and get treatment. As with other types of depression, postpartum depression is treated with a combination of therapy and antidepressant medications. Postpartum psychosis requires immediate treatment and may include medication or even electroconvulsive therapy.

There are potential risks of using antidepressants during pregnancy or when breastfeeding. It is important for a woman and her doctor to weigh the benefits and risks before deciding whether or not to use medications during treatment. With or without medication, therapy is crucial and should be used to help a new mother manage her symptoms, change negative thoughts, and develop strategies for bonding with and caring for her baby. Because depression can recur, it is important to keep up with therapy even after symptoms lessen.

Lifestyle changes and self-care are also important for managing postpartum depression and are useful for the more common baby blues as well. This means relying on others for help, getting enough sleep, practicing healthy stress management, eating well and being physically active, and connecting with other new mothers going through a similar experience. New mothers should be able to feel comfortable talking about depression, but that isn’t always possible. It is important for supportive family and friends to watch for signs of depression and to encourage treatment as needed.