Postpartum depression is depression that affects new mothers. Depression is more serious than feeling sad or down for a short period; people with depression feel sad, empty, or anxious for extended periods. Symptoms may be mild or severe and can interfere with daily activities, responsibilities, and personal relationships. Fortunately, however, treatment for depression—including postpartum depression—is often effective.

Postpartum Depression In Depth

Out from the Shadows

The symptoms of depression and postpartum depression are similar. The main difference is that postpartum depression affects women who have recently given birth. And because postpartum depression may affect a new mother’s ability to care for her baby, effective treatment is important for the health of both mother and child.

Postpartum depression is common. According the U.S. Department of Health and Human Services, it affects approximately 13 percent of new mothers.

If you experience postpartum depression, it’s important to remember that this doesn’t mean that you’re a bad person or a bad mother. Rather, postpartum depression is simply a complication of giving birth, and like other complications, it can be managed with treatment.

Causes of Postpartum Depression

There are several factors that can contribute to the development of postpartum depression. Hormonal changes associated with pregnancy and childbirth are thought to trigger depression in new mothers. Specifically, levels of female hormones estrogen and progesterone increase greatly during pregnancy and then quickly return to normal with 24 hours of childbirth. It is thought that this dramatic shift in hormone levels may contribute to depression in new mothers.

Another possible biological trigger for postpartum depression is a change in thyroid hormone levels, which can fall after giving birth. Low levels of thyroid hormone are associated with symptoms of depression. Your doctor can measure thyroid hormone levels with a blood test.

Other changes and events surrounding the birth or your baby may contribute to postpartum depression. These include:

  • Feeling tired after delivery and feeling tired due to lack of sleep or interrupted sleep
  • Feeling overwhelmed by your new responsibilities
  • Worries about your ability to be a good mother
  • Stress from changes at home and at work
  • Feeling less attractive
  • Having no time to yourself
  • Having high expectations to be a perfect mom

Some women may have a higher risk of developing postpartum depression. The following factors may increase risk:

  • A personal history of depression or another mental illness
  • A family history of depression or another mental illness
  • A lack of support from family and friends
  • Anxiety or negative feelings about the pregnancy (such as with an unplanned or unwanted pregnancy)
  • Problems with previous pregnancy or birth
  • Marriage or money problems
  • Stressful life events
  • Young age
  • Substance abuse
  • Depression during pregnancy

Prevention

If you have any of the risk factors described above, with your doctor’s help, you can take measures to prevent postpartum depression. If you have a history of depression, discuss it with your doctor as soon as you know you are pregnant. Your doctor can monitor you for early signs of depression as well as recommend support groups or counseling. As well, you may be screened for postpartum depression after your baby is born. Sometimes, women with a history of depression are prescribed antidepressant medication during pregnancy.

The Baby Blues

In addition to postpartum depression, new mothers may also experience a milder period of sadness call the “baby blues”. Characterized by mood swings, sad or anxious feelings, crying spells, loss of appetite, and difficulty sleeping, the baby blues will usually go away within days or a week and don’t require treatment.

Postpartum Psychosis

Postpartum psychosis is a rare but severe mental disorder affecting new mothers. One to four out of every 1,000 births may be affected, according to the U.S. Department of Health and Human Services. Symptoms include seeing things that aren’t there, feeling confused, having rapid mood swings, and trying to hurt yourself or your baby. Postpartum psychosis usually begins within two weeks following childbirth. Women with mental health problems, including bipolar or schizoaffective disorders, have a greater risk of postpartum psychosis. Postpartum psychosis requires immediate treatment.

KNOW THIS
If you have thoughts of harming yourself or your baby, call 9-1-1 immediately.

Symptoms

Pregnancy and childbirth are of course major life changes—both emotionally and physically. It can be normal to feel down or sad after your baby is born. When the following symptoms of depression following childbirth are severe and last for more than two weeks, however, you should call your doctor.

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  • Feeling restless or moody
  • Feeling sad, hopeless, or overwhelmed
  • Crying a lot
  • Having no energy or motivation
  • Eating too little or too much
  • Sleeping too little or too much
  • Having trouble focusing or making decisions
  • Having memory problems
  • Feeling worthless and guilty
  • Losing interest or pleasure in activities you once enjoyed
  • Withdrawing from friends and family
  • Having headaches, aches, and pains or stomach problems that don’t go away

Symptoms unique to postpartum depression include:

  • Thoughts of hurting the baby
  • Not having interest in the baby

Diagnosis

If you experience any of the following symptoms after your baby is born and the symptoms don’t go away after two weeks, you should call your doctor to discuss postpartum depression:

  • You feel sad or anxious and have major mood swings for more than two weeks.
  • Your symptoms of depression become increasingly severe.
  • You experience symptoms of depression at any time, even months after your baby is born.
  • You’re having trouble performing tasks at work and at home.
  • You’re not able to care for yourself or your baby.
  • You have thoughts of harming yourself or your baby.

Be prepared to discuss with your doctor the symptoms described above, as well and your personal medical history, a personal or family history of mental health problems, and stressful events or circumstances that may be contributing to your sadness or anxiety.

Treatment

Treatment for postpartum depression may include two main parts: counseling and medication.

You may first discuss your concerns about postpartum depression with your regular doctor (your primary care doctor or OBGYN, for example), but he or she may refer you to a mental health specialist for further treatment or counseling (also called talk therapy). Mental health specialists include therapists, psychologists, and social workers. With these specialists, you’ll discuss postpartum depression and learn ways to change how it affects you.

Medication for postpartum depression includes antidepressant medicines as well as hormone therapy (estrogen replacement), which may help counteract the drop in estrogen at the time of childbirth. Both types of medication are prescribed by your doctor. Talk with your doctor about the benefits and risks of antidepressants and hormone therapy, especially if you are breastfeeding.

In addition to medical treatment of postpartum depression, you can take measures that will help you feel better. These include:

  • Get as much rest as possible. Sleep when the baby is sleeping.
  • Maintain a healthy lifestyle by staying physically active, eating nutritious foods, and avoiding alcohol.
  • Set realistic goals: don’t try to do much or be perfect.
  • Ask your partner, family, and friends for help.
  • Visit with friends, spend time with your partner, or do something enjoyable on your own.
  • Discuss your feelings with your partner, family, and friends, as well as with other mothers who have had similar experiences.
  • Join a support group. Your doctor may be able to help you find one.
  • Don’t make any major life changes during pregnancy or immediately after giving birth. If a big change can’t be avoided, find support to help you make the transition.

Why Treatment Is Important
Postpartum depression can affect your own health as well as your ability to care for your baby—this makes early and effective treatment critical. Problems among children of mothers affected by postpartum depression may include delays in language development, problems with mother-child bonding, behavior problems, and increased crying. If postpartum depression is not treated, it can last up to a year or longer and may become a chronic depressive disorder.

Resources

National Institute of Mental Health

Postpartum Education for Parents

Postpartum Support International

Sources

Depression During and After Pregnancy. The U.S. Department of Health and Human Services Web site. Avalable at: womenshealth.gov/faq/depression-pregnancy.cfm. Accessed August 2010.

Postpartum Depression. The Mayo Clinic Web site. Available here.

Accessed August 2010.