Within two to three days after giving birth, between 70 and 80 percent of women have feelings of heightened sensitivity, sadness, fear, anxiousness, or of being overwhelmed. Usually the "baby blues" go away within a week, but if they don't it, may be a sign of a more serious condition.
In some cases, normal post-birthing feelings such as irritability and fatigue may be accompanied by paranoia, sleeplessness, and even mania.
Researchers believe that changes in a woman's hormone levels both during pregnancy and shortly after the birth of a child are at the root of what is known as postpartum depression (PPD). Most often, PPD occurs within one to three weeks following delivery.
It is estimated to affect as many as 13 percent of new mothers. In the U.S., that's half a million women.
Symptoms of Postpartum Depression
The biological transformations following childbirth affect all women. For some, however, the changes in hormone levels may lead to depression.
The symptoms of postpartum depression may include:
- anxiety attacks
- trouble eating or sleeping
- crying for no apparent reason
- feelings of worthlessness
- questioning one's ability to parent
- suicidal ideation or thoughts of harming the baby
- feelings of franticness, mania, or paranoia
Women who have the most dangerous symptoms associated with PPD often require hospitalization to protect their health and the welfare of their newborn.
In a small number of cases, PPD can develop into the much more serious condition known as postpartum psychosis.
During pregnancy, an expectant mother's levels of estrogen and progesterone rise dramatically in order to help the uterus expand and to sustain the placenta. Within 48 hours of delivery, however, the levels of both hormones plummet dramatically. Because both of the hormones are also associated with neurotransmitters that affect mood, the "postpartum hormonal crash" may make some women more susceptible to depression.
Women who have had any type of depression in the past are more vulnerable to PPD than others. Twenty-five percent of women who have experienced a prior depression will develop postpartum depression—as opposed to ten percent who have not. Fifty percent of women who have experienced prior PPD will incur a relapse after another delivery.
In addition to the trauma of pregnancy and childbirth, the experiences associated with parenting can lead to postpartum depression. Sleep deprivation, which is extremely common in new mothers, can exacerbate PPD to the point where it may be hard to tell if a woman is "sleepy or weepy" (as one recent paper on the subject put it).
The stresses of new parenthood may also lead to social isolation and relationship conflicts that can increase the likelihood that a person will develop PPD. Thus, it is important that new mothers reach out to friends and family for support during this difficult, yet rewarding time in their lives.
If a new mother suspects she has PPD, she or a family member should contact her doctor or midwife immediately.
Postpartum depression is highly treatable. However, left untreated, the condition can last for months or even years in some cases.
Postpartum depression is considered a major form of depression; it is, therefore, important for clinicians to rule out other medical problems that may cause symptoms similar to PPD. For instance, anemia—a deficiency of red blood cells—is a common complication with pregnancy and may lead to fatigue and other symptoms of depression.
Another condition that must be ruled out is a thyroid deficiency, which may contribute to lowered mood and energy. Both conditions are easily treatable with either iron pills or hormone supplements.
As with other forms of major depression, PPD is best treated with a combination of antidepressants and talk therapy. However, unlike other depressions, prescribed medications must be safe for nursing mothers.
In addition, current research reveals that a hormone treatment including estradiol—a form of estrogen—may have a "rapid antidepressant effect" on women with PPD. Studies are ongoing but, so far, they look encouraging.
A Note for New Dads
A 2010 study published in the Journal of the American Medical Association found that 10.4 percent of new fathers developed "paternal depression" at some time during their partner's pregnancy or during the first year of the new baby's life.
The numbers—which are about twice the rates of depression for men in general—increased if the man’s partner also had PPD.
Symptoms in men with parental depression are similar to those for women with PPD and may include sadness, anger, irritability, changes in sleeping or eating problems, and a loss of interest in once-pleasurable activities.
Men with these symptoms should contact their health care providers immediately.