What is postpartum depression?
You’ve probably heard of the “baby blues.” That’s because it’s quite common for new mothers to feel a little sad, worried, or fatigued. As many as 80 percent of mothers have these feelings for a week or two following childbirth. It’s completely normal and usually fades in a few weeks.
While some of the symptoms sound the same, postpartum depression is different from the baby blues.
Postpartum depression is a lot more powerful and lasts longer. It follows about 15 percent of births, in first-time moms and those who’ve given birth before. It can cause severe mood swings, exhaustion, and a sense of hopelessness. The intensity of those feelings can make it difficult to care for your baby or yourself.
Postpartum depression shouldn’t be taken lightly. It’s a serious disorder, but it can be overcome through treatment.
Although it’s normal to feel moody or fatigued after having a baby, postpartum depression goes well beyond that. Its symptoms are severe and can interfere with your ability to function.
Symptoms of postpartum depression vary person to person and even day to day. If you have postpartum depression, chances are you’re familiar with several of these indicators:
- You feel sad or cry a lot, even when you don’t know why.
- You’re exhausted, but you can’t sleep.
- You sleep too much.
- You can’t stop eating, or you aren’t interested in food at all.
- You have various unexplained aches, pains, or illnesses.
- You don’t know why you’re irritable, anxious, or angry.
- Your moods change suddenly and without warning.
- You feel out of control.
- You have difficulty remembering things.
- You can’t concentrate or make simple decisions.
- You have no interest in things you used to enjoy.
- You feel disconnected from your baby and wonder why you’re not filled with joy like you thought you’d be.
- Everything feels overwhelming and hopeless.
- You feel worthless and guilty about your feelings.
- You feel like you can’t open up to anyone because they’ll think you’re a bad mother or take your baby, so you withdraw.
- You want to escape from everyone and everything.
- You have intrusive thoughts about harming yourself or your baby.
Your friends and family may notice that you’re withdrawing from them and from social activities or that you just don’t seem like yourself.
Symptoms are most likely to start within a few weeks of delivery. Sometimes, postpartum depression doesn’t surface until months later. Symptoms may let up for a day or two and then return. Without treatment, symptoms may continue to worsen.
If you have symptoms of postpartum depression, you should see your doctor as soon as possible so that you can get started on treatment.
There are two main treatments for postpartum depression: medication and therapy. Either one can be used alone, but they may be more effective when used together. It’s also important to make some healthy choices in your daily routine.
It may take a few tries to find out what treatment works for you. Keep open communication with your doctor.
Antidepressants have a direct effect on the brain. They alter the chemicals that regulate mood. They won’t work right away, though. It can take several weeks of taking the medication before you notice a difference in your mood.
Some people have side effects while taking antidepressants. These may include fatigue, decreased sex drive, and dizziness. If side effects seem to be making your symptoms worse, tell your doctor right away.
Some antidepressants are safe to take if you’re breastfeeding, but others may not be. Be sure to tell your doctor if you breastfeed.
If your estrogen levels are low, your doctor may recommend hormone therapy.
A psychiatrist, psychologist, or other mental health professional can provide counseling. Therapy can help you make sense of destructive thoughts and offer strategies for working through them.
This part of treatment may be a little more difficult than it sounds. Practicing self-care means cutting yourself some slack.
You shouldn’t attempt to shoulder more responsibility than you can handle. Others may not instinctively know what you need, so it’s important to tell them. Take some “me time,” but don’t isolate yourself. Consider joining a support group for new mothers.
Alcohol is a depressant, so you should steer clear of it. Instead, give your body every opportunity to heal. Eat a well-balanced diet and get some exercise each day, even if it’s only a walk around the neighborhood.
Treatment helps most women feel better within six months, though it can take longer.
Postpartum depression is serious and not something you should attempt to treat without a doctor’s input.
Along with medical treatment, natural remedies such as exercise and getting the right amount of sleep can help improve symptoms. Massage, meditation, and other mindfulness practices may help you feel better. Maintain a diet high in nutrients, but low in processed foods. If you’re not getting the nutrients you need in your diet, ask your doctor to recommend the right dietary supplements.
Herbal remedies may be appealing. However, the U.S. Food and Drug Administration (FDA) doesn’t regulate dietary supplements in the same way they regulate medications. The agency monitors supplements for safety, but it doesn’t evaluate the validity of health claims.
Also, natural supplements can still interact with medications and cause problems. Tell your doctor or pharmacist about all the supplements you take and in what amounts, even if they seem harmless. Many things you ingest can end up in your breast milk, which is another reason to keep your doctor informed.
St. John’s wort is an herb some people use to treat depression. According to March of Dimes, there’s simply not enough research to know if this supplement is safe for treating postpartum depression.
There’s some evidence that a lack of omega-3 fatty acids may be associated with postpartum depression. However, there’s not enough research to know if taking omega-3 supplements would improve symptoms.
The exact cause isn’t clear, but there are some factors that may contribute to postpartum depression. Postpartum depression may be triggered by a combination of physical changes and emotional stressors.
One of the biggest physical changes after giving birth involves hormones. While you’re pregnant, your levels of estrogen and progesterone are higher than usual. Within hours of giving birth, hormone levels drop back to their previous state. This abrupt change may lead to depression.
Some other physical factors may include:
- low thyroid hormone levels
- sleep deprivation
- inadequate diet
- underlying medical conditions
- drug and alcohol misuse
You may be more likely to develop postpartum depression if you’ve had a mood disorder in the past or if mood disorders run in your family.
Emotional stressors may include:
- recent divorce or death of a loved one
- you or your child having serious health problems
- social isolation
- financial burdens
lack of support
Depression vs. the blues
About 80 percent of mothers have the baby blues in the weeks following childbirth. In contrast, a large-scale 2013 study found that just 14 percent of mothers screened positive for depression. Of those women, 19.3 percent thought about harming themselves and 22.6 percent had previously undiagnosed bipolar disorder.
The study found that women who had depression were more likely to be:
- less educated
- publicly insured
The study authors also found by conducting home visits or phone interviews with 973 women that:
- 26.5 percent had onset of depression before pregnancy
- 33.4 percent started having symptoms during pregnancy
- 40.1 percent noticed symptoms after childbirth
According to the nonprofit Postpartum Progress, only about 15 percent of women with postpartum depression get professional help. In addition, these figures represent only women who had live births. They don’t include postpartum depression in women who miscarried or whose babies were stillborn. That means the actual incidence of postpartum depression might be higher than we think.
- Postpartum anxiety is common, affecting more than 1 in 6 women following childbirth. Among first-time mothers, the rate is 1 in 5.
- Suicide is said to be the reason for about 20 percent of postpartum deaths. It’s the second most common cause of death in postpartum women.
- Postpartum OCD is fairly rare. About 1 to 3 in 100 childbearing women are affected.
- Postpartum psychosis is rare, affecting 1 to 2 per 1,000 women after childbirth.
- It’s estimated that
up to 25 percentof fathers experience depression in the first year postpartum.
- Going beyond the first year postpartum, a
2010 studyfound that 39 percent of mothers and 21 percent of fathers had an episode of depression by the time their child was 12 years old.
First, consult with your OB-GYN to address your physical symptoms. If you’re interested, your doctor can refer you to a therapist or other local resources. Your local hospital is another good place to get referrals.
You might feel more comfortable reaching out to others who’ve been through the same thing. They understand what you’re feeling and can offer nonjudgmental support. Consider joining a group for new mothers. Some of them may also be living with depression, anxiety, or postpartum depression.
These organizations can help guide you to the appropriate resources:
- Postpartum Depression Support Groups in the U.S. and Canada: This is a comprehensive list of support groups around the United States (by state) and Canada.
- Postpartum Education for Parents at 805-564-3888: Trained volunteers answer the “warmline” 24/7 to provide support.
- Postpartum Progress: This organization has information and support for pregnant women and new moms who have postpartum depression and anxiety.
- Postpartum Support International at 800-944-4PPD (800-944-4773): This resource offers education, online support, and information about local resources.
If you don’t like one support system, it’s okay to try another. Keep trying until you find the help you need.
After you consult with your doctor, there are a few other things you can do to deal with postpartum depression.
You may be tempted to keep your feelings to yourself, especially if you’re a naturally reserved person. But it might be helpful to talk things over with someone you trust. You may find out that you’re not alone and that others are willing to listen.
2. Fight isolation
Remaining in seclusion with your feelings can feed into depression. It’s not necessary to have a whirlwind social life, but do try to maintain your closest relationships. It can help you feel connected.
If you’re comfortable in a group setting, you can join a depression support group or a group specifically for new moms. If you’ve stopped participating in previously enjoyable group activities, try them again to see if it helps. Being in a group can help you focus on other things and relieve stress.
3. Cut back on chores
If you’re not up to chores and errands, let them go. Use your energy to take care of basic needs for you and your baby. If at all possible, enlist the help of family and friends.
4. Rest and relax
Both your body and your spirit need a good night’s sleep. If your baby doesn’t sleep for long periods, get someone to take a shift so you can sleep. If you have trouble drifting off, try a hot bath, a good book, or whatever helps you relax. Meditation and massage may help ease tension and help you fall asleep.
Selective serotonin reuptake inhibitors
Paroxetine (Paxil), fluoxetine (Prozac), and sertraline (Zoloft) are selective serotonin reuptake inhibitors (SSRIs). They’re the most commonly used antidepressants. These drugs affect serotonin, a chemical in the brain that regulates mood. They generally have fewer side effects than other antidepressants.
These newer antidepressants also target several neurotransmitters in the brain. Duloxetine (Cymbalta) and venlafaxine (Effexor) are examples of atypical antidepressants.
Tricyclic antidepressants and monoamine oxidase inhibitors
These older antidepressants affect neurotransmitters in the brain. They tend to produce side effects and are not usually prescribed unless all other options haven’t worked.
Antidepressant side effects and considerations
All antidepressants can cause side effects, such as:
- dry mouth
- weight gain
- decreased sex drive
Antidepressants often take several weeks to start working, so patience is required. They must be taken exactly as prescribed, without skipping doses. You’ll start with the smallest dose, but your doctor can increase the dosage a little at a time if it’s not working. It may take some trial and error to find the best medication and the right dosage for you. While taking antidepressants, you’ll need to see your doctor regularly.
If you’re taking a high dose or take antidepressants for a long time, you may have to taper off when you’re ready to stop. Stopping suddenly can increase side effects.
Hormone therapy may be an option if your estrogen levels are down. Side effects of hormone therapy may include:
- weight changes
- breast pain or tenderness
- nausea and vomiting
Hormone therapy can also increase your risk of developing certain cancers.
Before taking any medication or hormone therapy, tell your doctor if you’re breastfeeding. Some of these medications can be passed to your baby through breast milk.
Without treatment, postpartum depression can get progressively worse. It’s most dangerous when it leads to thoughts of harming yourself or others. Once these thoughts begin to occur, medical intervention is necessary.
Signs of severe postpartum depression include:
- hallucinations, or seeing, hearing, smelling, or feeling things that aren’t really there
- delusions, or having irrational beliefs, placing too much importance on insignificant things, or feeling persecuted
- disorientation, confusion, and talking nonsense
- strange or erratic behavior
- rage or violent actions
- suicidal thoughts or attempted suicide
- thoughts of harming your baby
These are all signs that you need emergency medical treatment. Hospitalization may be necessary. Severe postpartum depression may be life-threatening, but it can be treated successfully.
Any new mother can develop postpartum depression regardless of age, ethnicity, or how many children she has.
These things might increase your risk:
- previous depression or other mood disorder
- family history of depression
- serious health problems
- recent stress, such as a divorce, death, or serious illness of a loved one
- unwanted or difficult pregnancy
- having twins, triplets, or other multiples
- having your baby born prematurely or with health problems
- being in an abusive relationship
- isolation or lack of emotional support
- poor diet
- drug or alcohol misuse
- sleep deprivation and exhaustion
If you have some of these risk factors, talk to your doctor as soon as you notice symptoms. Postpartum depression can increase your risk of substance abuse or of harming yourself or your baby.
Absolute prevention isn’t really possible. Still, some factors can make you more prone to postpartum depression, so you may be able to do a few things to reduce your risk.
Firstly, be proactive. During pregnancy, tell your doctor if:
- you’ve had a previous episode of postpartum depression
- you’ve ever had major depression or another mood disorder
- you currently have symptoms of depression
Your doctor may be able to prescribe the appropriate therapy and make recommendations in advance.
You may also be able to reduce your chances of developing postpartum depression by following these tips:
- Get your support system in place before your baby is born.
- Make an action plan and write it down. Include contact information for your doctor, local support services, and a family member or friend you can confide in.
- Have an arrangement for childcare in place so you can take a break. If symptoms appear, you’ll know exactly what to do.
- Maintain a healthy diet and try to get some exercise every day.
- Don’t withdraw from activities you enjoy and try to get plenty of sleep.
- Keep the lines of communication open with loved ones.
A new baby in the house changes family dynamics and alters sleep patterns. You don’t have to be perfect, so go easy on yourself. Report symptoms to your doctor right away. Early treatment can help you recover faster.
The most severe form of postpartum depression is postpartum psychosis. Postpartum psychosis is a rare occurrence. When it does happen, it’s usually within the first few weeks after delivery. Psychosis is more likely if you have a history of mood disorders.
Psychosis means you’re no longer grounded in reality. Postpartum psychosis is rare. When it does happen, it’s usually within the first few weeks after you’ve given birth. Often, postpartum psychosis is associated with bipolar illness.
The earliest symptoms are restlessness, irritability, and insomnia. These could easily be overlooked as baby blues or even sleep deprivation.
Hallucinations and delusions are also common symptoms that include seeing, hearing, smelling, and feeling things that seem real, but aren’t. For example, you could hear a voice telling you to harm your baby or feel that your skin is crawling with bugs.
Delusions are irrational or grandiose ideas or feelings of persecution despite evidence to the contrary. For example, you may believe people are plotting against you. Delusions can also revolve around your baby.
Other symptoms include:
- nonsensical chatter, confusion, and disorientation
- feelings of rage for no apparent reason
- erratic or violent behavior, such as throwing things, breaking things, and lashing out at people around you
- rapidly shifting moods
- preoccupation with death that might include suicidal thoughts or suicide attempt
- intrusive thoughts about your baby, such as blaming your baby for the way you feel or wishing they would go away
Postpartum psychosis is a severe, life-threatening emergency. The risk of hurting yourself or your baby is real. If you or someone close to you exhibits these symptoms after giving birth, seek immediate medical attention. Postpartum psychosis is treatable. It usually requires hospitalization and antipsychotic medication.
Several medications are used to treat psychosis. They may be used alone or in combination and include:
- mood stabilizers
These medications can help control your symptoms and keep you stabilized. If they don’t, another option is electroconvulsive therapy (ECT). ECT uses electrical currents to trigger chemical changes in the brain. It’s usually well-tolerated and can be effective in treating postpartum psychosis.
Once you’re stabilized, your doctors may recommend that you consult with a therapist who can help you work through your feelings.
Treatment should continue even after you’ve been discharged from the hospital. As you recover, your medications may need some adjusting.
If you also have bipolar or another mental health disorder, you’ll need to continue to follow your treatment plan for that health issue as well.
Postpartum depression gets more attention, but postpartum anxiety is more common. It affects more than 1 in 6 women after childbirth.
It’s normal to feel a little stressed or worried when you bring a new baby into your home. Sometimes, those feelings cause anxiety that interferes with everyday life.
Common symptoms include episodes of hyperventilation and panic attacks. Hyperventilation occurs when you breathe so quickly and deeply that you run low on carbon dioxide. This can leave you feeling as though you can’t catch your breath.
Panic attacks can mimic symptoms of a heart attack. The symptoms include:
- pounding heartbeat
- chest pain
- shortness of breath
Other symptoms of postpartum anxiety include:
- excessive worry, even about inconsequential matters
- being unable to sleep because of worry
- running the same problems over in your mind, even though they’ve been solved or aren’t important
- poor concentration due to worry
- overprotecting your baby due to constant worry about what could go wrong
- worrying about or imagining you have various illnesses
You can have anxiety and depression together, making it difficult to figure out what’s going on without a doctor’s help.
While postpartum anxiety may go away on its own, it could also worsen. It’s a good idea to talk to your doctor. Anxiety can be treated with antianxiety medications and therapy.
You likely want to raise your baby in a healthy environment, and you might feel pressure to have everything perfect. Those aren’t unusual thoughts for a new mom. But the pressure can sometimes blossom into obsessive-compulsive disorder (OCD).
Postpartum OCD isn’t very common. About 1 to 3 percent of childbearing women develop OCD. It usually starts within a week of delivery.
Obsessions could be about anything, but they’re likely to focus on the baby’s safety. For example, you might worry about your baby dying during the night or that you’ll drop them.
If you have postpartum OCD, you might engage in ritualistic behaviors related to those thoughts. These are a few examples:
- repetitive organizing, cleaning, and obsessing over germs that may come in contact with your baby
- repeatedly checking on your baby during the night, even though you did so recently
- mental compulsions, such as constantly praying for your baby’s safety
- rituals such as counting or touching something a certain way, thinking it will prevent bad things from happening
- spending a lot of time researching your or your baby’s health
You may not be able to control these behaviors. If you have symptoms of postpartum OCD that don’t go away within a few weeks, see your doctor.
Postpartum OCD can be treated with therapy alone or with antidepressant medication.
It’s not uncommon for new fathers to have the blues on occasion. As with new mothers, these feelings are normal in men and tend to fade away as everyone makes the transition.
Men can also develop a type of postpartum depression, called paternal postnatal depression.
Symptoms and prevalence
Symptoms of depression are similar in men and women, but they may come on more gradually in fathers. That can make them harder to recognize. New fathers also don’t have follow-up exams with doctors like new mothers do, so depression can go unnoticed. There’s also less information and fewer systems in place to help new fathers cope with these feelings.
Men are less likely to report symptoms of depression, but estimates say
There haven’t been many studies into the causes of postpartum depression in men. Researchers
Fathers may be at higher risk of postpartum depression if their partner has depression.
Another risk factor is having previous depression or other mood disorder. If that’s the case, you should talk to your doctor before the baby is born. Mention any signs of depression, however small.
Fathers should also try to get a support system in place. This could involve arranging for childcare, joining a depression support group, or spending time out with friends.
Like new mothers, new fathers need to maintain a nutritious diet, exercise daily, and get plenty of rest. If your symptoms of depression don’t clear up or are severe, you should see your doctor for a proper diagnosis.
Depression can be treated with antidepressant medications, either alone or with therapy. In cases where both parents show signs of depression, couples counseling or family counseling may be good options.