Postpartum Depression Overview

Postpartum depression is not just the "baby blues." Many women feel overwhelmed, teary, or moody in the days and weeks after having a baby, but postpartum depression is a more serious condition that can last for months. If you feel hopeless or filled with anxiety, treatment can help.

What Is It?

Pregnancy, childbirth, and bringing home a new baby brings about huge physical, mental, and lifestyle changes that can rock your world. While this adjustment can be tough for many people, postpartum depression (PPD) is a mental illness that occurs after having a baby. Postpartum depression may also be called peripartum depression, which includes the time during pregnancy and postpartum.

PPD is common, with as many as 1 in 8 women experiencing the condition. People who have PPD experience symptoms of depression, like sadness, emptiness, or withdrawal, for longer than two weeks. These feelings can be really common when adjusting to a new life with a baby or expanding your family. However, when sadness or anxiety gets in the way of your ability to care for yourself or your baby or you struggle to function or complete day-to-day tasks, you may have PPD.

The condition often develops within a few weeks of giving birth. However, PPD can also make itself known later. Some people develop PPD up to a year postpartum.

Types

There are three main types of postpartum depression:

Postpartum Blues

No matter how much you love your baby and are excited that they're here, 50% to 85% of women experience the baby blues. The "baby blues" often appear within a few days after giving birth, which happens to coincide with the time that baby usually comes home from the hospital. These feelings of depression, anxiety, or anger typically persist for one to two weeks and then gradually go away.

Postpartum Depression

You can think of PPD as a step beyond the baby blues when symptoms of depression or anxiety linger for longer than two weeks. This is considered a serious condition, and it can be treated with psychotherapy or medication.

Postpartum Psychosis

Psychosis is a severe form of PPD that affects one or two women per 1,000 women after giving birth. This psychiatric illness poses a danger to both mom and baby, as women report hearing voices, hallucinations, and a desire to harm themselves or their infant. It is considered a medical emergency.

Symptoms

Not everyone who has PPD feels the same. But it's important to know that if you recently had a baby and feel that at least a few of the following symptoms of postpartum depression can describe you, you should not feel ashamed or guilty, and it does not make you a "bad mom," as there are so many people who have similar struggles. There is help, but first, you'll want to identify if any of the symptoms on this list ring true to you:

• Feeling sad.
• A low or depressed mood.
• Frequent crying.
• Being more angry than usual.
• Withdrawing.
• Worrying that you are able to care for your baby.
• Changes in appetite.
• Not enjoying activities that you once loved.
• Fatigue.
• Changes in energy levels, from an inability to sit still to extremely slow movements.
• Feelings of guilt.
• Having trouble thinking.
• Feeling worthless.
• Lack of interest in the baby.
• Feeling disconnected from baby.
• Fear that you will harm yourself or the baby.
• Anxiety and worry.

Causes

Hormonal Changes

One of the big factors behind PPD is the abrupt swings in hormone levels after birth. While levels of hormones like estrogen and progesterone rise during pregnancy, they then plummet back down to pre-pregnancy levels hours after giving birth. That severe swing may be the catalyst for depression.

Other Medical Conditions

Thyroid function is essential for your mood, energy levels, appetite, and more. Birth can affect your thyroid levels and contribute to symptoms of depression.

Lifestyle Factors

The stress of having a baby and the abrupt change to your life, routine, and relationship with your partner can have a profound effect on your mental health. Lack of sleep—common with a newborn at home—can also play a big role in your mood.

Birth Story

While women who had a healthy pregnancy and delivery can still develop PPD, the condition may also occur following birth trauma, complications, or if the baby has to spend time in the NICU following birth.

In addition, there are certain risk factors that might make you more prone to developing postpartum depression:

• Experiencing stressful life events (e.g. death of a loved one, moving, job loss)
• A lack of social support.
• Having an unwanted pregnancy.
• Marital problems.
• A personal or family history of depression.
• Difficulties becoming pregnant.
• Giving birth to multiples.
• Having pregnancy complications.
• Having a traumatic birth.

Diagnosis

The first step in diagnosis is to talk to your healthcare provider right away. At the postpartum visit, and possibly a baby's first checkups, your ob/GYN or pediatrician may ask you to complete a screening form to evaluate you for PPD. This screening questionnaire is called the Edinburgh Postnatal Depression Scale, which is a compilation of 10 questions about your mood, anxiety, and enjoyment of typical activities.

However, if you feel as if you're struggling, your symptoms have persisted for more than two weeks, or you struggle with day-to-day tasks, you should reach out to a trusted healthcare professional for help rather than waiting for your doctor to ask you about it. At your appointment, your doctor will talk to you about how you've been feeling, and they may also order other tests to look for an underlying medical condition that can affect mood, like a thyroid disorder.

Treatment

There are several ways postpartum depression is treated. Through a conversation with your doctor, you can determine what the right treatment plan is for you, possibly including:

Medication

Prescription antidepressants, such as SSRIs or SNRIs, can be used to balance the neurotransmitters in your brain, which are chemicals that play a role in mood regulation. If you choose to breastfeed, small amounts of these medications may pass into breastmilk. Your doctor can help advise you on breastfeeding while taking antidepressants.

Talk Therapy

Connecting with a counselor is not only useful for discussing your feelings, but a mental health professional can also give you useable strategies to help you cope with sadness and anxiety, as well as suggest lifestyle habits that may help lift your mood. Talk therapy can be done one-on-one or via a support group.

Prevention

Being aware of risk factors for postpartum depression—particularly if you have a personal or family history of depression—can help you prepare and organize the support and resources that you may need in your postpartum journey.

While a history of depression does not mean you will experience PPD, you can make a pre-birth plan, such as organizing help from loved ones, determining a therapy schedule, or regular check-ins if you are already in contact with a counselor.

In addition, during pregnancy and in the postpartum period, it's important to prioritize what you need, such as exercise, sleep, and time for daily hygiene. This can be difficult when you have a baby to look after, but your partner, friends, and family can help give you the support and opportunity to care for yourself. Staying connected with loved ones can also positively affect your mental health.

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