Postpartum depression affects women after childbirth, typically within the first year. Mild and major depression is estimated to affect more than 19% of women in the first few months after childbirth. Some women experience depressive symptoms during pregnancy, a condition known as antenatal depression. Symptoms of depression often go unrecognized, though, because women experience dramatic shifts in hormones during pregnancy and postpartum. Most new moms are likely to show signs of fatigue, for example, along with changes in appetite and sleep patterns, as they adjust to caring for a new baby. The full set of depressive conditions and mood issues that can occur around a pregnancy are collectively known as perinatal depression or perinatal mood disorders.
The baby blues describe a temporary change in mood that affects up to 70% of new moms in the first week or two postpartum. Many new moms feel hypersensitive, anxious, emotional, irritable, and may have difficulty sleeping or experiencing elation. These symptoms tend to dissipate within several days and generally do not significantly interfere with functioning. When symptoms persist or worsen, postpartum depression may be indicated.
All big changes in life require a period of adjustment during which people may intermittently feel frazzled or anxious, and perhaps elated, particularly when the change is a good one. New parents who find their former routines and sleep patterns disrupted by meeting the needs of their new baby may feel increasingly stressed and irritable. Changes in mood and feelings of anxiety are common after childbirth, but when symptoms persist for more than two weeks, or become more severe, affecting a person’s ability to cope with everyday stressors and responsibilities, it may be time to consult a medical or mental health professional to be evaluated for postpartum depression and discuss possible treatment options.
Symptoms of postpartum depression can include:
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- Feelings of hopelessness
- Difficulty falling asleep or staying asleep
- Feelings of hostility, including thoughts of harming the baby
- Difficulty focusing or making decisions
- Obsessive-compulsive behaviors
- Poor coordination
- Difficulty caring for self or baby
The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) specifies that symptoms must appear within the first four weeks following childbirth, but many women will attest that symptoms may not fully manifest until much later. Popular wisdom suggests that postpartum depression may occur anytime within the first year following childbirth and that symptoms persist for at least two weeks.
The causes of postpartum depression can be difficult to pinpoint, as many variables come into play, and each woman faces a different set of circumstances. Women with a history of depression are more likely to experience postpartum depression, for example, though for some women, postpartum depression is the only depressive episode they will ever experience.
There are a number of risk factors for developing postpartum depression, including:
- A personal or family history of depression
- Having experienced prenatal or postpartum depression in the past
- Childhoood trauma
- Thyroid problems
- Young age
- Previous problems with a pregnancy, such as a miscarriage or a traumatic birth
- Negative feelings, anxiety, or ambivalence about the pregnancy
- Isolation or lack of social support
- Relationship problems
- A recent stressful event, such as a big move, loss of a loved one, or a loss of income or other financial issue
Hormones certainly play a part as well. Women experience a surge in estrogen during pregnancy, and those levels drop rapidly in the hours after giving birth. In general, women are at greater risk of depression at certain times in their lives, such as during puberty, during and after pregnancy, and during perimenopause. Some women also have depressive symptoms right before their period.
Postpartum depression can sometimes be so severe as to lead to a break with reality. Termed postpartum psychosis, the condition is rare, occurring in about 1 or 2 of every 1,000 births. It usually begins in the first two weeks after childbirth. Women who have schizophrenia, bipolar, or a history of psychotic episodes have a higher risk for experiencing postpartum psychosis.
Symptoms of psychosis may include:
- Experiencing rapid mood swings throughout the course of the day
- Delusions or hallucinations
- Paranoid thoughts, particularly with regard to the baby’s well-being
- Feelings of confusion
- Aggressive thoughts about hurting oneself or the baby
- Erratic or dangerous behavior
When these symptoms are present, both mother and baby may be in danger and professional help or emergency services should be contacted immediately. Although the condition is temporary and treatable, psychosis is a serious condition that can lead people to act in ways they would not ordinarily.
Depressive symptoms affect a large number of women during pregnancy, too. This is known as prenatal or antenatal depression. Symptoms are much like other depressive episodes, though any fears are likely to be associated with the birth process. As with postpartum depression, symptoms can be difficult to distinguish from the typical changes in appetite, mood, and sleep patterns that are associated with pregnancy. Antenatal depression is determined by looking at symptom severity and duration. Women experiencing persistent anxiety and depressive symptoms are encouraged to seek professional help for the safety and well-being of both mother and baby.
Perinatal depression is difficult to treat without professional help, but there are several self-care strategies that women can employ in an effort to avoid the onset of symptoms, or to help facilitate recovery. Self-care strategies that may help alleviate unwanted symptoms of postpartum depression include:
- Eat a healthy diet and avoid alcohol
- Try to catch up on sleep, perhaps in the middle of the day while the baby sleeps
- Make time for yourself
- Seek out social support and talk about your feelings with other moms, friends, and loved ones
- Find ways to get some exercise daily
Women who experience postpartum depression may be reluctant to seek help due to the social stigma associated with having a mental health condition, feelings of failure, or fear that the baby will be taken from them. They may also feel subject to the cultural belief that the experience of motherhood should bring only joy and fulfillment. Admitting that being a new mom is an emotional and a challenging transition may make women feel they have failed in this endeavor. Talking about ones’ symptoms, though, is an important step toward finding relief.
Qualified therapists can help women sort out the painful emotions and family experience of perinatal depression in several ways, including:
- Helping women understand perinatal depression
- Discussing coping mechanisms for the demands of motherhood
- Empowering new moms to re-frame negative thought processes
- Examining any issues other than new motherhood—such as childhood trauma, pre-existing mental health concerns, or job stress—that are contributing to the depression
- Helping women develop social support systems
- Addressing anxiety and developing coping skills
- Establishing healthy lifestyle habits—such as regular sleep—and developing the support structure necessary to create these habits
Antidepressant medications can be highly effective in treating postpartum depression. However, nursing mothers may be concerned about taking these medications, and medication is typically more effective when combined with therapy.
- Feeling alone and overwhelmed as a new mom: June, 27, comes for therapy accompanied by her husband. They recently had their first child together, and since the second week, June has been overwhelmed by sadness, even crying anytime the baby wants to feed, and once becoming enraged at the baby’s crying to the point that her husband took the baby in another room. June is mortified, ashamed, and afraid. The therapist normalizes these feelings, and explains what postpartum depression is. The therapist takes a history and finds out some important information: The birth was difficult, and June felt very anxious and alone in the hospital. She did not like her doctor. She believes her mother disapproves of her husband and her parenting values. Her husband recently got a promotion and cannot help much at home, and she harbors some resentment toward him for this. Talking about all this helps, and the therapist builds on this small bit of progress by suggesting some self-care and coping skills. June’s husband also agrees to take some time off work to help out, and June is referred to a support group for new mothers.
- Ali, N. S., Azam, I. S., Ali, B. S., Tabbusum, G., & Moin, S. S. (2012). Frequency and Associated Factors for Anxiety and Depression in Pregnant Women: A Hospital-Based Cross-Sectional Study. The Scientific World Journal, 2012, 653098. doi:10.1100/2012/653098
- Kettunen, P., Koistinen, E., & Hintikka, J. (2014). Is postpartum depression a homogenous disorder: Time of onset, severity, symptoms and hopelessness in relation to the course of depression. BMC Pregnancy and Childbirth, 14doi:http://dx.doi.org/10.1186/s12884-014-0402-2
- Postpartum depression. (n.d.) Retrieved from http://www.mayoclinic.org/diseases-conditions/postpartum-depression/basics/definition/con-20029130
- Postpartum depression and the baby blues. (n.d.). Help Guide. Retrieved from http://www.helpguide.org/mental/postpartum_depression.htm