Postpartum depression (PPD), “postpartum” meaning “after pregnancy,” is a serious mental health concern that most often affects mothers within the first year after the baby’s birth. Though it most often affects the parent who has given birth, it can affect any new parent. PPD is common: Between 10% and 20% of new mothers experience it.
This mental health concern is one of a group of mood issues that occur around the time of childbirth. This group is referred to as perinatal mood disorders. Other mood issues included in this group include postpartum anxiety, postpartum psychosis, and antenatal depression, or depression during pregnancy.
It’s normal to feel fatigued, stressed, or anxious after having a child. It’s also common to worry about being a good parent or making the right choices for the baby and the family. New parents often experience tearfulness, a low mood, fatigue, and other symptoms for two or three weeks after childbirth.
But if feelings of sadness, hopelessness, or excessive worry persist, or if you have thoughts about harming yourself or your baby, you may have postpartum depression. It’s important to reach out for help. Your doctor can help you find a therapist or counselor who can offer support and treatment.
It’s especially important to seek emergency help right away if you have delusions or hallucinations, paranoid thoughts, confusion, or persistent thoughts of hurting yourself or your baby. These signs can indicate postpartum psychosis, a rare but serious issue.
Postpartum depression is real, and it is treatable. But it’s important to reach out for help.
Myths about postpartum depression can make it harder to recognize the condition. People who have heard myths about PPD may believe them and be less likely to seek help.
Here are some important facts about PPD:
- Mood swings after childbirth are normal and often go away after a week or two. Clinical depression is not typical, and it may not go away without treatment.
- PPD is not the same as “baby blues.” About 80% of women experience baby blues after childbirth. Baby blues are characterized by mild to moderate feelings of tiredness, stress, sadness, weepiness, or loneliness. These symptoms usually go away on their own after about two weeks.
- PPD often develops in the first six months after childbirth, but it develops even later in some people. In most cases, symptoms of PPD appear in the first year after childbirth.
- PPD can affect any new parent, whether they are an adoptive or biological parent. Fathers can also experience PPD—it can affect any person of any age or background.
- Disturbing thoughts about bad things happening to the baby are common with PPD. Having these thoughts does not mean a parent will harm their baby.
- Symptoms of PPD vary widely. Feeling sad or tearful can indicate PPD, but feelings of anxiety, disconnect, anger, sadness, or worthlessness are also common.
Without treatment, postpartum depression can last a long time. It may not go away for weeks, months, or even years. During this time, symptoms might remain the same, but they could also change or become more severe.
With treatment, full recovery from PPD is likely. The length of time it takes to recover can depend on how long PPD went untreated, how serious depression symptoms were, and the type of treatment, among other things. Some depression is treatment resistant, and the best treatment differs for each person.
For example, some people may recover simply through getting more support and practicing meditation and relaxation daily. Some might need several sessions of therapy before they see improvement. Others might not improve without a combination of therapy and antidepressants.
PPD affects not only the health of the parent who has it, but also their relationship with their partner and other children. Parents with PPD may find it difficult to care for their baby or connect with their baby. This can have a lifelong impact on the child’s behavior and health.
With treatment, PPD usually begins to improve. Counseling is a recommended treatment for PPD. Some people feel better right away after talking to a counselor. Some people feel better after a few sessions.
If symptoms of depression persist, medication may be recommended. It can take a few weeks for medications to be fully effective, but some people see improvement within a few days.
According to the American Psychological Association, about one in seven women will experience postpartum depression. About 600,000 women are diagnosed with PPD each year. But this count only includes live births. When the count includes those who have had a stillbirth or miscarriage, it increases to almost 900,000 diagnoses each year.
- In new mothers, rates of clinical postpartum depression are as high as 20%.
- About 8% of adoptive parents experience severe PPD.
- Because statistics tend to rely on self-reporting, the actual rate of people who have PPD may be much higher.
- People who have depression, anxiety, or other mood-related mental health concerns are up to 35% more likely to experience PPD.
- A person who has previously had PPD is anywhere from 10% to 50% more likely to develop PPD with later births.
- People who live in poverty and/or who do not have access to quality health care are at a higher risk for PPD. A 2010 study found women who had four socioeconomic risk factors were 11 times more likely to develop PPD than women with none of the four risk factors. (The study emphasized the fact people of any socioeconomic status can develop PPD.)
Depression after childbirth affects people in different ways. Many people who have just had a baby feel tired, worried, anxious, or stressed. They might also experience mild feelings of depression. Sometimes these feelings go away on their own, without medical treatment. But sometimes they last for a long time.
Having a few symptoms of postpartum depression may mean it’s a good idea to talk to a trained health care professional, especially if symptoms affect day-to-day life or cause lasting distress. A good first step is talking to a doctor, but therapists and counselors are trained to help with depression. A doctor can provide a referral to a counselor.
Many different symptoms might indicate PPD. Here are some of the most common:
- Feelings of sadness, hopelessness, or emptiness
- Disinterest in hobbies or spending time with friends and family
- Sleep problems, including oversleeping or insomnia
- Moodiness, anger, or rage
- Feeling panicky, having panic attacks
- Feeling overly nervous, anxious, worried, or restless
- Head, stomach, or muscle pain
- Lack of appetite or increased appetite
- Memory and concentration issues
- Tearfulness, frequent crying
- Doubting ability to be a good parent
- Thoughts about self-harm or harming the baby
The cause of postpartum depression is not known. It’s believed the rapid decrease of estrogen and progesterone hormones after childbirth play a part. Lack of sleep and the emotional overwhelm that often accompanies becoming a parent can also contribute.
Some risk factors can make it more likely a person will develop depression during pregnancy or after childbirth. It’s important to talk to a doctor about risk factors and postpartum depression screening during pregnancy. Being screened for depression early on can help keep symptoms from becoming serious.
Risk factors for postpartum depression include:
- Family history of depression
- Personal history of depression, anxiety, or other mood issues
- A challenging baby or a baby with special needs
- Being a first-time mother
- Stressful life events (other than childbirth) during pregnancy or after childbirth
- Little or no social support
- A traumatic or complicated childbirth
- An unwanted pregnancy or uncertain feelings about pregnancy or parenting
The most severe perinatal mood issue is postpartum psychosis. This condition is rare. It occurs in only one or two in every 1,000 women. It also usually occurs quickly, often as soon as 72 hours after childbirth, but most often within two weeks after childbirth.
Having bipolar or a family history of bipolar is the primary risk factor for postpartum psychosis. Women with bipolar are 40% more likely to experience psychosis after childbirth. Those who have had a psychotic episode in the past are also more at risk.
Symptoms of postpartum psychosis include:
- Hearing or seeing things that no one else can see (hallucinations)
- Restlessness, hyperactivity, insomnia
- Paranoid thoughts
- Mood swings
- Communication difficulties, confusion
Postpartum psychosis is said to resemble a manic episode. The condition is so dangerous because it can lead to a break with reality, which can lead to self-harm or harming the baby.
This condition is temporary, and it is treatable. Many people recover completely. But about 5% of postpartum psychosis cases end in suicide, and about 4% end in infanticide. So, postpartum psychosis is considered a medical emergency. Those who have any symptoms, particularly delusions or hallucinations, should see a doctor right away.
Another perinatal mood issue is prenatal (antenatal) depression, or depression during pregnancy. Between 15% and 24% of women will experience depression during pregnancy. People with prenatal depression may feel worried, anxious, stressed, or worthless. They might lose interest in the hobbies they typically enjoy, feel irritated or angry, have sleep issues, experience loss of energy, or feel more or less hungry than usual.
Some people are reluctant to discuss symptoms of depression during pregnancy with their health care provider, believing they should feel happy and excited rather than anxious, stressed, and depressed. Social or cultural factors can also make it difficult to talk about depression or seek help. Some people may believe their low mood is normal during pregnancy or due to hormone changes. But when symptoms cause distress, the health of both parent and baby can suffer. Depression during pregnancy has been linked to low birth weight and premature birth.
Because some symptoms of prenatal depression are similar to the changes that typically characterize pregnancy, it’s important to discuss emotional or mood changes with a doctor, even if they don’t ask. Therapy or counseling for prenatal depression can be helpful. It’s especially important to seek help if depressed feelings or a low mood occur at least every other day for more than two weeks.
Postpartum anxiety is another perinatal mood issue that people can experience after childbirth. This condition is common: One study looking at 1,024 women for three months after childbirth found it affected more than 11% of the women, while only 6% developed postpartum depression.
Postpartum anxiety often goes unrecognized, so it may be even more common than PPD. But it is not as well-known. People who are aware of the signs of PPD and experience symptoms that don’t match up to that condition may not realize what they are experiencing is a mental health issue that can improve with treatment.
Postpartum anxiety often begins during pregnancy, but it may be triggered after childbirth by stress or a difficult event. Risk factors include a history of anxiety or depression, eating disorders, obsessive compulsive disorder (OCD), or weepiness or agitation during PMS.
Signs of postpartum anxiety include:
- Worry, panic, or stress that interferes with everyday life
- Excessive energy or racing thoughts
- Disturbing or intrusive thoughts about bad things happening to the baby
- Changes in appetite
- Difficulty sleeping
- Difficulty concentrating, memory problems
Like postpartum depression, postpartum anxiety is treatable. It may not go away on its own, so it’s important to seek help. It’s also possible to have both PPD and postpartum anxiety, so it’s a good idea to bring up all symptoms, even if they don’t seem particularly distressing at the time. Treatment often includes cognitive behavioral therapy, mediation and relaxation exercises, mindfulness practices, and sometimes medication. Exercise is also often recommended.
Mothers (or the parent who gives birth) aren’t the only ones who can experience postpartum depression. Fathers (or the parent who did not give birth) may also experience what is known as paternal postpartum depression (PPPD). This condition affects about 10% of fathers worldwide. Risk factors include a history of depression, financial issues, lack of social support, relationship stress, fatigue, or traumatic childbirth experience. An important risk factor is whether the mother is also experiencing depression. Research suggests as many as half of all fathers with a partner who has PPD also have depression.
Some signs of postpartum depression in men include:
- Abuse of alcohol or drugs
- Anger, irritability, impulsivity, or violent behavior
- Head or stomach pain, digestive issues
- Loss of interest in work or hobbies
- Feelings of worthlessness
- Changes in temperament, personality, or behavior
- Thoughts of suicide
- Self-isolating from friends and family
PPPD can lead to relationship difficulties and make it hard to be present as a parent. Feelings of depression can also get worse and lead to thoughts of suicide or, in some cases, death. It’s important to seek help. Treatment options can include therapy, support groups, family or relationship counseling, and in some cases, antidepressants. PPPD is treatable, and most people feel better soon after beginning treatment.
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