What Is Postpartum Depression?

postpartum depression

Verywell / Alex Dos Diaz 

What Is Postpartum Depression?

Postpartum depression (PPD) is clinical depression that occurs following childbirth. It is characterized by symptoms that include sadness, irritability, difficulty bonding with your baby, insomnia, and loss of appetite. While it can be very serious, it is treatable and very common. In fact, the Centers for Disease Control Prevention report that approximately 1 in 8 women experience postpartum depression.

Symptoms

The symptoms of postpartum depression are similar to a major depressive episode. In the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5), the description of postpartum major depression is a "major depressive episode with a peripartum-onset specifier." Postpartum depression tends to develop within several weeks of delivery.

Some experts feel the criteria to qualify for postpartum-onset should extend longer, perhaps up to six months after childbirth. Symptoms of PPD may include the following:

  • Change in weight or appetite
  • Crying
  • Depressed mood, loss of interest or pleasure
  • Difficulty making decisions
  • Feelings of inadequacy
  • Feelings of worthlessness or guilt
  • Insomnia or hypersomnia
  • Loss of energy or fatigue
  • Problems with concentration
  • Restlessness or agitation
  • Sadness

Some women also experience suicidal thoughts.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

Diagnosis

If you're feeling overwhelmed by symptoms of postpartum depression, contact your healthcare provider immediately. Only your doctor or counselor can diagnose postpartum depression. Your doctor will evaluate your symptoms and determine if you are experiencing baby blues, depression, or something else—and create a plan for treatment.

During your evaluation, you will likely:

  • Complete a depression screening questionnaire
  • Discuss the symptoms you've been having, including the duration and severity
  • Have blood tests to check for medical abnormalities that might be contributing to your symptoms

The most common barrier to treatment for PPD is shame and silence. Women often don't talk about the depressive symptoms they are experiencing. Mental health stigma and the idea that new mothers should be overjoyed contribute to this hesitation.

What people should know is that adjusting to being a new mom is really hard—and depression after giving birth is very common. Effective treatment can make a world of difference. So, don't be afraid to talk to someone if you are feeling stressed, sad, irritable, overwhelmed, and/or depressed.

Postpartum Depression Guide

Get our printable guide to help you ask the right questions at your next doctor's appointment.

Mind Doc Guide

Impact on Men

Depression after becoming a parent doesn't just affect moms. In fact, some research has shown that around 10% of men may experience depression following the birth of a child.

Causes

Researchers are uncertain about exactly why postpartum depression occurs—and why it affects one person and not another. However, some potential causes that are believed to contribute to this mental health condition include:

  • Genetic factors
  • Lack of sleep
  • Low thyroid hormone levels
  • Rapidly changing hormonal levels following childbirth

Some of the risk factors that increase your chance of developing PPD are the following:

  • Diabetes (pre-existing or gestational diabetes)
  • Difficulty breastfeeding or caring for your baby
  • Health issues with your baby
  • Life stressors, such as unstable relationships, illness, or financial troubles
  • Limited support from family or friends
  • Negative feelings about being a mom
  • Past experience of depression or postpartum depression
  • Pregnancy complications, such as preterm birth, stillbirth, or birth defects

Types

Other postpartum mental health conditions related to PPD include postpartum psychosis and postpartum anxiety disorders.

Postpartum Psychosis

Sometimes called puerperal psychosis, this postpartum mental health condition develops in around 1 to 2 out of 1,000 women. Postpartum psychosis usually begins earlier than postpartum depression, within the first two weeks after giving birth.

Postpartum psychosis may be preceded by agitation, confusion, memory problems, irritability, worsening insomnia, and anxiety.

Postpartum psychosis is distinguished from postpartum depression by the presence of delusions (believing things that aren't actually true) and/or hallucinations (hearing things or seeing things that aren't there). Other symptoms can include intrusive thoughts and an inappropriate response to or disinterest in one's child.

Postpartum psychosis symptoms may change rapidly, with periods of elevated mood being quickly followed by profound sadness or rage. Periods of lucidity are common and not necessarily an indicator of recovery. It is thought that postpartum psychosis often represents an episode of bipolar illness.

Postpartum Anxiety Disorders

Anxiety disorders are also common following childbirth. You may find that you are so anxious that you find it difficult to care for your baby or yourself, such as being unable to eat or sleep. Some women find themselves afraid that they will harm their baby.

Specific anxiety disorders that may occur or be exacerbated postpartum include generalized anxiety disorder, obsessive-compulsive disorder, and panic attacks. In addition, anxiety is common in postpartum depression.

In fact, according to the Women's Preventive Services Initiative (WPSI), which is a national coalition of women's health professionals, anxiety is one of the most prevalent health disorders in the U.S. Impacting as many as 40% of women over the course of their lifetime, anxiety can be caused by a number of underlying issues, including the stresses of childbirth and becoming a mother.

Consequently, if you are experiencing signs of anxiety, talk to your healthcare professional. They can administer a quick questionnaire to assess your anxiety and make a referral for care as needed.

PPD vs. "Baby Blues"

When healthcare providers talk about "baby blues," they're referring to a short-term, milder version of postpartum depression. However, having baby blues does not meet the clinical criteria for PPD. Baby blues are commonly experienced by many women after childbirth as they adjust mentally and physically to the realities of parenthood.

Symptoms of baby blues include:

  • Anxiety
  • Crying
  • Insomnia
  • Tiredness
  • Moodiness
  • Sadness

During this time, women may suddenly feel like they can't possibly handle taking care of a baby no matter how prepared they are as mothers. Lack of sleep and the postpartum hormonal adjustment both contribute to the symptoms of baby blues. Fortunately, the experience of baby blues is usually short-lived (a week or two is a common duration) and resolves as mothers get used to being moms.

Treatment

If you suspect you may have postpartum depression, contact your doctor right away. It's extremely important to get professional help, even if you aren't sure whether you are depressed or coping with prolonged baby blues. Treatment can make a big difference in both your quality of life and the health of your baby, but many women with postpartum depression don't seek and receive treatment.

Care for postpartum depression depends on the symptoms, diagnosis, and severity of the condition. While self-care and social support are often sufficient to help women return to normal functioning if they have mild baby blues, true PPD usually needs formal treatment from an expert in postpartum depression to resolve.

Even if you feel like you are experiencing a mild case of the baby blues, tell your doctor about your symptoms so they can monitor your progress. Having support can ensure that you get treatment as soon as possible should your symptoms worsen. If you feel like your symptoms are getting more intense and/or are interfering with your life, seek care right away.

Treatment options may include medications, psychotherapy, support groups, and more. Enlisting the support of family and friends is crucial, as well, particularly for help with caring for your baby while you follow the treatment protocol prescribed by your doctor.

Therapy

Psychotherapy involves talking to a mental health professional such as a psychiatrist, psychologist, or social worker. This treatment often involves developing new coping skills that can help you better manage your symptoms. Therapy may also tackle any emotional issues that may be impacting your mental health.

Common types of psychotherapy that are used to treat postpartum depression include cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). CBT focuses on changing unhealthy thinking patterns and behaviors while IPT works to help people understand and change problematic relationships.

Medications

Medication treatment for postpartum depression often involves the use of antidepressants. Antidepressants can take a few weeks to be effective, and you may need to try out a few medications before finding one that helps you. Your doctor will determine which type of medication and dosage are right for you. If you're breastfeeding, your doctor will prescribe a medication that is safe for your baby.

In 2019, the medication Zulresso (brexanolone) became the first drug to be approved by the FDA specifically to treat postpartum depression. Other antidepressants are approved to treat depression generally.

Postpartum Psychosis Treatment

Treatment for postpartum psychosis may also include hospitalization, medications, electroconvulsive therapy (ECT), and assistance in caring for the baby. For women who experienced postpartum psychosis in the past, psychiatric treatment during and after subsequent pregnancies is usually recommended.

Coping

The time shortly after birth is also a recovery, readjustment, and let-down period for many women following months of pregnancy. Fortunately, there are some things that you can do to make managing this transition a bit easier:

  • Accept help from others.
  • Ask for help if you are struggling.
  • Don't blame yourself.
  • Eat a healthy diet.
  • Exercise.
  • Get out of the house for a change of scenery.
  • Get someone to watch the baby while you take a break.
  • Join a social group for new moms to maintain social connections.
  • Prioritize time for self-care.
  • Talk to other women who have "been there."
  • Try to get as much sleep as possible.

Self-care and lifestyle changes can also be important complements to other treatments. For example, make time for a baby-and-me yoga class, go for a long walk, take a bubble bath, get a massage, or book a haircut. Several studies have found that exercise can reduce the symptoms of postpartum depression.

If you need extra help coping, you can reach out to Postpartum Support International. They offer a free hotline, an online support group, free live phone sessions with an expert, and coordinators who can help connect you with providers in your community, 24 hours a day.

A Word From Verywell

Postpartum depression, anxiety, and psychosis are serious conditions and can come on very rapidly. If you or your loved one are experiencing signs of depression, know that it's no one's fault, and reaching out to a doctor or therapist can help. If someone is showing signs of delusions or hallucinations postpartum, seek medical attention immediately.

Many resources, including the Postpartum Support International hotline above, are available any time of day. Don't hesitate to talk to someone. Even if you think it's "just" the baby blues, a little extra support can go along way.

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Article Sources
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  1. Centers for Disease Control and Prevention. Depression among women. Reviewed May 14, 2020.

  2. March of Dimes. Postpartum depression. Reviewed March 2019.

  3. Paulson JF, Bazemore SD. Prenatal and postpartum depression in fathers and its association with maternal depression: A meta-analysis. JAMA. 2010;303(19):1961-9. doi:10.1001/jama.2010.605

  4. VanderKruik R, Barreix M, Chou D, et al. The global prevalence of postpartum psychosis: A systematic reviewBMC Psychiatry. 2017;17(1):272. doi:10.1186/s12888-017-1427-7

  5. Gregory KD, Chelmow D, Nelson HD, et al. Screening for anxiety in adolescent and adult women: A recommendation from the Women's Preventive Services Initiative. Ann Intern Med. 2020. doi:10.7326/M20-0580

  6. Povatos-Leon R, Garcia-Hermoso A, Sanabria-Martinez G, et al. Effects of exercise-based interventions on postpartum depression: A meta-analysis of randomized controlled trials. Birth. 2017;44(3):200-208. doi:10.1111/birt.12294

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