An Overview of Postpartum Depression

Woman laying on sofa with crying baby
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Postpartum depression (PDD) involves depression that occurs following childbirth. It is characterized by symptoms that include sadness, irritability, difficulty bonding with the baby, insomnia, and loss of appetite. While it can be very serious, it is common and treatable.

There are different types of postpartum depression that run on a spectrum of severity, ranging from mild baby blues to postpartum major depression to postpartum psychosis.

Baby Blues

When we talk about "baby blues" we mean a short-term, milder type of postpartum depression.

The baby blues are experienced by 30—80% of all new mothers. Symptoms often begin within three to ten days of delivery and are usually gone by two to three weeks postpartum.

Symptoms 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. Fortunately, the symptoms are usually short-lived.

Postpartum Major Depression

In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the designation for postpartum major depression is a "major depressive episode with a peripartum-onset specifier." This is experienced by about 10 percent of women who have given birth, and it tends to develop within four weeks after delivery.

Some feel the criteria to qualify for postpartum-onset should extend longer, perhaps up to six months.

The symptoms are the same as for a major depressive episode and may include:

  • Depressed mood, loss of interest or pleasure
  • Change in weight or appetite
  • Insomnia or hypersomnia
  • Psychomotor retardation or agitation
  • Loss of energy or fatigue
  • Worthlessness or guilt
  • Crying
  • Problems with concentration
  • Difficulty making decisions
  • Feelings of inadequacy (longer lasting that with the baby blues)
  • Sadness

Some women also experience suicidal thoughts.

Postpartum Psychosis

Sometimes called puerperal psychosis, this type of postpartum condition will develop in around one to two in 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 which aren't actually true) and/or hallucinations (hearing things or seeing things which 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 you find it difficult to care for your baby or seem to be unable to eat or sleep. Some women find themselves afraid that they will harm their baby.

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

Causes

Nobody is exactly certain why women experience baby blues and sometimes depression after the birth of a child. Vulnerability to the hormonal shifts that occur around pregnancy is often implicated. 

There are some factors that have been implicated in the development of depressive symptoms after giving birth.

  • Physical factors: In addition to the abrupt hormonal changes in estrogen and progesterone levels that take place within hours of giving birth, other physical factors are also thought to contribute to postpartum depression. Lack of adequate sleep, poor diet and nutrition, changes in thyroid levels, and other medical issues can also play a role.
  • Stress: The emotional changes that take place after having a child can also factor in the onset of postpartum depression. Caring for a child, lack of social support, social isolation, relationship stress, and financial concerns can all create considerable stress for new mothers.

Whatever the cause, however, we know these disorders not only reduce your quality of life but can be very serious if not life-threatening. If you are wondering at all whether you might be experiencing postpartum depression or postpartum anxiety, make an appointment to talk with your obstetrician right away. Treatments are available which are very effective.

Women who have had postpartum psychosis after the birth of one child are at risk of experiencing psychosis again with subsequent pregnancies.

Diagnosis

If you are having symptoms of postpartum depression, you should see your healthcare provider immediately. Only your doctor can diagnose postpartum depression. Your symptoms will be evaluated and your doctor will determine if you are experiencing depression or something else.

During your evaluation:

  • You will likely complete a depression screening questionnaire
  • Discuss the of symptoms you've been having, including the duration and severity
  • Have blood tests to check your thyroid function

One difficulty is that people often do not 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 depression after giving birth is very common, so you should not be afraid to talk to someone if you are feeling stressed, sad, irritable, or depressed.

How Common Is Postpartum Depression?

CDC research has found that one in nine women experience postpartum depression symptoms. Some research has shown that around 10% of men may experience depression following the birth of a child.

Treatment

If you believe you may have postpartum depression, it's important to see your doctor right away. It's extremely important to get professional help, even if you aren't sure whether you are depressed or just coping with prolonged baby blues. Sadly, only 15 percent of women with postpartum depression receive treatment, and treatment can make a big difference in both your quality of life and that of your baby.

Treatments for postpartum depression depend on the symptoms, diagnosis, and severity of the condition. For milder cases of the baby blues, self-care and social support are often sufficient to help women return to normal functioning.

Even if you feel like you are just experiencing a mild case of the baby blues, mention your symptoms to your doctor who 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 worse or if they seem to be lasting longer than you expect, talk to your doctor about your treatment options.

Treatment for postpartum major depression may include medications, psychotherapy, support groups, and more.

Therapy

Psychotherapy involves talking to a mental health professional (often a psychologist, counselor, psychiatrist, or social worker. This treatment often involves developing new coping skills that can help people to better manage their symptoms.

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

Medications often involve the use of antidepressants, which work by altering the brain chemicals that are involved in the regulation of mood. Antidepressants often take a few weeks to be effective. Your doctor will help determine which type of medication and dosage are right for you.

One newer option is Zulresso, which in 2019 became the first drug to be approved by the FDA specifically to treat postpartum depression.

Postpartum Psychosis Treatment

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

Coping

The time shortly after birth is also a let-down period for many women following almost 10 months of pregnancy. Fortunately, there are some things that you can do to make managing this transition a bit easier.

  • Accept help from others
  • Talk to other women who have "been there"
  • Get out of the house for a change of scenery
  • Ask for help if you are struggling
  • Get someone to watch the baby while you take a break
  • Try to get plenty of sleep
  • Strive to stick to a healthy diet
  • Join a social group for new moms to maintain social connections

Self-care and lifestyle changes can also be an important complement to other treatments. Several studies have found that exercise can reduce the symptoms of postpartum depression.

If you need extra help coping, you can reach out to the 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 is experiencing signs of depression, talk to them about reaching out to their doctor for help. If someone is showing signs of delusions or hallucinations postpartum, seek medical attention immediately.

Many resources, including the 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.

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