After having a baby, many women experience bouts of sadness or crying starting in the first several days after giving birth. If these feelings get worse or persist beyond two weeks, you may be experiencing signs of postpartum depression, a condition characterized by severe mood swings, hopelessness, and fatigue. Untreated postpartum depression can challenge your ability to tend to you and your baby’s needs, but with the help of your doctor, you can find a therapeutic or medicinal treatment regimen that works for you.
What Is Postpartum Depression?
Postpartum depression is a specific depression that occurs after childbirth. It’s important to note that postpartum depression often begins as milder symptoms prior to delivery, and many who experience postpartum depression symptoms also experience peripartum depression. Postpartum depression is intense, long-lasting depression and can develop into major depression if left untreated. To add, postpartum depression can affect your mood, behaviors and physical health, all of which impact your newborn and family. It can leave you feeling isolated and unable to emotionally connect with your newborn. Postpartum depression may affect one or both parents.
How Common Is Postpartum Depression?
Postpartum depression occurs in about 15% to 20% of births.1,2
When Does Postpartum Depression Start?
Symptoms typically present within the first few weeks after birth, but can begin during pregnancy or up to a year after birth.3
How Long Does Postpartum Depression Last?
Postpartum depression generally lasts for at least 2-3 weeks for those who experience it (this period is sometimes called the baby blues), but it can last for as long as 1-3 years. This is why it’s critical to discuss how you are feeling with your loved ones and physicians to ensure you have the proper treatment.
Postpartum Depression Symptoms
It is common to feel exhaustion, fatigue, and mild fluctuations in mood after delivering a baby or welcoming a newborn into your family, but the signs and symptoms of postpartum depression are more intense. If left unchecked they can even interfere with daily tasks and functioning, making it difficult to complete household chores and tend to yourself and your baby.
Symptoms of postpartum depression include:
- Anger and irritability post-pregnancy
- Anxiety as a new mom
- Panic attacks
- Excessive or unexplained crying
- Extreme worry or feeling out of control
- Difficulty sleeping but feeling exhausted
- Reduced interest or pleasure in things you enjoy
- Feeling apathetic, flat, or empty
- Feeling overwhelmed and hopeless
- A sense of “this wasn’t what I expected”
- Feeling worthless, guilty, shameful, or inadequate
- Difficulty making decisions, thinking clearly, or remembering things
- Sleeping and eating too much or not enough
- Withdrawing from others
- Intrusive thoughts, such as hurting yourself or your baby, or thoughts about your baby being seriously harmed
Some parents feel a sense of stigma surrounding their postpartum depression because they are struggling during what is considered to be a happy time. The reality is, the time after having a newborn is stressful for mothers and other parents, and feeling depressed after having your baby is nothing to be ashamed about.
When to Call Your Doctor
If you have any of the above signs or symptoms for longer than 2 weeks, make an appointment to speak with your medical provider as they could be a sign of a perinatal mood and anxiety disorder (PMAD).
Set up an appointment with your doctor if you are experiencing signs and symptoms of depression with any of these features:3
- Symptoms persist beyond two weeks
- Symptoms are less than 2 weeks but rapidly worsening
- Your symptoms are getting worse
- Your symptoms make it difficult to tend to your baby
- You find daily tasks such as eating or bathing difficult to complete
- You have thoughts of harming yourself or your baby
If You Have Suicidal Thoughts
Postpartum depression can lead to suicidal thoughts and attemps if left untreated. Death by suicide is one of the top causes of postpartum death. There are many resources and services available to postpartum parents experiencing suicidal thoughts and reduce the risk factors. Your OBGYN and mental health professionals can help you through this and get you the right kind of intervention. If you are having suicidal thoughts, call the suicide hotline at 800-273-8255 or present to your local emergency room for care as soon as possible.
Postpartum Depression in Other Parents
New fathers (and other parents) are sometimes impacted by paternal postpartum depression, a condition that presents very similarly to what is experienced by new parents who have given birth.3 Symptoms typically begin soon after the baby is born, and include feeling overwhelmed or sad, experiencing fatigue or anxiety, and changes in sleeping or eating patterns.
A new parent is at a higher risk for postpartum depression if they are young, having relationship or financial issues, have a prior history of depression, and if their parenting partner is depressed.3 If you believe you are affected by paternal postpartum depression, there are treatments available. Reach out to your doctor or health care provider to find appropriate services in your area.
Conditions Related to Postpartum Depression
Postpartum depression is much more than just feeling sad, and yet it is also not always as extreme as it is portrayed in the media. Some parents may not even recognize they are experiencing postpartum depression. However, it is a serious condition that affects your physical and emotional health.4 If you have signs of postpartum depression, take your symptoms seriously, no matter how many you have or how intense they are.
The Baby Blues
Within days after having a baby many women experience a sense of sadness, known as the baby blues. These feelings are usually attributed to the hormonal changes after childbirth and are completely normal.2 About 80% of women experience the baby blues, starting within the first two or three days after birth and lasting for up to two weeks.3
Signs of the baby blues include the following:3
- Mood swings
- Crying episodes
- Anxiety
- Sadness
- Feeling overwhelmed or irritable
- Difficulty sleeping and eating
- Difficulty concentrating
Postpartum Psychosis
Postpartum psychosis is a rare and severe form of postpartum depression that affects 4 out of every 1,000 births.4 The signs and symptoms of postpartum psychosis can be severe and may require immediate intervention or treatment.
Signs and symptoms include:3,5
- Confusion or disorientation
- Excessive energy or agitation
- Delusions or hallucinations
- Paranoia or obsessive thoughts
- Bizarre or reckless behavior
- Thoughts or attempts to harm your baby
- Thoughts or attempts of suicide
If you have thoughts or urges to harm yourself or your baby, do not wait to seek help. If in the US, immediately call 911 or your local emergency assistance number. Another valuable resource is The National Suicide Prevention Lifeline, a 24-hour, confidential suicide prevention hotline, which can be reached at 1-800-273-TALK.6
If you are not in imminent danger but struggle with suicidal thoughts, you can seek help from your doctor or medical provider, a mental health clinician or psychiatrist, or confide in a trusted friend or family member.3
What Causes Postpartum Depression?
Postpartum depression can happen after the birth of any child and is caused by an interconnected mix of complex physical, emotional, and lifestyle factors.3,4
Hormones
One of the main contributors to postpartum depression is hormones. During pregnancy, your body produces higher levels of the estrogen and progesterone hormones. Soon after giving birth, these hormone levels rapidly drop back down to normal, pre-pregnancy levels and the brain must suddenly adapt. This shift is a huge component of postpartum depression.2 Your thyroid produces other hormones that may drop after childbirth, leaving you feeling depressed, tired, and fatigued.
Physical and Emotional Changes
Your body and mind go through many changes during pregnancy and after childbirth. These changes are normal but can be challenging, particularly if the changes are not what you are expecting, or you have complications of some sort.
Social Factors
Relationship problems, financial burdens, a weak support system, and difficult life circumstances, such as illness or job loss, can make the adjustment after having a baby more difficult.
Added Stress
Having a newborn is exciting, but it comes with many adjustments. Different home and work routines, sleep deprivation, and feeling isolated from others may create added stress during what is already a tumultuous time.
Are You at Risk for PPD?
A history of postpartum depression can increase your vulnerability by as much as 30-50% and is the most significant risk factor.5 However, there are several other factors that may increase your risk of postpartum depression.
Postpartum depression risk factors include:2,3
- History of major depression or bipolar disorder
- Family history of depression
- Multiple births (twins or triplets, etc.)
- Challenges with breastfeeding
- Financial or relationship problems
- Young age
- The pregnancy was unplanned or unwanted
- Weak or no support system
Complications if PPD Is Left Untreated
Untreated postpartum depression can impede your ability to care for yourself, your partner, and your baby.
Complications for the parent who gave birth can include:
- Difficulty connecting with the baby
- Low energy and mood
- Inability to focus on the needs of the baby
- Emotionally unavailable
- Exacerbation of baseline depression and potential for suicide attempts
Complications for the baby can include:
- Difficulty with regulating emotions
- Potential for delay in cognitive development
- Higher likelihood of insecure attachment
- Higher likelihood of developing depression as a teen
Complications for the partner can include:
- Higher likelihood of stress and depression
- Lower quality interactions with mother and baby
- Increase feelings of guilt
- Exacerbation of any existing depression
- Poor self-image
Ultimately, it is better to err on the side of caution and get checked by your healthcare provider if something feels off, rather than minimizing what may develop into a very serious condition.
PPD Prevention
Postpartum depression is largely influenced by hormonal factors, but there are still things you can do to reduce your risk or intensity of symptoms, including prioritizing your own health, informing your doctor of any changes you are experiencing, setting realistic expectations, and more.
1. Prioritize Your Physical and Emotional Health
Even before or during pregnancy, consuming adequate nutrition, staying hydrated, getting plenty of sleep, exercising regularly, and engaging in self-care are all important to you and your baby’s health. Maintaining these habits can also help you reduce your likelihood of developing postpartum depression after the birth of your baby.7,8
2. Keep Your Doctor Informed
If you have a history of major depression or have experienced postpartum depression from a prior pregnancy, make sure your doctor is aware. They can monitor for signs and symptoms of depression throughout your pregnancy and after. You can also preemptively schedule a postpartum checkup for after childbirth to assess for signs of depression.3 Even without a history of postpartum depression, be sure to be transparent with your doctor if you exhibit any signs or symptoms, as early intervention is best.
3. Prepare Yourself With Realistic Expectations
Motherhood undoubtedly comes with many rewards and moments of splendor and joy. But the adjustment to motherhood often means accepting changes to your lifestyle, body, emotions, and time. Having realistic expectations about how your life will be transformed after your new arrival will prepare you for what to expect, and minimize any potential feelings of letdown.7
4. Create a Support Network
If you have friends or loved ones who are willing to help during your pregnancy or after the birth of your baby, let them help. It does not make you a bad mother to let someone else help care for your baby, nor does it make you selfish to take time for yourself. Embrace the support that you find in other people around you and help prevent burnout as a new mom.
5. Seek Assistance from a Professional
A counselor or other mental health professional can assist you before, during, or after pregnancy. You will develop your own personalized treatment plan with your provider, but the goals you set for depression therapy might include:
- Helping you monitor or reduce any symptoms of depression or anxiety
- Regaining a sense of control over your life
- Increasing self-confidence about your skills as a mother
- Feeling more attractive post-baby
- Exploring your identity after having a baby
When & How to Get Help for Postpartum Depression
You may find yourself hesitating to seek help because you are feeling embarrassed, guilty, or ashamed. Postpartum depression is not a reflection of you as a mother and is nothing to be ashamed of. Seek assistance as soon as you recognize the signs and symptoms so that you can ensure your treatment is swift and effective. If you have a history of major depression or postpartum depression, tell your doctor early so they can help you monitor for symptoms.
OB-GYNs Often Detect Signs of Postpartum Depression & Recommend Therapy
Choosing Therapy conducted a survey of 135 OB-GYNs on Sermo, a global data collecting platform of over 800,000 anonymous, verified physicians, regarding the mental health of their patients—they reported that about 11% of their patients present with postpartum or peripartum depression. Of those surveyed, 73% say that they’d ideally like the patients they recommend speak with a therapist have their first session within a week. However, the majority say that of the patients they recommend speak to a therapist, 30% or less actually make it to a first therapy session.
Postpartum Depression Treatment
Postpartum depression can ultimately be managed, although treatment should be tailored to the unique needs of each woman. Some women can reduce their symptoms by making healthy lifestyle changes to their eating, sleeping, and activity levels.
Other women find mental health services or support groups for postpartum depression to be helpful for learning coping tools and building connections. For others, medical intervention such as antidepressant medication or hormone therapy is necessary. The right treatment should be determined in conjunction with your doctor and other health care professionals.
Further treatments available for postpartum depression include:
- Medication: Antidepressant medication influences the chemicals in our brains that regulate mood. After starting a medication regimen, it can take up to several weeks to notice a change in your mood. Be sure to communicate any side effects or concerns to your prescribing doctor and consult with them before choosing to stop treatment.
- Psychotherapy: A psychologist, counselor, social worker, marriage and family therapist, or psychiatrist can provide various forms of evaluation and psychotherapy. Therapy can help you identify triggers for anxiety or sadness, increase your knowledge and use of coping strategies, and help you discover ways to increase personal support.
- Hormone therapy: If estrogen levels are low, hormone therapy may be a successful treatment option for women with postpartum depression.9 This type of treatment is typically pursued after antidepressants or other treatments have been unsuccessful. There are side effects with hormone therapy so it is important to weigh the pros and cons with your doctor.
- Self-care: Engage in activities and practices that make you feel good about yourself and your body. Remember that it is not selfish for you to prioritize your own needs and mental health.
It is likely that you will find the best approach to be a combination of treatments that can specifically target the areas with which you need help. Talk with your doctor, medical provider, or mental health counselor to develop an individualized treatment plan that is right for you.
Do’s and Don’ts for Postpartum Depression
Ultimately, what is right for one woman will be different from another regarding how she handles and manages her postpartum depression. The following list provides a general guide for healthy practices to follow and others which you may want to avoid.
Do:
- Prioritize self-care. Tend to your physical and emotional health in the same way you would care for a friend or loved one.
- Practice stress reduction exercises, such as breathing exercises, progressive relaxation, and guided imagery.8 Using calming exercises such as these can help you minimize symptoms of anxiety and depression.
- Accept help from friends and loved ones. If they are willing to help you shoulder the weight of being a new mother, let them. Be sure to also communicate your needs to those around you.
- Make efforts to bond with your baby. Parents with postpartum depression are more inconsistent and interact less with their babies.5 Bonding with your baby will help you be more responsive to each other and form secure attachment.
- Attend a local support group or mommy/baby group. You can make social connections and find support in other women who are going through a similar experience. If you are comfortable, share your story with other parents.
- Reach out for professional help. Remember it is in your baby’s best interest to take care of yourself while adjusting to this new phase of life.
Do not:
- Wait to get treatment. Early intervention is best.
- Drink alcohol. Alcohol is a depressant and may make symptoms worse.
- Overschedule yourself or take on more than you can handle. Learn how to say no!
- Go against the medical advice of your doctor. Consult with your doctor before changing or stopping medication.
- Expect perfection. You are human and have done nothing wrong. Be kind to yourself and do things that make you happy and feel good about yourself.
How Partners & Loved Ones Can Help
It can be really hard for someone with postpartum depression to find ways to cope, but support from their friends and family can be really powerful. It’s important that you take the time to listen to what the new parent is sharing and validate their emotions. It’s common to feel very isolated when dealing with PPD, so actively listening and being in the same space can feel validating and encouraging. It’s important that you give your undivided attention and make sure you are not showing any kind of judgment.
It’s important also to ensure you are not trying to “fix” their postpartum depression. When talking about a loved one’s depression, try not to offer unsolicited advice or share what you did and make it about you. It is a different experience for everyone, so learning what does and doesn’t work for this new parent is what the focus should be. While your suggestions may come from a good place, it can leave someone feeling like their needs and negative emotions are a problem. Make sure you are offering unconditional love and support and know that it goes a long way.
