Postpartum Depression

Postpartum depression (PPD) is a complex mix of physical, emotional, and behavioral changes that happen in a woman after giving birth. According to the DSM-5, a manual used to diagnose mental disorders, PPD is a form of major depression that has its onset within four weeks after delivery. The diagnosis of postpartum depression is based not only on the length of time between delivery and onset, but also on the severity of the depression.

What Is Postpartum Depression?

Postpartum depression is linked to chemical, social, and psychological changes associated with having a baby. The term describes a range of physical and emotional changes that many new mothers experience. The good news is postpartum depression can be treated with medication and counseling.

The chemical changes involve a rapid drop in hormones after delivery. The actual link between this drop and depression is still not clear. But what is known is that the levels of estrogen and progesterone, the female reproductive hormones, increase tenfold during pregnancy. Then, they drop sharply after delivery. By three days after a woman gives birth, the levels of these hormones drop back to what they were before she got pregnant.

In addition to these chemical changes, social and psychological changes associated with having a baby create an increased risk of depression.

What Are the Symptoms of Postpartum Depression?

Symptoms of postpartum depression are similar to what happens normally following childbirth. They include difficulty sleeping, appetite changes, excessive fatigue, decreased libido, and frequent mood changes. However, these are also accompanied by other symptoms of major depression, which are not normal after childbirth, and may include depressed mood; loss of pleasure; feelings of worthlessness, hopelessness, and helplessness; thoughts of death or suicide or thoughts or hurting someone else.

What Are the Risk Factors for Getting Postpartum Depression?

A number of factors can increase the risk of postpartum depression, including:

  • a history of depression prior to becoming pregnant, or during pregnancy
  • age at time of pregnancy -- the younger you are, the higher the risk
  • ambivalence about the pregnancy
  • children -- the more you have, the more likely you are to be depressed in a subsequent pregnancy
  • having a history of depression or premenstrual dysphoric disorder (PMDD)
  • limited social support
  • living alone
  • marital conflict

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Is Postpartum Depression Common?

Most new mothers experience the "baby blues" after delivery. About one out of every 10 of these women will develop a more severe and longer-lasting depression after delivery. About one in 1,000 women develops a more serious condition called postpartum psychosis.

Are There Different Types of Postpartum Depression?

There are three types of mood changes women can have after giving birth:

  • The "baby blues," which occur in most women in the days right after childbirth, are considered normal. A new mother has sudden mood swings, such as feeling very happy and then feeling very sad. She may cry for no reason and can feel impatient, irritable, restless, anxious, lonely, and sad. The baby blues may last only a few hours or as long as one to two weeks after delivery. The baby blues do not usually require treatment from a health care provider. Often, joining a support group of new moms or talking with other moms helps.
  • Postpartum depression (PPD) can happen a few days or even months after childbirth. PPD can happen after the birth of any child, not just the first child. A woman can have feelings similar to the baby blues -- sadness, despair, anxiety, irritability -- but she feels them much more strongly than she would with the baby blues. PPD often keeps a woman from doing the things she needs to do every day. When a woman's ability to function is affected, she needs to see her health care provider, such as her ob-gyn or primary care doctor. This doctor can screen her for depression symptoms and develop a treatment plan. If a woman does not get treatment for PPD, symptoms can get worse. While PPD is a serious condition, it can be treated with medication and counseling.
  • Postpartum psychosis is a very serious mental illness that can affect new mothers. This illness can happen quickly, often within the first three months after childbirth. Women can lose touch with reality, having auditory hallucinations (hearing things that aren't actually happening, like a person talking) and delusions (strongly believing things that are clearly irrational). Visual hallucinations (seeing things that aren't there) are less common. Other symptoms include insomnia (not being able to sleep), feeling agitated and angry, pacing, restlessness, and strange feelings and behaviors. Women who have postpartum psychosis need treatment right away and almost always need medication. Sometimes women are put into the hospital because they are at risk for hurting themselves or someone else.

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Do Anxiety or Obsessive-Compulsive Disorder Symptoms Increase With Postpartum Depression?

Symptoms of obsessive-compulsive disorder that are new rarely occur in the postpartum period (about 1%-3% of women). The obsessions are usually related to concerns about the baby's health, or irrational fears of harming the baby. Panic disorder may also occur. Both conditions often coexist with depression.

Tips for Coping After Childbirth

Here are some tips that can help you cope with bringing home a newborn:

  • Ask for help -- let others know how they can help you.
  • Be realistic about your expectations for yourself and baby.
  • Exercise -- within the limits of any restrictions your doctor may place on your level of activity; take a walk, and get out of the house for a break.
  • Expect some good days and some bad days.
  • Follow a sensible diet; avoid alcohol and caffeine.
  • Foster the relationship with your partner -- make time for each other.
  • Keep in touch with family and friends -- do not isolate yourself.
  • Limit visitors when you first go home.
  • Screen phone calls.
  • Sleep or rest when your baby sleeps!

How Is Postpartum Depression Treated?

Postpartum depression is treated differently depending on the type and severity of a woman's symptoms. Treatment options include anti-anxiety or antidepressant medications, psychotherapy, and participation in a support group for emotional support and education.

In the case of postpartum psychosis, drugs used to treat psychosis are usually added. Hospital admission is also often necessary.

If you are breastfeeding, don't assume that you can't take medication for depression, anxiety, or even psychosis. Talk to your doctor. Under a doctor's supervision, many women take medication while breastfeeding. This is a decision to be made between you and your doctor.

When Should a new Mom Seek Professional Treatment?

Untreated postpartum depression can be dangerous for new moms and their children. A new mom should seek professional help when:

  • symptoms persist beyond two weeks.
  • she is unable to function normally.
  • she can't cope with everyday situations.
  • she has thoughts of harming herself or her baby.
  • she is feeling extremely anxious, scared, and panicked most of the day.
WebMD Medical Reference Reviewed by Joseph Goldberg, MD on April 09, 2016

Sources

SOURCES:

National Institute of Mental Health: "What is Depression?"

National Institute of Mental Health: "Depression: What Every Woman Should Know."

MedlinePlus: "Medical Encyclopedia: Post-partum Depression."

National Institutes of Health: News in Health: "Understanding Post Partum Depression, Common but Treatable."

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, American Psychiatric Pub, 2000.

Fieve, R, MD. Bipolar II, Rodale Books, 2006.

The Journal of the American Medical Association. “Recommendations for Screening Depression in Adults,” Vol. 315, No. 4, January 26, 2016.

 

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