Postpartum Depression

Postpartum depression is a mood disorder that affects women after childbirth. Like clinical depression, postpartum depression causes women to experience feelings of extreme sadness, anxiety, hopelessness and exhaustion that can make it difficult for them to fulfill daily needs and care for themselves and others. It may cause women to feel like they can’t or don’t want to bond with or care for their child.

Postpartum depression can develop any time during the first year after birth, but it most commonly affects mothers during the first three weeks after birth. It can sometimes be hard to tell the difference between postpartum depression and the normal stress and exhaustion of being a new parent. Many women experience some symptoms of depression after childbirth, but these “baby blues” are not severe and generally go away within a few days or a week. Postpartum depression symptoms are prolonged and severe. If you experience strong negative feelings, such as sadness, hopelessness, and lack of interest, that interfere with daily life and last for prolonged periods of time – for weeks or even months – you may have postpartum depression.

While the exact cause of postpartum depression is not known, hormonal and physical changes after birth and the stress of caring for a newborn may play a role. Women who previously experienced depression have a higher risk of developing postpartum depression.

It is important to seek out help and speak with your doctor if you experience signs or symptoms of depression during your pregnancy. Untreated depression can worsen and pose more risk to you and your child.

How Often Does Postpartum Depression Happen?

Around 10 percent of new mothers develop postpartum depression. A study of 10,000 mothers with newborns found that around 1 in 7 developed postpartum depression. However, these actual numbers could be even higher, because many people who struggle with depression are reluctant to admit it or seek treatment.

What Are Some Symptoms of Postpartum Depression?

Symptoms of clinical depression and postpartum depression are the same. Symptoms usually develop within the first few weeks after giving birth, but may begin up to six months after birth. You may have postpartum depression if you experience the following symptoms for most of the day, every day, for at least two consecutive weeks:

• Feelings of extreme sadness, emptiness, or hopelessness
• Frequent and excessive crying, or crying for no apparent reason
• Loss of interest or lack of enjoyment in usual activities and hobbies
• Oversleeping or trouble falling asleep
• Severe anxiety, worrying or panic attacks
• Loss of appetite or eating too much, or unintentional weight loss or weight gain
• Overwhelming feelings of worthlessness, inadequacy or guilt
• Feelings of extreme anger or rage
• Feeling moody, irritable, or restless
• Extreme mood swings
• Difficulty concentrating, remembering things or making decisions
• Feeling that life isn't worth living
• Having low energy or extreme fatigue that doesn't improve with rest
• Physical aches and pains, including frequent headaches, stomach problems, and muscle pain
• Withdrawing from or avoiding friends and family
• Difficulty bonding or forming an emotional attachment with the baby
• Being uninterested in or unable to care for the baby
• Persistent doubt in ability to care for the baby or worrying excessively about the baby
• Thoughts of harming oneself or baby
• Recurrent thoughts of death or suicide

In rare cases, some women with postpartum depression experience delusional thoughts or hallucinations, paranoia, and obsessions, and may harm their baby. This is called postpartum psychosis and requires immediate treatment.

What Are Some Causes of Postpartum Depression?

Postpartum depression can develop due to a combination of hormonal, environmental, emotional, and genetic factors. Some women who experience postpartum depression have a history of major depression prior to or during pregnancy. Changes such as sleep deprivation, physical exhaustion and emotional adjustments, while normal after giving birth and caring for a newborn, can also contribute to the development of postpartum depression.

Unlike depression that is unrelated to pregnancy, postpartum depression is linked to unique hormonal changes that occur after childbirth. Sudden changes in hormone levels after delivering a baby can trigger depression in women who are more sensitive to shifts in estrogen and progesterone.

While any new mother can experience postpartum depression, some women are at a higher risk. Risk factors for postpartum depression include:

• Depression or anxiety during pregnancy
• Stressful life events during pregnancy or soon after giving birth
• Traumatic childbirth experience
• Preterm delivery
• A baby needing neonatal intensive care
• Lack of social support
• Personal or family history of depression or psychiatric problems
• Breastfeeding problems
• Unplanned or unwanted pregnancy
• A baby with birth defects or other medical problems
• Having multiple babies, such as twins or triplets
• Being a single mother
• Financial instability or unemployment
• Relationship problems, including domestic violence
• Substance abuse, including smoking or drinking alcohol
• Pregestational or gestational diabetes

How Can Postpartum Depression Be Treated?

If you think you are struggling with postpartum depression, the first and most important step you can take is seeking help. Speak with your doctor about your symptoms and issues. Only your doctor can diagnose you with postpartum depression. He or she can recommend treatment that would be best suited to you and your child. Treatment methods for depression during pregnancy may include:

• Counseling or therapy: You will discuss your thoughts and feelings with a counselor or therapist, who will help you understand your feelings and cope with your issues. They may have you practice specific techniques such as cognitive behavioral therapy and interpersonal psychotherapy. Your doctor may recommend family or couples therapy, where a therapist works with you and your partner or relatives.
• Support groups: These are groups of people going through similar circumstances who meet in person or talk online to share their feelings and experiences about specific topics.
• Medication: Depression is often treated with antidepressants. Your doctor may prescribe you one or a combination of antidepressants. Your doctor should discuss the benefits and risks of taking antidepressants and which antidepressants would be safest for you to use, so you can make an informed decision about your treatment and if medication is the best option. Most antidepressants are safe to use while breastfeeding. If you were taking a prescribed antidepressant while pregnant, do not stop taking them without first talking to your provider. Stopping medication may make your depression worsen. If you are prescribed antidepressants and the side effects make it difficult for you to function in daily life, let your doctor know right away.
• Brain stimulation therapies: Electroconvulsive therapy is a brain stimulation therapy in which an electric current is passed through the brain to produce a seizure and change the brain’s chemistry to relieve depression symptoms. Your doctor may recommend electroconvulsive therapy if you have severe depression, or if medication is deemed to be too risky to take.

Making changes at home may also help you manage your depression symptoms. Speak with your partner, family, or friends about your issues and ask for support. Allow yourself to relax, slow down, cut down on chores and tasks, and put your health and well-being first. Taking care of yourself is vital to taking care of baby. Some other changes that may help manage depression symptoms include:

• Exercise: Exercise is a natural way to increase serotonin levels and decrease cortisol levels. Speak with your doctor to find the best workouts that would be safe and appropriate for you.
• Eating a healthy diet:  Many foods have been shown to affect mood, the ability to handle stress and focus. Caffeine, sugar, processed carbohydrates, artificial additives and lack of protein can negatively affect your mental and physical health.  Ask to speak with a registered dietitian to determine an individualized healthy eating plan that would most benefit you.
• Get enough sleep: A lack of sleep can greatly affect the body’s and mind’s ability to handle stress and cope with day-to-day challenges. Although depression and caring for a newborn can affect your ability to sleep, try to establish a sleep schedule routine to get as much sleep as you can around your baby’s sleep schedule.

When Should I see My Doctor?

If you have any symptoms of depression, call your doctor to set up an appointment to discuss your issues and treatment options.

If you find yourself having frequent or obsessive thoughts about harming yourself or your baby, or other symptoms of postpartum psychosis [ I think this is the first time this word is used, and it seems stronger and less “normal” than depression. Are we sure we want to use it without definition or explanation? Scary word.], contact your doctor or emergency services immediately.

It's important to call your doctor as soon as possible if your depression symptoms exhibit any of these features:

• Remain after two weeks
• Are worsening over time
• Make it hard for you to care for your baby
• Make it hard to complete everyday tasks
• Include thoughts of harming yourself or your baby

Seeking help is the best step you can take to ensuring that you and your child stay safe and healthy.

Learn more about Multidisciplinary Obstetric Medicine Service (MOMS) at Brown University Health