A Guide to Helping You Understand Postpartum Depression

A Guide to Helping You Understand Postpartum Depression

Definitions

What is Postpartum Depression?

Postpartum depression is a form of depression that occurs within the first year after a woman has given birth. If you have ever given birth, you know that it is a powerful and emotional experience. It can result in feelings of excitement, joy, fear, anxiety, stress and in some cases, depression.

For many new mothers, this can be an unexpected feeling since having a baby is meant to be a happy and exciting time. There is absolutely no shame however, in experiencing feelings of depression after giving birth, and it is quite common.

Postpartum depression usually occurs within the first month after giving birth but can occur at any time in the first year. Apart from the fact that it occurs after childbirth, postpartum depression is not clinically different than any other form of depression. The symptoms and diagnosis of postpartum depression are similar to general depression; however, many of the symptoms relate to motherhood and caring for a baby.

On Baby Blues

Many new mothers (70-80%) experience the “baby blues” which include mood swings, crying spells, anxiety, and difficulty sleeping. They typically occur in the first two or three days after delivery and usually only last for a few days, and at most, a couple of weeks. The “baby blues” are not the same as postpartum depression and do not require any treatment. Some mothers however, experience a more severe and long-term form of depression which is called postpartum depression.

What is Postpartum Psychosis?

Although postpartum depression is quite common among new mothers, a more extreme and rare mood disorder that can occur is called postpartum psychosis.

Postpartum psychosis refers to psychotic symptoms that happen suddenly after childbirth. There are only about 1-2 cases of postpartum psychosis per 1000 births, and treatment is similar to other forms of psychosis.1 Women who have a history of bipolar disorder are 40% more likely to develop postpartum psychosis, and 10% of postpartum psychosis cases result in suicide or infanticide.

What are Perinatal Mood and Anxiety Disorders?

While postpartum depression refers to depression that occurs after giving birth, perinatal mood and anxiety disorders refer to symptoms of depression that occur both during pregnancy and/or up to one year postpartum. Some disorders related to pregnancy are depression during pregnancy, pregnancy loss, and infertility. Disorders related to postpartum are postpartum depression, postpartum anxiety disorders, and postpartum psychosis.

How Common are Perinatal Mood and Anxiety Disorders?

Many women tend to feel alone in their feelings of postpartum depression when, it is more common than you might think. In the US, approximately 70% to 80% of women will experience the baby blues, and 10% to 20% of new mothers have been reported to have clinical postpartum depression. Keep in mind that this percentage includes only mothers who have been diagnosed with postpartum depression, and there are likely many other mothers who feel too ashamed to reach out for help and have gone undiagnosed.

Medical experts believe that rates of postpartum depression could be twice as much as what is actually reported. This means that postpartum depression is much more common than anyone thinks and no new mothers are alone in feeling this way.

A recent study found that approximately 1 in 7 women experience postpartum depression, which means that out of the 4 million live births that occur yearly in the US, approximately 600,000 of these cases result in postpartum depression diagnoses. When including women who have had miscarriages or stillbirths (which do not count towards the 4 million live births), the number of women that experience postpartum depression jumps to 900,000 yearly.

Symptoms

Baby Blues Symptoms

The “baby blues’” typically last only a few days to a week or two after giving birth and usually subside by themselves. Symptoms include:

  • Mood swings
  • Anxiety
  • Irritability
  • Crying/sadness
  • Lack of concentration
  • Appetite problems
  • Sleeping problems
  • Overwhelmed feeling

Postpartum Depression Symptoms

Postpartum depression symptoms are more severe than “baby blues” and last for longer. They require diagnosis and treatment. Signs of postpartum depression include:

  • Depressed mood
  • Severe mood swings
  • Uncontrollable crying spells
  • Difficulty bonding with your baby
  • Loss or increase in appetite
  • Inability to sleep
  • Sleeping too much
  • Extreme fatigue/loss of energy
  • Social isolation/withdrawal from family and friends
  • Lack of interest in previously enjoyed activities
  • Disinterest in baby, family, or friends
  • Irritability/anger
  • Hopelessness
  • Feelings of shame/guilt/inadequacy
  • Feeling like a bad mother/fear of being a bad mother
  • Fear of being left alone with the baby
  • Not able to think clearly/make decisions
  • Severe anxiety
  • Panic attacks
  • Restlessness
  • Thoughts of harming yourself or the baby
  • Thoughts of suicide

Postpartum Psychosis Symptoms

Postpartum psychosis is rare and typically develops within the first week after giving birth. Symptoms are severe and require immediate attention. Symptoms of postpartum psychosis include:

  • Hallucinations/delusions
  • Confusion/disorientation
  • Sleep disturbances
  • Refusing to eat
  • Excessive energy and agitation
  • Paranoia
  • Attempts to harm yourself or your baby

Causes and Risk Factors

As with general depression, there is no single cause as every individual is different. Physical, hormonal, social, psychological, and emotional factors all play a role in triggering postpartum depression.

Causes

Physical Changes

After childbirth, a woman experiences a dramatic drop in hormones which may contribute to postpartum depression. The change in hormones can result in feeling tired, sluggish and depressed.

Emotional Issues

With a new baby comes a severe lack of sleep and a lot of overwhelming feelings. Women may feel anxious about their ability to care for a newborn, overwhelmed with the big change in their life, and may have trouble dealing with small problems. The dramatic changes that happen in your life after giving birth are not to be underestimated. Being a new mother is hard, and the emotional changes that accompany it can be very difficult.

Risk Factors

Any new mother can develop postpartum depression, however the risk of developing postpartum depression increases if you have:

A personal or family history of depression or other mental illness

Depression or mental illness in your partner

Stressful life events (pregnancy complications, illness, etc.)

Twins, triplets, or other multiple births

Probelsm breastfeeding

Financial/employment problems

Anxiety/negativity about the pregnancy

Substance use disorders

Family violence

A lack of support from family and friends

Postpartum depression after a previous pregnancy 

Health problems/special needs in your baby

Preterm birth

Relationship problems with spouse/significant other

Unplanned/unwanted pregnancy

Prenancy at a young age

Chronic illness

Minority, immigrant or refugee status

What Do Statistics Say?

Research regarding risk factors shows that women with a history of depression or anxiety disorders are 30%-35% more likely to develop postpartum depression. If a woman has experienced postpartum depression in the past, she is between 10%-50% more likely to experience it again.

Interestingly, about half of all women who develop postpartum depression began to experience symptoms during pregnancy. Additionally, women in poverty or of a low socioeconomic status are 11 times more likely to experience postpartum depression than women who are better off socioeconomically.

Although young mothers are at a higher risk of postpartum depression, older mothers are as well, as they are also more likely to have had multiple pregnancies already. Research shows that 10% of women with postpartum depression are between the ages of 20-24, 10.6% are between the ages of 25-29, 5.7% are between the ages of 30-34, 4% are between the ages of 35-39, and 17% are between the ages of 40-44.

Postpartum Depression Statistics

10% Between the Ages 20-24
10.6% Between the Ages 25-29
5.7% Between the Ages 30-34
4% Between the Ages 35-39
17% Between the Ages 40-44

Diagnosis

Who Should You Talk To if You Think You Might Have Postpartum Depression?

Many women feel embarrassed or ashamed to be feeling symptoms of postpartum depression during a time that people think should be joyful and happy. The reality is that as exciting as having a new baby is, it is also very overwhelming and difficult, and many women experience symptoms of postpartum depression after giving birth. It is completely normal to feel this way and no mother should feel any shame.

Obstetrician

Although most women have 1-2 postpartum visits with their obstetricians, the obstetrician may not always check for postpartum depression, in which case a pediatrician may also be a good point of contact. New mothers typically visit a pediatrician when their baby is a month old, 2 months old, 4 months old, and 6 months old, during which you should not hesitate to ask your pediatrician about any depressive symptoms you are feeling.

Family Doctor

If your symptoms of depression do not go away after two weeks, are getting worse, and are interfering with taking care of your baby, another option is to make an appointment to see your family doctor. If you have experienced previous mental health issues and have a psychologist or psychiatrist that you are familiar with, they would also be a good person to contact about how you are feeling.

How Do You Get Diagnosed With Postpartum Depression?

Track Symptoms: The first step to reaching any diagnosis is to take note of the initial symptoms and keep track of when they first started and how they have progressed. Keeping a journal of your symptoms can be useful in order to track how you’re feeling and be able to share that with your doctor.

Doctor Visit: Once you visit your doctor, they will take note of your past medical history and any history of depression or mental illness. They will also test for other medical conditions in order to rule those out and make sure that you really do have postpartum depression. For example, many women develop an underactive thyroid condition after childbirth that has similar symptoms to postpartum depression.

Psychological Screening Test: Once other medical conditions have been ruled out, doctors will conduct a psychological screening test or questionnaire to determine the extent and severity of your symptoms and to make sure that the symptoms are linked to childbirth. Sometimes your doctor may choose to work together with a mental health professional who might use a diagnostic tool found in the Diagnostic and Statistical Manual of Mental Disorders in order to diagnose your postpartum depression.

Distinguish Type: Your doctor will also make sure to distinguish between types of perinatal anxiety disorders to make sure that you are not experiencing the baby blues or something more severe like postpartum psychosis.

Treatment: Once you have been diagnosed with postpartum depression, a treatment plan will be implemented, which usually involves medication and therapy/counseling.

Treatment

When postpartum depression goes undiagnosed and untreated, it can have very negative consequences for the mother, the baby, and the rest of the family. It can harm the mother’s relationship and bond with her baby and impair the baby’s long-term development.

Although it may be difficult for new mothers to admit how they are feeling and to reach out for help, it is very important to do so. Because postpartum depression presents similar symptoms to general depression, the treatment options are similar.

While most women’s treatment plans include a combination of medication and psychotherapy, there are various options that include:

Psychotherapy (e.g. interpersonal therapy and cognitive behavioral therapy)

Supportive counseling

Antidepressants 

Social support from family and friends

Maternal relaxation 

Hormone therapy

Psychotherapy

Because postpartum depression is a mental health disorder, one of the main methods of treatment is psychotherapy that typically includes cognitive behavioral therapy (CBT) or interpersonal therapy (IPT). Through speaking with a psychiatrist or psychologist, women have the opportunity to talk about their feelings in a safe space and with a professional. 

Mental health professionals help women to understand and cope with their feelings and to create realistic goals to work towards. Other forms of therapy might include the spouse or other family members in working towards acknowledging, addressing and recovering from postpartum depression as a family.

Antidepressants

Antidepressants are the most commonly prescribed medication that is used for postpartum depression. While some people believe that mothers who are breastfeeding cannot take antidepressants, that is simply not true. Antidepressants help to elevate and stabilize mood to regulate symptoms such as mood swings, crying spells, sadness, and irritability. Antidepressants can also help to improve sleep and appetite as well as overall well-being.

Although antidepressants can take up to four weeks to work, many people start to feel better sooner. Antidepressants are a great combination with therapy because they allow the person to be in a better head space for psychotherapy to work. Doctors will consider individual factors when deciding which antidepressant to prescribe in making sure that it is safe for both you and your baby.

Breastfeeding and Antidepressants

Many people believe that you can’t take antidepressants while breastfeeding. However, there are a lot of medications that are used to treat depression and anxiety disorders and are safe to use while breastfeeding, and women should not feel shame at having to take medication.

While it is recommended that mothers breastfeed exclusively for 6 months and up to a year if desired, it is perfectly alright for a mother to seek alternatives to breastfeeding if she feels that it worsens her symptoms of depression. If a mother enjoys breastfeeding and feels as though it strengthens her bond with her baby, then it is important to create a treatment plan that prioritizes breastfeeding.

Can You Recover From Postpartum Depression?

Yes! The good news is that with the right combination of therapy, medication, and healthy life choices, women can recover from postpartum depression. Postpartum depression generally lasts for about six months, and although there will be ups and downs in the process, many women make a full recovery. Studies show that the overall success rate for treating postpartum depression is 80%, so receiving treatment really is crucial.

80% of People Who Receive Treatment for Postpartum Depression Successfully Recover
80%

Consequences of Avoiding Treatment

For women who don’t receive treatment, the consequences can be harmful to the mother, her baby, and her family. The earlier postpartum depression is detected, the higher the rate of success of treatment. It is important to remember that a happy and healthy mom helps to develop a happy and healthy baby. Treating postpartum depression is extremely important not just for the mother, but for her baby and family as well.

Misconceptions

Misconception #1: Men Can’t Experience Postpartum Depression

The biggest misconception surrounding postpartum depression is that men/fathers can’t experience it. While this seems to make sense since men don’t give birth, men can also struggle with the difficulties that come with having a new baby. Research shows that approximately 10% of new fathers experience postpartum depression within the first year after their baby is born. 50% of men who have partners with postpartum depression will develop depression themselves.

Conversely, women whose partners have postpartum depression are also more likely to develop postpartum depression themselves. While men might cope with their symptoms differently, the symptoms are fairly similar, including guilt, lack of sleep, loss of interest in activities, irritability, frustration and more. The good news is that postpartum depression in men is also treatable.

Misconception #2: Adoptive Parents Can’t Experience Postpartum Depression

While one might also not expect that adoptive parents can experience postpartum depression, they actually can. These feelings tend to stem from the pressures that adoptive parents put on themselves in trying to make their new baby feel at home. There are still social stigmas that surround adoption that make it harder for adoptive parents to navigate having a new baby.

Misconception #3: It’s Just The “Baby Blues”

While mood swings, stress, and anxiety can be normal after giving birth, if these symptoms persist for more than a couple of weeks, then you most likely have postpartum depression.

Misconception #4: Postpartum Depression Begins Right After Birth

Although postpartum depression typically occurs within the first few months after giving birth, it can occur at any time within the first year postpartum.

Misconception #5: Postpartum Depression Goes Away on its Own

Postpartum depression is a mental illness that is a treatable condition and is unlikely to fully go away on its own without treatment.

Misconception #6: All Women Feel Happy After Giving Birth

Although pregnancy is thought to be an exciting and happy time for mothers, that is not always the case. About 13% of women experience depression while pregnant, and up to 18% of mothers will experience some form of depressive disorder.

Misconception #7: Postpartum Depression Can Be Prevented

Just like other mental disorders, there is nothing you can do to make sure you don’t get postpartum depression. While you can try to decrease the risks by leading a healthy lifestyle and maintaining a strong support system, postpartum depression simply can’t be prevented as it is an illness caused by chemical imbalances in your brain. If you have a history of mental health issues, you can have your doctor screen you for depression during your pregnancy.

Misconception #8: Having Postpartum Depression Makes You a Bad Parent

Postpartum depression is a mental illness that can’t be prevented. It is nobody’s fault and does not make you a bad parent. Everybody struggles with different things in their lives, and feelings of guilt or feeling like a failed parent are symptoms of depression and are not reflective of your abilities as a parent. Remember, you are not your depression!

Misconception #9 You Can’t Take Antidepressant Medications While Breastfeeding

Many antidepressants are safe to take while pregnant and breastfeeding. You should speak to your doctor about what medication is best for you. There are also other safe treatments for breastfeeding mothers such as psychotherapy and peer support groups.

Tips to Help Deal with Postpartum Depression

  • Exercise or go outside daily
  • Eat healthy and make sure you are eating nutritious food
  • Try to get enough rest and stay hydrated
  • Try meditation, mindfulness, and deep breathing
  • Spend time out of the house but avoid isolating yourself
  • Spend time with your friends and in social settings
  • It's okay to create time for yourself and prioritize yourself
  • Focus on how breastfeeding makes you feel and don't feel guilty if it's not working for you
  • Call your doctor if you need help
  • Join support groups
  • Ask for help when you need it

Finding Support

Someone experiencing postpartum depression needs a very strong support system. Whether they gain this from a group of strangers who are going through the same experience or from their family or friends, a good support system is crucial towards recovering.

Husbands/partners, siblings, other children, parents, in-laws, friends, and co-workers can all play their part in trying to offer support to someone with postpartum depression. There are also a variety of support groups available that new mothers can join where they can talk about their personal experiences, discuss coping skills and challenges they are having, talk about their treatment, and share/hear success stories.

The benefits of support groups include: 

Communal encouragement in a comfortable and safe environment 

Helping each other feel accepted, understood, and validated

Participate in a non-judgmental setting

Regular and ongoing treatment through weekly meetings

More affordable than individual therapy treatment options 

Facilitation by professional health care providers ensures accurate treatment

Develop an understanding of your condition and how it affects you

Learn healthy coping skills

There are support groups available for mothers and fathers who have postpartum depression, as well as family members of loved ones and for couples who may experience marital problems as a result. There are also specialized support groups available for people who speak other languages, mothers facing addiction and substance abuse, and military families. It is also important to remember that your doctors can offer you support as well and are there to help you. Never be afraid to call your obstetrician, midwife, pediatrician, or other healthcare provider.

National Organizations that offer Support Groups:2

American Congress of Obstetricians and Gynecologist (ACOG)

U.S. Department of Health and Human Services – Women’s Health

Mental Health America

Online Support Groups:

Postpartum Support International Online Meetings 

Smart Patients Postpartum Community 

What to Expect Postpartum Depression Discussion Forum 


Resources

  1. https://www.postpartumdepression.org/resources/statistics/
  2. https://www.postpartumdepression.org/support/groups/
  3. https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617
  4. https://www.healthychildren.org/English/ages-stages/prenatal/delivery-beyond/Pages/Understanding-Motherhood-and-Mood-Baby-Blues-and-Beyond.aspx
  5. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/postpartum-depression
  6. https://www.med.unc.edu/psych/wmd/mood-disorders/perinatal/