Postpartum depression

Definition

The birth of a baby can trigger a jumble of powerful emotions, from excitement and joy to fear and anxiety. But it can also result in something you might not expect — depression.

Many new moms experience the baby blues after childbirth, which commonly include mood swings and crying spells and fade quickly. But some new moms experience a more severe, long-lasting form of depression known as postpartum depression. Rarely, an extreme form of postpartum depression known as postpartum psychosis develops after childbirth.

Postpartum depression isn't a character flaw or a weakness. Sometimes postpartum depression is simply a complication of giving birth. If you have postpartum depression, prompt treatment can help you manage your symptoms — and enjoy your baby.

Symptoms

Signs and symptoms of depression after childbirth vary depending on the type of depression.

Baby blues symptoms
Signs and symptoms of the baby blues — which last only a few days or weeks — may include:

• Mood swings
• Anxiety
• Sadness
• Irritability
• Crying
• Decreased concentration
• Trouble sleeping

Postpartum depression symptoms
Postpartum depression may appear to be the baby blues at first — but the signs and symptoms are more intense and longer lasting, eventually interfering with your ability to care for your baby and handle other daily tasks. Postpartum depression symptoms may include:

• Loss of appetite
• Insomnia
• Intense irritability and anger
• Overwhelming fatigue
• Loss of interest in sex
• Lack of joy in life
• Feelings of shame, guilt or inadequacy
• Severe mood swing
• Difficulty bonding with the baby
• Withdrawal from family and friends
• Thoughts of harming yourself or the baby

Untreated, postpartum depression may last for a year or more.

Postpartum psychosis
With postpartum psychosis — a rare condition that typically develops within the first two weeks after delivery — the signs and symptoms are even more severe. Signs and symptoms of postpartum psychosis may include:

• Confusion and disorientation
• Hallucinations and delusions
• Paranoia
• Attempts to harm yourself or the baby

When to see a doctor
If you're feeling depressed after your baby's birth, you may be reluctant or embarrassed to admit it. But it's important to call your doctor if the signs and symptoms of depression:

• Don't fade after two weeks
• Are getting worse
• 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

Getting early treatment for postpartum depression can speed your recovery.

If you suspect that you're developing postpartum psychosis, seek medical attention immediately. Don't wait and hope for improvement. Postpartum psychosis may lead to life-threatening thoughts or behaviors.

Causes

There's no single cause for postpartum depression. Physical, emotional and lifestyle factors may all play a role.

• Physical changes. After childbirth, a dramatic drop in hormones in your body (estrogen and progesterone) may contribute to postpartum depression. Other hormones produced by your thyroid gland also may drop sharply — which can leave you feeling tired, sluggish and depressed. Changes in your blood volume, blood pressure, immune system and metabolism can be further stresses that contribute to fatigue and mood swings.
• Emotional factors. When you're sleep deprived and overwhelmed, you may have trouble handling even minor problems. You may be anxious about your ability to care for a newborn. You may feel less attractive or struggle with your sense of identity. You may feel that you've lost control over your life. Any of these factors can contribute to postpartum depression.
• Lifestyle influences. Many lifestyle factors can lead to postpartum depression, including a demanding baby or older siblings, difficulty breast-feeding, exhaustion, financial problems, and lack of support from your partner or other loved ones.

In addition, some women may be genetically more vulnerable than others to postpartum depression. However, it's not clear whether hereditary factors that increase a woman's risk of postpartum depression are different from those that increase her risk of depression overall.

Risk factors

Postpartum depression can develop after the birth of any child, not just the first. The risk increases if:

• You have a history of depression, either during pregnancy or at other times
• You had postpartum depression after a previous pregnancy
• You've experienced stressful events during the past year, including illness, job loss or pregnancy complications
• You're having problems in your relationship with your spouse or significant other
• You have a weak support system
• You have financial problems
• The pregnancy was unplanned or unwanted

The risk of postpartum psychosis is higher for women who have bipolar disorder.

Complications

Left untreated, postpartum depression can interfere with mother-child bonding and cause family problems. Children of mothers who have untreated postpartum depression are more likely to have behavioral problems, such as sleeping and eating difficulties, temper tantrums and hyperactivity. Delays in language development are more common as well.

Untreated postpartum depression can last up to a year or longer. Sometimes untreated postpartum depression becomes a chronic depressive disorder. Even when treated, postpartum depression increases a woman's risk of future episodes of major depression.

Preparing for your appointment

If you have signs and symptoms common to postpartum depression, call your doctor. Don't let shame or anxiety stop you. Postpartum depression is common and your doctor knows it's not your fault. To protect your health and the health of your baby, the condition needs to be treated as soon as possible.

After your initial appointment, your doctor may refer you to a mental health provider who can create the right treatment plan for you.

Here's some information to help you prepare for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you've been experiencing, and for how long.
• Write down all of your medical information, including other physical or mental health conditions with which you've been diagnosed. Tell your doctor if you've been diagnosed with any type of depression or other mental health disorder in the past. Also write down the names of any medications you're taking, including over-the-counter medications, vitamins and supplements.
• Find a trusted family member or friend to join you for your appointment. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Questions to ask a doctor who sees you for possible postpartum depression include:

• What is my diagnosis?
• What treatments are likely to be helpful in my case?
• What are the possible side effects of the treatments you're proposing?
• How much and how soon do you expect my symptoms to improve with treatment?
• How long will I need to be treated?
• What lifestyle changes can help me manage my symptoms?
• How often should I be seen for follow-up visits?
• Am I at increased risk of other mental health problems?
• Am I at risk of this condition recurring if I have another baby?
• Is there any way to prevent a recurrence if I have another baby?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared in advance, don't hesitate to ask for more information at any time that you don't understand something.

What to expect from your doctor
A doctor or mental health provider who sees you for possible postpartum depression may ask:

• What are your symptoms, and when did they first develop?
• Have your symptoms been getting better or worse over time?
• Are your symptoms affecting your ability to care for your baby?
• Do you feel as bonded to your baby as you expected?
• Are you able to sleep when you have the chance, and get out of bed when it's time to wake up?
• How would you describe your energy level?
• Has your appetite changed?
• How often would you say you feel anxious, irritable or angry?
• Have you had any thoughts of harming yourself or your baby?
• How much support do you have caring for your baby?
• How much stress are you otherwise under, such as financial or relationship problems?
• Have you been diagnosed with any other medical conditions, including mental illnesses such as depression or bipolar disorder?
• Have you been treated for other psychiatric symptoms or mental illness in the past? If yes, what type of therapy was most beneficial?

What you can do in the meantime
While you wait for your appointment with your doctor, try to open up to the people close to you and let them know you need help. If someone offers to baby-sit your baby so that you can take a break, take them up on it. If you can sleep, take a nap. Catch a movie with an old friend or meet a trusted relative for coffee. Breaking the isolation may help you feel human again.

If at any point you have thoughts of harming yourself or your baby, immediately give your baby to your partner or another loved one and call 911 or your local emergency assistance number.

Tests and diagnosis

The Diagnostic and Statistical Manual of Mental Disorders (DSM) considers postpartum depression a subtype of major depression. The DSM is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

According to the DSM, in order for postpartum depression to be diagnosed, signs and symptoms of major depression must develop within four weeks of giving birth.

Signs and symptoms of a major depressive episode include, in part:

• Depressed mood most of the day, nearly every day
• Reduced interest and pleasure in activities you used to enjoy
• Significant change in your appetite or unintended change in your weight
• Inability to sleep (insomnia) or excessive sleepiness (hypersomnia)
• Restlessness or notable slowed movements
• Fatigue or loss of energy
• Feelings of worthlessness
• Diminished ability to think, concentrate or make decisions
• Recurrent thoughts of death or suicide

To distinguish between a short-term case of the baby blues and a more severe form of depression, your doctor may ask you to complete a depression-screening questionnaire.

In addition, your doctor likely will perform blood tests to determine whether an underactive thyroid is contributing to your signs and symptoms.

Treatments and drugs

Treatment and recovery time vary, depending on the severity of your depression and your individual needs.

Baby blues
The baby blues usually fade on their own within a few days to weeks. In the meantime, get as much rest as you can. Accept help from family and friends. Connect with other new moms. Avoid alcohol, which can make mood swings worse. If you have an underactive thyroid, your doctor may prescribe thyroid medication.

Postpartum depression
Postpartum depression is often treated with counseling and medication.

• Counseling. It may help to talk through your concerns with a psychiatrist, psychologist or other mental health professional. Through counseling, you can find better ways to cope with your feelings, solve problems and set realistic goals. Sometimes, family or relationship therapy also is helpful.
• Antidepressants. Antidepressants are a proven treatment for postpartum depression. If you're breast-feeding, it's important to know that any medication you take will enter your breast milk. However, some antidepressants can be used during breast-feeding with little risk of side effects for your baby. Work with your doctor to weigh the potential risks and benefits of specific antidepressants.
• Hormone therapy. Estrogen replacement may help counteract the rapid drop in estrogen that accompanies childbirth, which may ease the signs and symptoms of postpartum depression in some women. Research on the effectiveness of hormone therapy for postpartum depression is limited, however. As with antidepressants, weigh the potential risks and benefits of hormone therapy with your doctor.

With appropriate treatment, postpartum depression usually goes away within a few months. In some cases, postpartum depression lasts up to a year. It's important to continue treatment after you begin to feel better, however. Stopping treatment too early may only lead to a relapse.

Postpartum psychosis
Postpartum psychosis requires immediate treatment, often in the hospital.

When your safety is assured, a combination of medications — such as antidepressants, antipsychotic medications and mood stabilizers — may be used to control your signs and symptoms. Sometimes electroconvulsive therapy (ECT) is recommended as well. During ECT, a small amount of electrical current is applied to your brain to produce brain waves similar to those that occur during a seizure. The chemical changes triggered by the electrical currents can reduce the symptoms of depression, especially when other treatments have failed or when you need immediate results.

Treatment for postpartum psychosis can challenge a mother's ability to breast-feed. Separation from the baby makes breast-feeding difficult, and some medications used to treat postpartum psychosis aren't recommended for women who are breast-feeding. If you're experiencing postpartum psychosis, a team of health care providers will help you work through these challenges.

Lifestyle and home remedies

Postpartum depression isn't generally a condition that you can treat on your own — but you can do some things for yourself that build on your treatment plan. In fact, taking good care of yourself can help speed your recovery.

• Make healthy lifestyle choices. Include physical activity, such as a walk with your baby, in your daily routine. Eat healthy foods, and avoid alcohol.
• Set realistic expectations. Don't pressure yourself to do everything. Scale back your expectations for the perfect household. Do what you can and leave the rest. Ask for help when you need it.
• Make time for yourself. If you feel like the world is coming down around you, take some time for yourself. Get dressed, leave the house, and visit a friend or run an errand. Or schedule some time alone with your partner.
• Avoid isolation. Talk with your partner, family and friends about how you're feeling. Ask other mothers about their experiences. Ask your doctor about local support groups for new moms or women who have postpartum depression.

Remember, the best way to take care of your baby is to take care of yourself.

Prevention

If you have a history of depression — especially postpartum depression — mention it to your doctor as soon as you find out you're pregnant. Your doctor will monitor you closely for signs and symptoms of depression. Sometimes mild depression can be managed with support groups, counseling or other therapies. In other cases, antidepressants are recommended — even during pregnancy.

After your baby is born, your doctor may recommend an early postpartum checkup to screen for signs and symptoms of postpartum depression. The earlier postpartum depression is detected, the earlier treatment can begin. If you have a history of postpartum depression, your doctor may recommend antidepressant treatment immediately after delivery.

Coping and support

Postpartum depression can have a ripple effect, causing emotional strain for everyone close to a new baby. When a new mother is depressed, the risk of depression in the baby's father may also increase. And new dads are already at increased risk of depression, whether or not their partner is affected.

Regardless, there's no question that the already stressful, exhausting period following a baby's birth is even much more difficult when depression is added to the mix. You may begin to resent a partner struggling with depression, especially when you're overworked and under-rested yourself. But remember: Depression is never anyone's fault, and it can't be fixed with a stiff upper lip or a positive attitude. Depression is a medical illness that needs treatment.

If you're having trouble coping with postpartum depression in your family, talk with a therapist. Depression is a treatable condition. The sooner you get help, the sooner you'll be fully equipped to help your partner and enjoy your new baby.