After childbirth, women’s bodies go through significant changes in a very short time. On top of the physical changes, the entire structure of the family and home life is also changing. A few days after giving birth, many women have heightened feelings. They may spend time crying, or they may have feelings of anger towards their new baby or their family. These feelings often go away in a few days. For about 13 to 20 percent of women, however, these feelings persist, and may be accompanied by other symptoms of depression. When this occurs, it may indicate postpartum depression.
When Does Postpartum Depression Start?
In most cases, symptoms of postpartum depression begin within the first three months after a woman has given birth, although symptoms can also take up to a year to become evident. This wide time frame during which postpartum depression can develop is one of the reasons why it can go unrecognized, especially in a woman who has given birth more than three months ago.
What Causes Postpartum Depression?
Postpartum depression is the most common complication of childbirth. The exact causes of postpartum depression are not well understood, but possible causes include the hormonal changes that women go through after the birth of a child and a personal or family history of psychiatric disorders.
Women’s bodies go through significant changes in the days after giving birth, and the fluctuation of hormones (a drop in the levels of estrogen and progesterone) may cause a change in mood. Some women appear to be more sensitive to these changes than others.
Non-hormonal factors that could contribute to the development of postpartum depression include:
Age: Women under the age of 20 are more likely to develop postpartum depression.
Alcohol and substance abuse: Women who abuse drugs or alcohol, or who have done so in the past, are at an increased risk.
Unintended pregnancy: Women whose pregnancies are not planned experience higher rates of postpartum depression. This effect can continue for a long time, and women who have unintended pregnancies are still at twice the risk of developing postpartum depression even 12 months after giving birth.
Prior diagnosis of mood disorder: Women who have been diagnosed with bipolar disorder, depression, or other psychiatric disorders are at higher risk.
Stress: A significant stressful event, such as a death in the family, premature delivery, or health problems in the baby can also predispose a woman to postpartum depression.
Family history of psychiatric disorders: Having a close family member who has a psychiatric or a mood disorder can also be a risk factor.
Socioeconomic status: Women who have income or housing problems during the postpartum period develop postpartum depression at a higher rate than women who do not.
Support system: Women who are single, who do not have friends and a strong family support system, or who have a poor relationship with their partner are at a higher risk of postpartum depression.
Symptoms Of Postpartum Depression
The symptoms of postpartum depression are similar to those of clinical depression. During the postpartum period, symptoms of depression that go away on their own may be a result of the “baby blues,” but those that persist or that begin more than a month after giving birth could be due to postpartum depression.
Symptoms of postpartum depression include:
- Change in appetite or a lack of interest in eating
- Disinterest in favorite activities
- Insomnia or excessive sleepiness
- Inability to concentrate
- Inability to care for the baby
- Extreme anxiety
- Fear of being alone with the baby
- Feelings of guilt, worthlessness, shame, or inadequacy
- Low energy or incapacitating fatigue
- Mood swings
- No interest in sex
- Severe irritability
- Suicidal thoughts
- Thoughts about harming the baby
- Trouble bonding with the baby
- Withdrawing or becoming disconnected from family and friends
Postpartum Depression Or “Baby Blues”?
After giving birth, 80 percent of women experience the Baby Blues. Baby Blues are considered normal and differ from postpartum depression in several ways. Baby Blues typically begin about four days after giving birth, but symptoms generally subside within 10 to 14 days, and the symptoms are milder than those of postpartum depression. Women who are merely suffering from Baby Blues also don’t have problems caring for themselves or their babies, while those with depression often do.
Symptoms of baby blues can include:
- Anxiety
- Confusion
- Crying often or easily
- Feeling stressed
- Feelings of sadness
- Irritability
Postpartum Depression Or Postpartum Psychosis?
As awareness of postpartum depression has grown, another, more severe form of this disorder has now also been recognized. Postpartum psychosis is more rare than postpartum depression, but is far more serious and is considered a psychiatric emergency. Women with postpartum psychosis may, in fact, do harm to themselves or their babies. Postpartum psychosis is often associated with a personal history of bipolar disorder or schizoaffective disorder.
The symptoms of postpartum psychosis include:
- Delusions
- Disorganized behavior (such as neglecting the baby)
- Hallucinations
- Lack of insight into the change in behavior
- Suicidal thoughts
- Unusual behavior
Diagnosis Of Postpartum Depression
There are no diagnostic tests that can confirm postpartum depression, but there are screening tools that can help aid diagnosis. A healthcare provider will administer the screening test, which includes a series of questions, and then take a careful family history. Important factors that could be included in the family history include any recent stressors, the health of the baby, and any other events that are going on at home or in the family. A physical exam is also often performed, and a blood test may be taken. The healthcare professional will be looking for any potential physical causes for the symptoms of depression, such as a thyroid imbalance.
Treatment of Postpartum Depression
Treating postpartum depression is important because left untreated, the symptoms may become worse. Treatment for postpartum depression may include psychotherapy, interpersonal therapy, cognitive behavior therapy, and drug therapy.
Psychotherapy: Psychotherapy, also sometimes called talk therapy, can be helpful in treating postpartum depression. For women who are breastfeeding or for whom drug therapy is not appropriate, this can be an effective treatment. Psychotherapy is done by a therapist, and may last from a few weeks to several months. Sometimes family members or partners may also be included in psychotherapy sessions.
Interpersonal therapy: In this type of therapy, a therapist helps the patient not only to understand the nature of postpartum depression, but also to cope with and to solve the problems faced by most new mothers. During sessions, new mothers will learn how to work through the issues that are occurring in their interpersonal relationships, such as with their partner or other family members. Patients are active participants in this therapy, and are encouraged to use skills learned in therapy to resolve conflicts and improve communication with family members.
Cognitive behavioral therapy: This type of therapy can help the patient change their thought patterns in order to better cope with problem thoughts that are negatively affecting their mood. During cognitive behavioral therapy, a new mother can learn to recognize negative thought patterns and replace them with more productive thoughts. The therapist and patient set short-term and long-term goals that can be achieved during the course of therapy and afterward. In many cases, this type of therapy lasts for anywhere from 14 to 16 weeks, and can be done either in group or in individual sessions.
Drug therapy: Several types of drugs are typically used to treat postpartum depression, including selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and atypical antidepressants. SSRIs are typically prescribed first, but if they are not effective, atypical antidepressants and TCAs may be used. MAOIs are sometimes still used, but they are not typically prescribed because they can interact with other drugs, and even with some foods. Drug therapy with antidepressants may take several weeks to be effective, but 60 percent of patients do respond.
Other support: New mothers may also benefit from non-medical therapy such as increased support at home. A mother’s helper, baby nurse, or parenting classes may help with the challenges of caring for a newborn. Mothers are also encouraged to communicate their feelings with family members, to make time for activities they enjoy, to spend time away from the baby and alone with their partners, and to avoid making major life decisions. Getting proper rest and nutrition is also beneficial to improving mood. Joining a support group for new mothers or for mothers with postpartum depression may also help.
Can Postpartum Depression Be Prevented?
There is no proven strategy for preventing postpartum depression, but reducing risk factors by maintaining a good support system and a stable home environment could help lessen the severity of symptoms.
When To Call Your Doctor
Anyone who suspects postpartum depression in themselves or in a loved one should seek help right away. Some warning signs that should be discussed with a healthcare provider include:
- Any symptoms of depression
- Baby blues that persist longer than two weeks
- Inability to complete tasks at home or at work
- Inability to care for oneself or the baby
- Thoughts of harming the baby
Don’t wait to seek help or delay discussing any concerns with a healthcare provider. With postpartum depression, prompt and effective treatment can help facilitate a better outcome and the resolution of symptoms.