What Is Postpartum Depression?

Postpartum depression is a serious mental health condition that can occur in the weeks and months following the birth of a child.

What Causes Postpartum Depression?

While every case of postpartum depression has a different combination of factors that lead to it, researchers believe that, in general, hormones, neurochemistry, and life history play roles in the development of the condition, which affects an estimated 14 to 20 percent of women. And those numbers may be even higher, as experts think that the condition is often underreported.

The risk of postpartum depression is higher among people who have a history of mental health issues, including depression, anxiety, or bipolar disorder. One study found that the risk was more than 20 times higher for women with a history of depression. Having one episode of postpartum depression can also increase your chances of having another.

But the condition isn’t permanent. With time and help, both medical and otherwise, you can return to your normal routines.

What Role Do Your Life Circumstances Play?

Pregnancy and birth are intensely emotional events. These milestones can bring joy, but they can also bring challenges that make you feel sad, tired, and anxious. These feelings are normal, and in fact, they have a name: the baby blues.

By some estimates, up to 85 percent of mothers feel some degree of sadness after their baby is born. But while the baby blues rarely last beyond a week or two, postpartum depression symptoms can persist for months.

“If symptoms go beyond a two-week period, and the mother is still experiencing problems, that will usually lead to a diagnosis of postpartum depression,” says Diane Young, MD, a staff physician in the department of regional obstetrics and gynecology at the Cleveland Clinic who is based in Willoughby Hills, Ohio.

But these feelings may be exacerbated and may lead to postpartum depression if there are past or current stresses that make you feel that you lack support and stability.

Your relationship with your spouse or partner may be difficult, or your finances may be unstable. Your pregnancy or delivery might have been hard, or you have a high-need newborn. Maybe you lost a parent while you were pregnant. You may be a very young mother or have experienced trauma and abuse as a child.

What Role Do Your Hormones Play?

External circumstances like these might also make you more vulnerable to the hormonal disruptions that occur after birth. During pregnancy, estrogen and progesterone levels increase to fortify both the uterus and the placenta. But delivery alters the levels of those and other hormones.

“After giving birth, hormone concentrations drop by 100 fold within a matter of days,” says Katherine Wisner, MD, the Norman and Helen Asher Professor of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine in Chicago. The sudden disruption in hormone levels may create disturbances in mood, particularly in women who have prior histories of depression or anxiety.

Periods of hormonal fluctuation, such as menstrual cycles and perimenopause, are associated with major depressive episodes, says Dr. Wisner. It could be that the fluctuations that occur during and after pregnancy may affect certain neurotransmitters or affect brain function in other ways. “This massive drop in hormones, along with the initiation of breast-feeding, disrupted sleep, and adapting to motherhood all contribute to the risk for developing depression,” she adds.

There is also research suggesting that both pregestational and gestational diabetes may increase the risk of the condition.

Can Men Suffer From Postpartum Depression?

Yes, men can suffer from postpartum depression, too. Studies have found that an estimated 4 to 10 percent of fathers suffer from depression in the first year after birth. In one study in particular, which looked at more than 1,700 fathers with 1-year-old children, researchers also found that depression had a negative effect on parenting: Depressed dads were more likely to spank their children and less likely to read to them.

What Is Postpartum Psychosis?

In rare cases — 1 or 2 out of 1,000 births — a new mother will experience postpartum psychosis. The symptoms are more severe than in postpartum depression, and they come on rapidly, usually within the first few days of giving birth.

Those suffering from postpartum psychosis may have bizarre, grandiose thoughts or delusions, and their moods may swing from one extreme to another. They may also hallucinate, hear voices, or see things that aren’t there, and may have recurring thoughts of harming themselves or their baby.

In some cases of postpartum psychosis, there may be a previous history of mental illness, such as bipolar disorder, schizophrenia, or schizoaffective disorder.

If you notice any of these changes in someone you love or are close to, it’s important to seek help right away so that both mother and child remain safe.

What Are the Risk Factors of Postpartum Depression?

Any parent can develop postpartum depression, but the following factors may increase your risk:

• Personal or family history of depression, anxiety, or another mental illness
• Previous postpartum depression
• History of severe premenstrual syndrome
• Sleep deprivation
• Chronic pain
• History of fertility treatments or miscarriage
• Abrupt discontinuation of breast-feeding
• History of trauma or abuse
• Traumatic or disappointing birthing experience
• Poor support system
• Stresses, such as marital or financial
• Substance abuse
• Having children while very young

What Are the Symptoms of Postpartum Depression?

Symptoms of postpartum depression vary from person to person. It’s unlikely that you will experience all of them, but these symptoms are included:

• Irritability or anger
• Anxiety
• Mood swings
• Sleep problems, such as insomnia or excessive sleep
• Appetite changes
• Suicidal thoughts
• Lack of interest in the baby
• Feeling disconnected from the baby
• Thoughts of harming the baby
• Sluggishness
• Exhaustion
• Memory loss
• Sense of guilt or shame
• Sense of doom
• Scary or odd thoughts that repeat in your mind

How Do You Treat Postpartum Depression?

Your medical practitioner may detect signs that you are at risk for postpartum depression during your monthly prenatal visits or during the typical six-week appointment after your baby is born. Often with postpartum depression, signs of depression emerge during pregnancy, so if you do notice any of the above symptoms before you deliver, tell your doctor.

Regardless of the extent of your symptoms, it’s important to be frank with your doctor so that you can get proper treatment during this important time in your life and the life of your baby.

If you develop postpartum depression, your doctor may suggest one or more treatment options:

Antidepressants You may be prescribed an antidepressant even before you have your baby, one that is safe to take during pregnancy and while breast-feeding. After your pregnancy and if you are not breast-feeding, you will have a wider array of antidepressant options, which you may need to take for six months or longer.

Talk Therapy It’s possible you won’t need medication at all, if you find a psychologist who can provide a safe emotional outlet and who is trained to help you find ways to manage your emotions.

Thyroid Medication Sometimes this type of depression is a sign that your thyroid hormone level is too low. Your doctor can check the level with a simple blood test and treat you with medication to bring your thyroid back into balance.

How Do You Cope With Postpartum Depression?

In addition to psychotherapy and medications, the following strategies will help you during treatment:

Make time for self-care. It’s important for people who have postpartum depression to take time to do things like eating healthy meals, exercising, and — perhaps most important — getting enough sleep.

Be patient. Treatment can help, but it may take some time before you feel like yourself again.

Say yes to caregiving help. Take people up on their offers to help. Your friends and family members can help around the house, watch the baby so you can sleep, run errands for you, or be there to listen when you need to talk.

Find a support group. It helps to be around other people who have experienced postpartum depression and can share experiences and coping skills.

Wean slowly. Discontinuing breast-feeding can bring on a hormonal change. Some doctors recommend that you wean slowly if you are going to stop breast-feeding.

Consider alternative treatments. Complementary and alternative therapies may help, though more research confirming their benefits is needed. Light therapy, omega-3 supplements, aromatherapy, and music therapy are among the approaches that have shown some effectiveness and promise.