Postpartum depression

Overview

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

Most new moms experience postpartum "baby blues" after childbirth, which commonly include mood swings, crying spells, anxiety and difficulty sleeping. Baby blues usually begin within the first 2 to 3 days after delivery and may last for up to two weeks.

But some new moms experience a more severe, long-lasting form of depression known as postpartum depression. Sometimes it's called peripartum depression because it can start during pregnancy and continue after childbirth. Rarely, an extreme mood disorder called postpartum psychosis also may develop after childbirth.

Postpartum depression is not a character flaw or a weakness. Sometimes it's simply a complication of giving birth. If you have postpartum depression, prompt treatment can help you manage your symptoms and help you bond with your baby.

Symptoms

Symptoms of depression after childbirth vary, and they can range from mild to severe.

Baby blues symptoms

Symptoms of baby blues — which last only a few days to a week or two after your baby is born — may include:

• Mood swings
• Anxiety
• Sadness
• Irritability
• Feeling overwhelmed
• Crying
• Reduced concentration
• Appetite problems
• Trouble sleeping

Postpartum depression symptoms

Postpartum depression may be mistaken for baby blues at first — but the symptoms are more intense and last longer. These may eventually interfere with your ability to care for your baby and handle other daily tasks. Symptoms usually develop within the first few weeks after giving birth. But they may begin earlier — during pregnancy — or later — up to a year after birth.

Postpartum depression symptoms may include:

• Depressed mood or severe mood swings
• Crying too much
• Difficulty bonding with your baby
• Withdrawing from family and friends
• Loss of appetite or eating much more than usual
• Inability to sleep, called insomnia, or sleeping too much
• Overwhelming tiredness or loss of energy
• Less interest and pleasure in activities you used to enjoy
• Intense irritability and anger
• Fear that you're not a good mother
• Hopelessness
• Feelings of worthlessness, shame, guilt or inadequacy
• Reduced ability to think clearly, concentrate or make decisions
• Restlessness
• Severe anxiety and panic attacks
• Thoughts of harming yourself or your baby
• Recurring thoughts of death or suicide

Untreated, postpartum depression may last for many months or longer.

Postpartum psychosis

With postpartum psychosis — a rare condition that usually develops within the first week after delivery — the symptoms are severe. Symptoms may include:

• Feeling confused and lost
• Having obsessive thoughts about your baby
• Hallucinating and having delusions
• Having sleep problems
• Having too much energy and feeling upset
• Feeling paranoid
• Making attempts to harm yourself or your baby

Postpartum psychosis may lead to life-threatening thoughts or behaviors and requires immediate treatment.

Postpartum depression in the other parent

Studies show that new fathers can experience postpartum depression, too. They may feel sad, tired, overwhelmed, anxious, or have changes in their usual eating and sleeping patterns. These are the same symptoms that mothers with postpartum depression experience.

Fathers who are young, have a history of depression, experience relationship problems or are struggling financially are most at risk of postpartum depression. Postpartum depression in fathers — sometimes called paternal postpartum depression — can have the same negative effect on partner relationships and child development as postpartum depression in mothers can.

If you're a partner of a new mother and are having symptoms of depression or anxiety during your partner's pregnancy or after your child's birth, talk to your health care provider. Similar treatments and supports provided to mothers with postpartum depression can help treat postpartum depression in the other parent.

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 if you experience any symptoms of postpartum baby blues or postpartum depression, call your primary health care provider or your obstetrician or gynecologist and schedule an appointment. If you have symptoms that suggest you may have postpartum psychosis, get help immediately.

It's important to call your provider as soon as possible if the symptoms of depression have any of these features:

• 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.

If you have suicidal thoughts

If at any point you have thoughts of harming yourself or your baby, immediately seek help from your partner or loved ones in taking care of your baby. Call 911 or your local emergency assistance number to get help.

Also consider these options if you're having suicidal thoughts:

• Seek help from a health care provider.
• Call a mental health provider.
• Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential. The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).
• Reach out to a close friend or loved one.
• Contact a minister, spiritual leader or someone else in your faith community.

Helping a friend or loved one

People with depression may not recognize or admit that they're depressed. They may not be aware of signs and symptoms of depression. If you suspect that a friend or loved one has postpartum depression or is developing postpartum psychosis, help them seek medical attention immediately. Don't wait and hope for improvement.

Causes

There is no single cause of postpartum depression, but genetics, physical changes and emotional issues may play a role.

• Genetics. Studies show that having a family history of postpartum depression — especially if it was major — increases the risk of experiencing postpartum depression.
• Physical changes. After childbirth, a dramatic drop in the hormones estrogen and progesterone in your body 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.
• Emotional issues. 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, struggle with your sense of identity or feel that you've lost control over your life. Any of these issues can contribute to postpartum depression.

Risk factors

Any new mom can experience postpartum depression and it can develop after the birth of any child, not just the first. However, your risk increases if:

• You have a history of depression, either during pregnancy or at other times.
• You have bipolar disorder.
• You had postpartum depression after a previous pregnancy.
• You have family members who've had depression or other mood disorders.
• You've experienced stressful events during the past year, such as pregnancy complications, illness or job loss.
• Your baby has health problems or other special needs.
• You have twins, triplets or other multiple births.
• You have difficulty breastfeeding.
• You're having problems in your relationship with your spouse or partner.
• You have a weak support system.
• You have financial problems.
• The pregnancy was unplanned or unwanted.

Complications

Left untreated, postpartum depression can interfere with mother-child bonding and cause family problems.

• For mothers. Untreated postpartum depression can last for months or longer, sometimes becoming an ongoing depressive disorder. Mothers may stop breastfeeding, have problems bonding with and caring for their infants, and be at increased risk of suicide. Even when treated, postpartum depression increases a woman's risk of future episodes of major depression.
• For the other parent. 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 other parent may also increase. And these other parents may already have an increased risk of depression, whether or not their partner is affected.
• For children. Children of mothers who have untreated postpartum depression are more likely to have emotional and behavioral problems, such as sleeping and eating difficulties, crying too much, and delays in language development.

Prevention

If you have a history of depression — especially postpartum depression — tell your health care provider if you're planning on becoming pregnant or as soon as you find out you're pregnant.

• During pregnancy, your provider can monitor you closely for symptoms of depression. You may complete a depression-screening questionnaire during your pregnancy and after delivery. Sometimes mild depression can be managed with support groups, counseling or other therapies. In other cases, antidepressants may be recommended — even during pregnancy.
• After your baby is born, your provider may recommend an early postpartum checkup to screen for symptoms of postpartum depression. The earlier it's found, the earlier treatment can begin. If you have a history of postpartum depression, your provider may recommend antidepressant treatment or talk therapy immediately after delivery. Most antidepressants are safe to take while breastfeeding.

Diagnosis

Your health care provider will usually talk with you about your feelings, thoughts and mental health to help determine if you have a short-term case of postpartum baby blues or a more severe form of depression. Don't be embarrassed — postpartum depression is common. Share your symptoms with your provider so that you and your provider can create a useful treatment plan.

As part of your evaluation, your health care provider may do a depression screening, including having you fill out a questionnaire. Your provider may order other tests, if needed, to rule out other causes for your symptoms.

Treatment

Treatment and recovery time vary, depending on how severe your depression is and what your individual needs are. If you have an underactive thyroid or an underlying illness, your health care provider may treat those conditions or refer you to the appropriate specialist. Your health care provider may also refer you to a mental health professional.

Baby blues

The baby blues usually fade on their own within a few days to 1 to 2 weeks. In the meantime:

• Get as much rest as you can.
• Accept help from family and friends.
• Connect with other new moms.
• Create time to take care of yourself.
• Avoid alcohol and recreational drugs, which can make mood swings worse.
• Ask your health care provider about getting help from a health professional called a lactation consultant if you're having problems with producing milk or breastfeeding.

Postpartum depression

Postpartum depression is often treated with psychotherapy — also called talk therapy or mental health counseling — medicine or both.

• Psychotherapy. It may help to talk through your concerns with a psychiatrist, psychologist or other mental health professional. Through therapy, you can find better ways to cope with your feelings, solve problems, set realistic goals and respond to situations in a positive way. Sometimes family or relationship therapy also helps. Examples of therapies used for postpartum depression include cognitive-behavioral therapy (CBT) and interpersonal psychotherapy.
• Antidepressants. Your health care provider may recommend an antidepressant. If you're breastfeeding, any medicine you take will enter your breast milk. However, most antidepressants can be used during breastfeeding with little risk of side effects for your baby. Work with your provider to weigh the potential risks and benefits of specific antidepressants.
• Other medicines. When needed, other medicines may be added to your treatment. For example, if you have postpartum depression that includes severe anxiety or insomnia, an antianxiety medicine may be recommended for a short time.

Brexanolone (Zulresso) is the first drug approved by the U.S. Food and Drug Administration specifically for postpartum depression in adult women. Brexanolone slows the rapid drop of certain hormones after childbirth that may lead to postpartum depression. Potential serious side effects require a stay in a health care facility and monitoring by a health care provider while receiving the medicine through a vein over 60 hours. Because of this, the treatment is not yet widely available.

Research continues on an oral medicine for postpartum depression with promising results. The medicine being studied works in a way similar to brexanolone. But it could be taken daily as a pill and may not have the same serious side effects.

With appropriate treatment, postpartum depression symptoms usually improve. In some cases, postpartum depression can continue and become long term, which is called chronic depression. It's important to continue treatment after you begin to feel better. Stopping treatment too early may lead to a relapse.

Postpartum psychosis

Postpartum psychosis requires immediate treatment, usually in the hospital. Treatment may include:

• Medicines. Treatment may require a combination of medicines — such as antidepressants, antipsychotic medicines, mood stabilizers and benzodiazepines — to control your signs and symptoms.
• Electroconvulsive therapy (ECT). If your postpartum depression is severe and you experience postpartum psychosis, ECT may be recommended if symptoms do not respond to medicine. ECT is a procedure in which small electrical currents are passed through the brain, intentionally starting a brief seizure. ECT seems to cause changes in brain chemistry that can reduce the symptoms of psychosis and depression, especially when other treatments have been unsuccessful.

A hospital stay during treatment for postpartum psychosis can challenge a mother's ability to breastfeed. This separation from the baby makes breastfeeding difficult. Your health care provider can recommend support for lactation — the process of producing breast milk — while you're in the hospital.

Lifestyle and home remedies

In addition to professional treatment, you can do some things for yourself that build on your treatment plan and help speed recovery.

• Make healthy lifestyle choices. Include physical activity, such as a walk with your baby, and other forms of exercise in your daily routine. Try to get enough rest. 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.
• Make time for yourself. Take some time for yourself and get out of the house. That may mean asking a partner to take care of the baby or arranging for a sitter. Do something you enjoy, such as a hobby or some form of entertainment. You might also schedule some time alone with your partner or friends.
• Avoid isolation. Talk with your partner, family and friends about how you're feeling. Ask other mothers about their experiences. Breaking the isolation may help you feel human again.
• Ask for help. Try to open up to the people close to you and let them know you need help. If someone offers to babysit, take them up on it. If you can sleep, take a nap, or maybe you can see a movie or meet for coffee with friends. You may also benefit from asking for help with parenting skills that can include caregiving techniques to improve your baby's sleep and soothe fussing and crying.

Remember, taking care of your baby includes taking care of yourself.

Coping and support

The already stressful, exhausting period following a baby's birth is more difficult when depression occurs. But remember, postpartum depression is never anyone's fault. It's a common medical condition that needs treatment.

So, if you're having trouble coping with postpartum depression, talk with your health care provider. Ask your provider or a therapist about local support groups for new moms or women who have postpartum depression.

The sooner you get help, the sooner you'll be fully equipped to cope with depression and enjoy your new baby.

Preparing for an appointment

After your first appointment, your health care provider may refer you to a mental health provider who can create the right treatment plan with you. You may want to find a trusted family member or friend to join you for your appointment to help you remember all the information discussed.

What you can do

Before your appointment, make a list of:

• Any symptoms you've been experiencing and for how long.
• All of your medical issues, including physical health conditions or mental health conditions, such as depression.
• All the medicines you take, including prescription and over-the counter medicines, as well as vitamins, herbs and other supplements, and the doses.
• Questions to ask your provider.

Questions to ask may include:

• What is my diagnosis?
• What treatments are likely to help me?
• What are the possible side effects of the treatments you're suggesting?
• How much and how soon do you expect my symptoms to improve with treatment?
• Is the medicine you're prescribing safe to take while breastfeeding?
• 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 printed materials that I can have? What websites do you recommend?

Don't hesitate to ask any other questions during your appointment.

What to expect from your doctor

Your health care provider or mental health provider may ask you some questions, such as:

• What are your symptoms, and when did they start?
• 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 in caring for your baby?
• Are there other major stressors in your life, such as financial or relationship problems?
• Have you been diagnosed with any other medical conditions?
• Have you ever been diagnosed with any mental health conditions, such as depression or bipolar disorder? If so, what type of treatment helped the most?

Your provider may ask additional questions based on your responses, symptoms and needs. Preparing for questions will help you make the most of your appointment.