Postpartum Depression

Overview

What is postpartum depression?

Postpartum depression is a complex mix of physical, emotional, and behavioral changes that occur after giving birth that are attributed to the chemical, social, and psychological changes associated with having a baby.

Who is affected by postpartum depression?

Postpartum depression is common. As many as 50 to 75% of new mothers experience the "baby blues" after delivery. Up to 15% of these women will develop a more severe and longer-lasting depression, called postpartum depression, after delivery. One in 1,000 women develop the more serious condition called postpartum psychosis.

What are the types of postpartum depression?

  • Postpartum blues: Better known as the "baby blues," this condition affects between 50 and 75% of women after delivery. If you are experiencing the baby blues, you will have frequent, prolonged bouts of crying for no apparent reason, sadness, and anxiety. The condition usually begins in the first week (one to four days) after delivery. Although the experience is unpleasant, the condition usually subsides within two weeks without treatment. All you'll need is reassurance and help with the baby and household chores.
  • Postpartum depression: This is a far more serious condition than postpartum blues, affecting about 1 in 10 new mothers. If you've had postpartum depression before, your risk increases to 30%. You may experience alternating highs and lows, frequent crying, irritability, and fatigue, as well as feelings of guilt, anxiety, and inability to care for your baby or yourself. Symptoms range from mild to severe and may appear within days of the delivery or gradually, even up to a year later. Although symptoms can last from several weeks up to a year, treatment with psychotherapy or antidepressants is very effective.
  • Postpartum psychosis: This is an extremely severe form of postpartum depression and requires emergency medical attention. This condition is relatively rare, affecting only 1 in 1,000 women after delivery. The symptoms generally occur quickly after delivery and are severe, lasting for a few weeks to several months. Symptoms include severe agitation, confusion, feelings of hopelessness and shame, insomnia, paranoia, delusions or hallucinations, hyperactivity, rapid speech, or mania. Postpartum psychosis requires immediate medical attention since there is an increased risk of suicide and risk of harm to the baby. Treatment will usually include admission to hospital for the mother and medicine.

What factors increase my risk of being depressed after the birth of my child?

  • Having a personal or family history of depression or premenstrual dysphoric disorder (PMDD).
  • Limited social support.
  • Marital conflict.
  • Ambivalence about the pregnancy.
  • A history of depression during pregnancy — 50% of depressed pregnant women will have postpartum depression.

Symptoms and Causes

What causes postpartum depression?

More research is needed to determine the link between the rapid drop in hormones after delivery and depression. The levels of estrogen and progesterone, the female reproductive hormones, increase tenfold during pregnancy but drop sharply after delivery. By three days postpartum, levels of these hormones drop back to pre-pregnant levels. In addition to these chemical changes, the social and psychological changes associated with having a baby create an increased risk of postpartum depression.

If you have had any of the following symptoms, please notify your healthcare provider right away:

  • Thoughts of harming yourself or your baby.
  • Recurrent thoughts of death or suicide.
  • Depressed mood for most of the day, nearly every day for the last two weeks.
  • Feeling anxious, guilty, hopeless, scared, panicked or worthless.
  • Difficulty thinking, concentrating making decisions, or dealing with everyday situations.
  • Loss of interest or pleasure in most of the activities during the day nearly everyday for the last two weeks.

If you do have any of the previous symptoms, your healthcare provider may ask you the following two questions:

  1. Over the past two weeks, have you felt down, depressed, or hopeless?
  2. Over the past two weeks, have you felt little interest or pleasure in doing things?

If you answer yes to either one, your healthcare provider will administer a more in-depth depression screening.

Management and Treatment

How is postpartum depression treated?

Postpartum depression is treated differently depending on the type and severity of the woman’s symptoms. Treatment options include anti-anxiety or antidepressant medicines, psychotherapy, and support group participation.

In the case of postpartum psychosis, medicines used to treat psychosis are usually added. Hospital admission is also usually necessary.

If you are breastfeeding, don’t assume that you can't take medicines for depression, anxiety, or even psychosis. Talk to your healthcare provider about your options.

Prevention

Can postpartum depression be prevented?

Here are some tips that can help prevent, or help you cope with postpartum depression:

  • Be realistic about your expectations for yourself and your baby.
  • Limit visitors when you first go home.
  • Ask for help — let others know how they can help you.
  • Sleep or rest when your baby sleeps.
  • Exercise — take a walk and get out of the house for a break.
  • Screen your phone calls.
  • Follow a sensible diet; avoid alcohol and caffeine.
  • Keep in touch with your family and friends — do not isolate yourself.
  • Foster your relationship with your partner — make time for each other.
  • Expect some good days and some bad days.

Outlook / Prognosis

What is the outlook for women with postpartum depression?

With professional help, almost all women who experience postpartum depression are able to overcome their symptoms.

Living With

A new mom should seek professional help when:

  • Symptoms persist beyond two weeks.
  • She is unable to function normally; she can’t cope with everyday situations.
  • She has thoughts of harming herself or her baby.
  • She is feeling extremely anxious, scared, and panicked most of the day.

Last reviewed by a Cleveland Clinic medical professional on 01/01/2018.

References

  • March of Dimes Foundation. Accessed 2/11/2019.Postpartum depression. (http://www.marchofdimes.org/pregnancy/postpartum-depression.aspx)
  • National Institute of Mental Health. Accessed 2/11/2019.Postpartum depression facts. (http://www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml)

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