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Pregnancy is a time of fluctuating hormone levels and mood swings, but those swings don’t just go away as soon as someone gives birth. That time after giving birth is called the postpartum period, and it can be full of just as many, if not more, changes for a woman’s physical and emotional health. Between pregnancy, delivery, and bringing home a new baby, all those changes can lead to many challenges.
It’s normal to expect some mood swings in the postpartum period. However, if those symptoms start to linger or feel severe, it may be a sign of postpartum depression.
What is postpartum depression?
Postpartum depression (PPD), sometimes called perinatal depression, is a type of depression that appears within the first year after childbirth and affects around one in seven women (Mughal, 2020).
The birth of a child can trigger a wide range of emotions, and the physical demands of pregnancy, labor, and breastfeeding can take a toll.
It’s common for some signs of mood changes to happen while recovering from childbirth. It’s when those symptoms continue or are severe that it may be a sign of postpartum depression.
Signs and symptoms of postpartum depression
Postpartum depression has similar symptoms to other types of depressive disorders. The major difference with PPD is the symptoms begin after childbirth.
Some of the common symptoms of postpartum depression include (Mughal, 2020):
- Low mood and feelings of sadness
- Loss of interest
- Sleep changes
- Difficulty moving
- Fatigue and loss of energy
- Guilt and feelings of worthlessness
- Trouble concentrating or feeling indecisive
- Changes in weight or appetite
To be diagnosed with PPD, the symptoms must last for longer than two weeks, and you have to experience at least five symptoms. Typically, the symptoms of PPD appear within the first six weeks after delivery.
8 types of depression: symptoms and treatments
Types of postpartum depression
The types of PPD vary based on which symptoms are present and how severe the symptoms are. Here are four different types of postpartum depression.
The postpartum blues, or “baby blues,” is a more mild form of PPD. Women experience many changing hormone levels during pregnancy and childbirth. For many women, this causes mood swings and sadness for the first couple of weeks after childbirth.
During the “baby blues,” women may experience (Mughal, 2020):
- Crying bouts
- Sleep disturbances
- Appetite changes
While the “baby blues” symptoms may be distressing, it doesn’t interfere with daily activities or caring for your new baby.
PPD has more severe symptoms than the “baby blues” and often interferes with caring for the infant and daily life. The depression symptoms have to last for longer than two weeks for a woman to be diagnosed with PPD.
During follow-up appointments with your OB/GYN, they will likely have you complete women’s health and depression screening for PPD for about six months after childbirth.
Untreated postpartum depression often leaves women feeling disconnected from social support and can lead to poor bonding between the mother and the infant (Mughal, 2020). PPD symptoms can often improve on their own, and research suggests symptoms may last around 3–6 months (Vliegen, 2014). However, without treatment, PPD symptoms sometimes linger for longer than six months.
Persistent depressive disorder: long term depression
Postpartum psychosis is the most severe form of postpartum depression. It is considered a psychiatric emergency because of the potential risk to the mother and child.
Symptoms specific to postpartum psychosis include (Mughal, 2020):
- Lack of sleep for multiple nights
- Unusual behavior
- Suicidal thoughts or thoughts of harming the infant
People experiencing postpartum psychosis are often hospitalized to help them get treatment more quickly and protect the health of the mother and child. If you suspect you or a loved one may have postpartum psychosis, it’s important to get help immediately.
Paternal postpartum depression
While postpartum depression is more common in new mothers, it can also affect the father. It’s estimated that around 10% of men experience postpartum depression (Paulson, 2010).
The cause of paternal postpartum depression is poorly understood. Still, research shows fathers are at high risk for paternal PPD if the mother is experiencing depression. The symptoms of paternal PPD are the same as those in women (Paulson, 2010).
Risk factors for postpartum depression
The exact cause of PPD is unknown. It’s believed the changes in reproductive hormones in women (estrogen, estradiol, progesterone, prolactin, and oxytocin) may disrupt the neurotransmitters in women who are at risk for PPD (Mughal, 2020).
While researchers are still working out the exact cause of PPD, they have found some factors associated with an increased risk for PPD. Risk factors for postpartum depression include:
- History of depression and anxiety
- Family history of depression
- History of trauma or abuse
- High-risk pregnancy
- Cesarean section
- Preterm infant
- Cigarette smoking
- Poor sleep
- History of bipolar disorder
Antepartum depression: symptoms, causes, and treatment
Treatment for postpartum depression
If your healthcare provider thinks you’re experiencing PPD, they will likely refer you to a mental health professional. The typical treatment for PPD is generally medication, psychotherapy, or a combination of the two (Mughal, 2020).
Antidepressant medications may be prescribed to help manage the symptoms of PPD. Among the common medications prescribed to treat PPD are selective serotonin reuptake inhibitors (SSRIs). If you are breastfeeding, your healthcare provider will help you find a medication plan that is safe for your new baby (Mughal, 2020).
With psychotherapy, sometimes called therapy or counseling, a trained mental health professional can help you process your emotions and develop coping skills to help you manage the stress of raising a baby and the postpartum period.
In severe cases of PPD that don’t respond to treatment or with postpartum psychosis, your healthcare provider may recommend electroconvulsive therapy (ECT). ECT is a procedure done under anesthesia that triggers a small seizure to stimulate the brain and help correct dopamine imbalances (Salik, 2020).
If you or a loved one is experiencing suicidal thoughts or thoughts of self-harm, seek immediate medical attention or call the National Suicide Prevention Lifeline, a national free hotline that’s available 24/7 at 1-800-273-8255. This helpline is designed to provide support and connect people with local services to help them through a mental crisis.
How to prevent postpartum depression
PPD too often goes unacknowledged and undiagnosed (Pearlstein, 2009). Often, new moms may resist seeking treatment because they fear family member’s reactions. Because it often goes untreated, there’s been an increase in efforts to provide health information about prevention and screening for depression.
Research suggests that healthy habits around physical activity, nutrition, sleep, and stress management can improve depressive symptoms and help prevent PPD (Mughal, 2020).
Birth control and depression: what you need to know
Joining a new mom support group may help to provide added emotional support from other new mothers going through the same experiences as you.
If you begin to notice persistent changes in your mood or other symptoms of depression, don’t hesitate to ask for help. The earlier you get support and professional help, the better you will be able to manage your symptoms and feel better.
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- Paulson, J. F., & Bazemore, S. D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA, 303(19), 1961–1969. doi: 10.1001/jama.2010.605. Retrieved from https://pubmed.ncbi.nlm.nih.gov/20483973/
- Pearlstein, T., Howard, M., Salisbury, A., & Zlotnick, C. (2009). Postpartum depression. American journal of obstetrics and gynecology, 200(4), 357–364. doi: 10.1016/j.ajog.2008.11.033. Retrieved from https://pubmed.ncbi.nlm.nih.gov/19318144/
- Salik I, Marwaha R. (2021). Electroconvulsive therapy. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK538266/
- Vliegen N, Casalin S, Luyten P. (2014). The course of postpartum depression: a review of longitudinal studies. Retrieved from https://journals.lww.com/hrpjournal/Fulltext/2014/01000/The_Course_of_Postpartum_Depression___A_Review_of.1.aspx
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.