As many as one in seven women can develop postpartum depression — also called postnatal depression — a mental health condition that develops after a woman has given birth. Longer lasting and more intense than the baby blues, the symptoms of which tend to dissipate two weeks after the birth, postpartum depression can seriously impair a woman’s ability to return to normal functioning after having a baby.
And yet, despite how common it is, it’s still not talked about as much as other mental health conditions. But why? Just like it’s not a person’s fault if they’re diagnosed with clinical depression, a woman isn’t to blame if she has postpartum depression — it’s a complication that has occurred after childbirth.
There are still many questions, and much shame, around postpartum depression — but there doesn’t need to be. Here, we’ll share what causes it, how it can be treated, and what can happen if left untreated.
What is postpartum depression?
People often describe how they feel after having a baby with a beaming — albeit tired — smile, gushing about their newborn, how in love they are with their new mini-me, and how they couldn’t imagine loving anyone as much as they love their new baby. But not everyone feels like this after giving birth — and that’s more than OK.
Postpartum depression is a mental health condition that occurs after childbirth — “postpartum” meaning “after childbirth.”
Sometimes, postpartum depression (PPD), or perinatal depression, can be mistaken for baby blues, symptoms of which include:
- Weepiness or crying for no apparent reason
- Impatience
- Irritability
- Restlessness
- Anxiety
- Fatigue
- Insomnia
- Sadness
- Mood changes
- Poor concentration
While baby blues tend to occur four to five days after childbirth, with symptoms lessening or disappearing two weeks after delivery, postpartum depression symptoms commonly materialize within six weeks of having a baby. However, it can start anytime within the first year after birth and may last anywhere from a few months to three years.
Symptoms
Even though it’s normal to have depressive-like symptoms after giving birth, if someone experiences the following, according to the Office on Women’s Health, for longer than two weeks, it’s advised they should call their doctor or midwife.
Symptoms of postpartum depression may include:
- Feelings of restlessness or moodiness
- Feelings of sadness, hopelessness, or overwhelm
- Crying often
- Thoughts of harming your baby
- Thoughts of harming yourself
- No feelings of interest in, or connection to, the baby
- Loss of energy and/or motivation
- Not eating enough or too much
- Lack of sleep or too sleeping much
- Problems focusing or making decisions
- Feelings of worthlessness, guilt, or like you’re a bad mother
- Losing interest or pleasure in activities you used to enjoy
- Withdrawing from friends and family members
Prevalence
Postpartum depression tends to occur most commonly within six weeks after childbirth. It usually appears in about 6.5% to 20% of women. Anyone can get postpartum depression, but it’s most prevalent among adolescent females, mothers who give birth to premature babies, and mothers who live in urban areas.
Only around 20% of women who experience PPD report symptoms to their healthcare providers. Evidence has been shown that the reason new mothers don’t report their feelings of depression is because they fear being stigmatized or labeled as a “bad mother.”
Julia Preamplume, a Grow Therapy Licensed Professional Counselor, believes there are many reasons women don’t report their symptoms. “Some mothers may not be aware of the symptoms of postpartum depression and the different ways it can present itself,” she says.
“They may not have been given enough information by their care team on signs and symptoms to be aware of following the birth of their child. If they lack support they may not have friends, family, or a partner to point out to them that they don’t seem like themselves.”
Preamplume adds, “Some people struggling with PPD may feel ashamed of it, especially if it’s preventing them from feeling bonded with their child. I also think moms in the U.S. are placed under a lot of pressure to be their child’s everything and this leads to perfectionism and a phenomenon called ‘mom guilt.’ These can make it difficult for moms to share when they are struggling.”
What causes postpartum depression?
There are several reasons someone might get postpartum depression — from hormone levels to a lack of social support — with some people being more predisposed than others.
Risk factors
Some risk factors can include:
- A history of depression, anxiety, and premenstrual syndrome (PMS)
- A negative attitude about your baby
- Being a survivor of sexual abuse or domestic abuse
- History of pregnancy complications, including emergency C-section, premature birth, or hospitalization during pregnancy
- Giving birth to a child with special needs or health problems
- Unhappiness about your baby’s gender
- Lack of social support during and after pregnancy
- Lifestyle factors, such as poor eating, lack of sleep, and lack of exercise
Biological factors and hormonal changes
There’s also the possibility that hormonal changes might trigger PPD. The levels of the hormones estrogen and progesterone are highly elevated during pregnancy, but then drop quickly within 24 hours after giving birth. It’s thought that this rapid decline in hormone levels may trigger depression in some women.
Another biological factor that could be considered is the dropping of thyroid levels after childbirth. Low thyroid levels can cause symptoms of depression, which is why women who have just given birth may be at increased risk of postpartum depression.
Being of young age could be another reason for the onset of PPD. It’s been reported that the highest level of depression was found in new mothers aged 13-19 years.
Psychological factors and life stressors
Women with a previous history of mental illness, such as depression and anxiety disorders, are associated with a higher risk of PPD because they’re more susceptible to hormonal changes that would trigger PPD.
Previous history of sexual abuse is also linked to PPD, as are major life events that cause severe emotional, financial, health, or relationship stress.
Preamplume adds, “A lack of paid maternity and paternity leave in the U.S. are significant contributors to PPD. Not having enough time for a mother’s body to recover from birth, as well as being forced to separate from her child so quickly to return to work, is devastating for many new moms.”
Social factors and support systems
A lack of social support is an important environmental factor when it comes to the onset of a depressive disorder, which is why mothers who experience an absence of familial or emotional support systems may be more at risk of postpartum depression.
What a woman goes through in the lead-up to childbirth can also affect whether she’s more prone to developing PPD, such as if she faces sexual or domestic violence during pregnancy.
Screening and diagnosis
A postpartum depression screening can be had as part of a routine check-up after childbirth and helps to diagnose the condition so that treatment can be started as soon as possible.
Your healthcare provider might ask you the questions, or you might fill out a form and discuss your answers afterward. One of the most common questionnaires is called the Edinburgh Postnatal Depression Scale (EPDS), and it includes 10 questions about your mood and thoughts. The EPDS can be repeated to check for symptoms that may develop later after childbirth.
A blood test can also be taken to see whether it’s hyperthyroidism or hypothyroidism that may be causing your depression.
Treatment options
The following interventions for postpartum depression can be used alone or together, depending on the advice given to you by your medical health provider.
Therapy
Psychotherapy, also called talk therapy, and cognitive behavioral therapy (CBT), are common types of treatment that might help someone dealing with postpartum depression deal with their feelings. “Sessions may focus on destigmatizing PPD, teaching coping skills, learning how to not over-identify with unhelpful thoughts, and helping the client to connect with or build a support system,” says Preamplume.
Support groups may also be helpful for those with PPD due to the inclusive environments and the feeling of being understood and accepted by others dealing with similar symptoms.
Medication
If your healthcare provider thinks it’s necessary, antidepressant medication might be prescribed to help manage the symptoms that come with postpartum depression. Antidepressants tend to be taken daily to correct chemical imbalances in the brain, restoring normal mood and behavioral functions.
It’s important to note that even though most medications taken when breastfeeding will enter your breast milk, many antidepressant medications can be taken with little risk of side effects for your baby. You can reach out to your pediatrician or a board certified lactation consultant (IBCLC) for more information about medications and their impact on breastfeeding.
Electroconvulsive therapy
If someone develops postpartum psychosis, a rarer and more severe condition than PPD, where a person may experience hallucinations, delusions, mood swings from mania to major depression, depersonalization, and thoughts of harming themselves or others, then electroconvulsive therapy (ECT) may be used as treatment.
Complications and risks of untreated postpartum depression
If PPD is left untreated, women might experience the following:
- Feeling like they don’t have enough energy
- Having problems focusing on the baby’s needs and their own needs
- Feelings of moodiness
- Not being able to care for their baby
- Having a higher risk of attempting suicide
Research has indicated that children of untreated depressed mothers (compared to mothers who don’t have PPD) may experience:
- Poor cognitive functioning
- Problems with mother-child bonding
- Trouble sleeping and problematic sleep patterns
- Impaired motor development
- Impaired language development
- Greater risk of illness, such as diarrhea
- Higher degrees of mood disorders, including anxiety
- Behavioral problems
Prevention and self-care strategies
While it may not be possible to prevent the onset of postpartum depression completely, there are things you can do to put yourself in the best possible position during pregnancy and after childbirth.
Prevention
Firstly, if any of the PPD risk factors apply to you, such as a history of depression, it’s important to tell your doctor this as soon as you are pregnant or are planning to get pregnant so that steps can be taken to make PPD less likely to occur. Other preventative measures include the following:
- Make sure you, your partner, and family members read up on health information about PPD so you can all recognize any symptoms, should they occur
- Get the right amount of sleep because the evidence shows a relationship between less sleep and PPD
- Sufficient consumption of vegetables, fruits, legumes, seafood, milk and dairy products, and olive oil may reduce the likelihood of high levels of postpartum depression symptoms by up to 50%
- Make sure you have a strong support system during pregnancy, the birth, and after
Additionally, prepare yourself for childbirth: go to classes, read books, follow evidence-based pregnancy social media accounts from reliable sources like medical centers or organizations. Inform yourself as much as possible so that there’ll be no surprises.
Self-care strategies
If you are dealing with postpartum depression and are in need of a few self-care strategies to ease your symptoms and alleviate a depressed mood, Preamplume advises to try out the following:
- All parents, especially those experiencing PPD, would benefit from connecting with a support system. Some options for connecting with other parents include breastfeeding support groups, first-time parent groups and even vetted, researched parenting apps with positive virtual communities. If you do have a support system, please ask them for help so that you can get some more sleep, take time to shower, eat, and have help completing housework.
- Take time to get outside, such as going for a walk with your baby or sitting in a park together.
- Make time to do something you enjoy during the week, and most importantly, practice self-compassion.
Taking care of yourself and meeting your own needs, such as seeking professional help, will allow you to better meet your child’s needs. Medical and mental health professionals that know about PPD want to help you feel less alone and find ways to enjoy parenthood more.
Getting therapy
Having a baby, while joyful, can certainly be hard work. And when you’re dealing with a mental health condition on top of that, things are much more difficult. The important thing to remember is that PPD is no one’s fault, and there’s no shame in admitting you have it or had it — it should never make you feel like a less capable mother. As Preamplume says, “being a parent is so hard. Struggling with your mental health does not make you a bad mom.”
Being open about your experience and seeking support and treatment might help not only you but your child, too.
If you or a loved one are dealing with PPD and need support, we have excellent, qualified therapists who specialize in dealing with this condition. Try searching our marketplace for a therapist who can offer professional advice and guidance.