Postpartum psychosis should be considered a medical emergency requiring immediate medical attention. Call 911 if you or someone you love is experiencing postpartum psychosis.
What is Postpartum Depression?
If you’ve just had a baby, you understand the mood swings that go along with your postpartum hormones. No matter how you love your child, how long you’ve wanted a baby, a new baby is stressful. Period. Lack of sleep, new important responsibilities, and a distinct lack of personal space and time to yourself, both parents can experience the baby blues. It’s extremely normal, but once symptoms of the baby blues last for a few weeks or worsen, you may be coping with postpartum depression.
Approximately 15% of new mothers and fathers will experience what is classified as postpartum depression (PPD). Symptoms may occur a few days after delivery or sometimes as late as a year later. People who experience postpartum depression will have alternating good days and bad days. Symptoms can be mild or severe, usually lasting for over 2 weeks.
There are lots of ways to help women suffering from postpartum depression, and remember that this is common, and you are never alone, no matter how you feel.
Is This Postpartum Depression or Is This The Baby Blues?
We know that you’ve just had a baby, and you’re expecting to be basking in the glory of a new life into this world. You thought you’d be celebrating with loved ones and enjoying every single second. But you’re not. In fact, you feel like crying or hiding away.
You thought you’d be joyous and excited, not weepy, exhausted, and anxiety-ridden. While you may not have intended this, you should know that mild depression, anxiety, and mood swings are totally normal. So normal that we can refer to them as the Baby Blues.
Approximately 50% to 75% of all new mothers will experience some negative feelings after giving birth. Normally these feelings occur suddenly four to five days after the birth of the baby.
Most women – to a greater or lesser extent – experience some symptoms of the baby blues after giving birth; the hormones that kept you pregnant are replaced by new hormones, lack of sleep, delivery, social isolation, major sleep loss, and stress, and it’s natural to notice them. Some women report that they feel emotionally fragile, sad, and overwhelmed. Generally the Baby Blues occur within a couple days of your delivery, last a week, and taper off by the second postpartum week.
What Are The Symptoms of Postpartum Depression?
In stark contrast from the baby blues, postpartum depression is a serious medical issue that should not be ignored. But how do you know the difference between postpartum depression and the Baby Blues?
PPD, as it’s often abbreviated, can look like the baby blues, so much so that they share many of the same symptoms, however the symptoms of postpartum depression last longer and are more severe. You may also feel hopeless and worthless, and lose interest in the baby. You may have thoughts of hurting yourself or the baby. Very rarely, new mothers develop something even more serious – postpartum psychosis – may have hallucinations or try to hurt themselves or the baby. They need to get treatment right away, often in the hospital.
The difference is that with postpartum depression, the symptoms are more severe (such as suicidal thoughts or an inability to care for your newborn) and longer lasting. Symptoms of postpartum depression begin either during pregnancy or within four weeks after having a baby.
The symptoms of postpartum mood disorders don’t differ from the non-postpartum mood disorders except that the feelings of guilt and inadequacy about being an incompetent mother feed a person’s worries about being less than an adequate parent.
- You might find yourself withdrawing from your partner or being unable to bond well with your baby.
- You might find your anxiety out of control, preventing you from sleeping—even when your baby is asleep—or eating appropriately.
- You might find feelings of guilt or worthlessness overwhelming or begin to develop thoughts preoccupied with death or even wish you were not alive.
- Feelings of profound sadness, emptiness, emotional numbness, irritability, or anger.
- A tendency to withdraw from relationships with family, friends, or from activities that are usually pleasurable for the PPD sufferer
- Constant fatigue or tiredness, difficulty sleeping, overeating, or loss of appetite
- A strong sense of failure or inadequacy
- Intense concern and anxiety about the baby or a lack of interest in the baby
- Thoughts about suicide or fears of harming the baby
- People with postpartum depression feel guilty about being depressed at a time when they are supposed to be happiest and may be reluctant to discuss their feelings.
- People with postpartum depression often experience a loss of appetite, leading to extreme weight loss.
- People with postpartum depression often report an increased yearning for sleep, sleeping heavily, but awakening (and unable to get back to sleep) the moment their baby makes a noise.
- The distinguishing feature in postpartum depression is irritability. Episodes of irritability may be unprovoked or provoked by the slightest infraction. These episodes of irritability are often directed at the significant other or baby and may escalate to violent outbursts or uncontrollable sobbing.
- People with severe postpartum depression often have terrible panic attacks, severe anxiety, and spontaneous crying, long after the duration of the “baby blues.”
- These people with PPD may feel jealous of their infant and have difficulties bonding with their babies.
These are all red flags for postpartum depression.
The Edinburgh Postnatal Depression Scale is a screening tool designed to detect postpartum depression. Follow the instructions carefully. A score greater than 13 suggests the need for a more thorough assessment because you could have postpartum depression.
If you’re a new mother or father, please don’t hesitate to bring up these feelings with your doctor. Don’t let your doctor brush it off. If s/he does, find another doctor.
Signs And Symptoms of Postpartum Psychosis:
Postpartum psychosis is a rare, but extremely serious disorder that can develop after childbirth, characterized by loss of contact with reality. Because of the high risk for suicide or infanticide, hospitalization is usually required to keep the mother and the baby safe.
Postpartum psychosis (PPP) is the most severe form of postpartum depression, but fortunately it is the rarest form. It occurs in 1 to 2 out of every 1,000 pregnancies. The onset is very sudden and severe, normally within 2 to 3 weeks after giving birth. Postpartum psychosis develops suddenly, usually within the first two weeks after delivery, and sometimes within 48 hours.
Symptoms are characterized by a loss of touch with reality and can include:
- Bizarre, erratic behavior
- Thoughts of hurting the baby
- Thoughts of hurting yourself
- Rapid mood swings
- Hallucinations (seeing things that aren’t real or hearing voices)
- Delusions (paranoid and irrational beliefs)
- Extreme agitation and anxiety
- Suicidal thoughts or actions
- Confusion and disorientation
- Inability or refusal to eat or sleep
- Thoughts of harming or killing your baby
Postpartum psychosis should be considered a medical emergency requiring immediate medical attention. Call 911 if you or someone you love is experiencing postpartum psychosis.
What Causes Postpartum Depression?
Just as in all types of depression, there is no single reason to point to as the definitive cause of postpartum depression. A variable combination of lifestyle, physical, and emotional factors can all play a part.
There’s no single reason why some new mothers develop postpartum depression and others don’t, but a number of interrelated causes and risk factors are believed to contribute to the problem.
- Hormonal changes. After childbirth, women experience a big drop in estrogen and progesterone hormone levels. Thyroid levels can also drop, which leads to fatigue and depression. These rapid hormonal changes—along with the changes in blood pressure, immune system functioning, and metabolism that new mothers experience—may trigger postpartum depression.
- Physical changes. Giving birth brings numerous physical and emotional changes. You may be dealing with physical pain from the delivery or the difficulty of losing the baby weight, leaving you insecure about your physical and sexual attractiveness.
- Stress. The stress of caring for a newborn can also take a toll. New mothers are often sleep deprived. In addition, you may feel overwhelmed and anxious about your ability to properly care for your baby. These adjustments can be particularly difficult if you’re a first-time mother who must get used to an entirely new identity.
Risk Factors For Postpartum Depression:
Several factors can predispose you to postpartum depression:
- The most significant is a history of postpartum depression, as a prior episode can increase your chances of a repeat episode to 30-50%.
- Mood Disorders: A history of non-pregnancy related depression or a family history of mood disturbances is also a risk factor.
- Addiction: People with any history of depression, anxiety, alcohol or another substance use disorder prior to the pregnancy are at risk for developing depression during the pregnancy or within a few weeks after delivery.
- Prenatal depression – Depression during pregnancy may be the strongest predictor for later suffering from PPD.
- Prenatal anxiety
- History of previous depression – Although not as strong a predictor as a depressive episode during the pregnancy, it appears that women with histories of depression previous to conception are also at a higher risk of PPD than those without
- Examples of specific illnesses that have been associated with being associated with the potential to develop postpartum depression include any form of major depression, such as premenstrual dysphoric disorder, bipolar disorder, and generalized anxiety disorder.
- Maternity blues – Especially when severe, the blues may herald the onset of PPD.
- Recent stressful life events
- Inadequate social supports
- Poor marital relationship – One of the most consistent findings is that among women who report marital dissatisfaction and/or inadequate social supports, postpartum depressive illness is more common.
- Low self-esteem
- Childcare stress – Difficult infant temperament
In addition, three factors are less definitively predictive, but still arise consistently as factors that increase a woman’s risk of PPD, especially in combination with one or more of the factors listed above:
- Single marital status
- Unplanned or unwanted pregnancy
- Lower socioeconomic status
What Is The Treatment For Postpartum Depression?
Postpartum depression (PPD) sometimes goes away on its own within three months of giving birth. But if it interferes with your normal functioning at any time, or if “the blues” lasts longer than two weeks, you should seek treatment. About 90% of women who have postpartum depression can be treated successfully with medication or a combination of medication and psychotherapy. Participation in a support group may also be helpful. In cases of severe postpartum depression or postpartum psychosis, hospitalization may be necessary. Sometimes, if symptoms are especially severe, electroconvulsive (ECT) therapy may be used to treat severe depressions with hallucinations (false perceptions) or delusions (false beliefs) or overwhelming suicidal thoughts
Untreated postpartum depression can affect your ability to parent. You may:
- Not have enough energy
- Have trouble focusing on the baby’s needs and your own needs
- Feel moody
- Not be able to care for your baby
- Have a higher risk of attempting suicide
Feeling like a bad mother can make depression worse. It is important to reach out for help if you feel depressed.
Researchers believe postpartum depression in a mother can affect her child throughout childhood, causing:
- Delays in language development and problems learning
- Problems with mother-child bonding
- Behavior problems
- More crying or agitation
- Shorter height and higher risk of obesity in pre-schoolers
- Problems dealing with stress and adjusting to school and other social situations
Postpartum depression, like other mental illnesses, presents along a continuum, and the type of treatment selected is based on the severity of the depression and type of symptoms present. However, before beginning psychiatric treatment, medical causes for mood disturbance (such as, thyroid dysfunction, anemia) must be excluded. Initial evaluation should include a thorough history, physical examination, and routine laboratory tests.
Non-pharmacological therapies are useful in the treatment of postpartum depression, including CBT, ITP, and couples counseling.
In a randomized study, it was shown that short-term cognitive-behavioral therapy (CBT) was as effective as treatment with fluoxetine (Prozac) in women with postpartum depression.
Interpersonal therapy (IPT) has also been shown to be effective for the treatment of women with mild to moderate postpartum depression. Not only is IPT effective for treating the symptoms of depression, women who receive IPT also benefit from significant improvements in the quality of their interpersonal relationships
These non-pharmacological interventions may be particularly attractive to those reluctant to use psychotropic medications (such as women who are breast-feeding) or for people with milder forms of depressive illness. Women with more severe postpartum depression may choose to receive pharmacological treatment, either in addition to or instead of, these non-pharmacological therapies.
Only a few studies have systematically assessed the pharmacological treatment of postpartum depression. Conventional antidepressant medications have shown efficacy in the treatment of postpartum depression at standard antidepressant doses were effective and well tolerated.
The choice of an antidepressant should be guided by the person’s prior response to antidepressant medication and a given medication’s side effects.
- Specific serotonin reuptake inhibitors (SSRIs) are ideal first-line agents, as they are anxiolytic, non-sedating, and well tolerated (examples include: fluoxetine, sertraline, fluvoxamine, and venlafaxine)
- For women who cannot tolerate SSRIs, bupropion (Wellbutrin) may be an alternative; although one pilot study suggests bupropion may not be as effective as SSRIs.
- Tricyclic antidepressants (TCAs) are frequently used and, because they tend to be more sedating, may be more appropriate for women who present with prominent sleep disturbance.
- Given the prevalence of anxiety symptoms in this population, adjunctive use of a benzodiazepine (e.g., clonazepam, lorazepam) may be very helpful.
Can I Breastfeed My Child If I’m On Medication?
The nutritional, immunologic, and psychological benefits of breastfeeding have been well documented. Women who plan to breastfeed must be informed that all psychotropic medications, including antidepressants, are secreted into the breast milk. Concentrations in the breast milk appear to vary widely. The amount of medication to which an infant is exposed depends on several factors, including dosage of medication, rate of maternal drug metabolism, and frequency and timing of feedings (Llewelyn and Stowe).
Over the past five years, data have accumulated regarding the use of various antidepressants during breastfeeding (reviewed in Newport et al 2002). Available data on the tricyclic antidepressants, fluoxetine, paroxetine, and sertraline during breastfeeding have been encouraging and suggest that significant complications related to neonatal exposure to psychotropic drugs in breast milk appear to be rare. While less information is available on other antidepressants, there have been no reports of serious adverse events related to exposure to these medications.
For women with bipolar disorder, breastfeeding may be more problematic.
First is the concern that on-demand breastfeeding may significantly disrupt the mother’s sleep and thus may increase her vulnerability to relapse during the acute postpartum period. Second, there have been reports of toxicity in nursing infants related to exposure to various mood stabilizers, including lithium and carbamazepine, in breast milk. Lithium is excreted at high levels in the mother’s milk, and infant serum levels are relatively high, about one-third to one-half of the mother’s serum levels, increasing the risk of neonatal toxicity. Exposure to carbamazepine and valproic acid in the breast milk has been associated with liver damage in the nursing infant.
Can We Prevent PPD?
While it is difficult to reliably predict which women in the general population will experience postpartum mood disturbance, it is possible to identify certain subgroups of women (i.e., women with a history of mood disorder) who are more vulnerable to postpartum affective illness. Current research indicates that prophylactic interventions may be instituted near or at the time of delivery to decrease the risk of postpartum illness.
Several studies demonstrate that women with histories of bipolar disorder or puerperal psychosis benefit from prophylactic treatment with lithium either prior to delivery (at 36 weeks gestation) or no later than the first 48 hours postpartum.
For women with histories of postpartum depression, several studies have described a beneficial effect of prophylactic antidepressant (either TCAs or SSRIs) administered after delivery. Patients with postpartum psychiatric illness are offered a variety of services by clinicians with particular expertise in this area:
- Clinical evaluation for postpartum mood and anxiety disorders
- Medication management
- Consultation regarding breastfeeding and psychotropic medications
- Recommendations regarding non-pharmacological treatments
- Referral to support services within the community
Coping With Postpartum Depression:
The most important task of infancy is the bonding process between the infant and parents, as the success of this wordless relationship enables a child to feel secure enough to develop fully, and affects how the child will interact, communicate, and form relationships throughout life.
A secure attachment between parent and child is formed when the parent responds warmly and consistently to your baby’s physical and emotional needs. When your baby cries, you quickly soothe him or her. If your baby laughs or smiles, you respond in kind. You and your child are in synch. You recognize and respond to each other’s emotional signals.
Postpartum depression can interrupt this bonding. Depressed parents may be loving and attentive sometimes, but others may react negatively or not respond at all. Sadly, parents with postpartum depression tend to interact less with their babies, and are less likely to breastfeed, play with, and read to their children. They may also be inconsistent caregivers.
However, learning to bond with your baby not only benefits your child, it also benefits you by releasing endorphins that make you feel happier and more confident as a parent.
Make yourself and your baby the priority. Give yourself permission to concentrate on yourself and your baby – there is more work involved in this 24/7 job then in a full-time job.
Try to remember that we, as human beings are naturally social. Positive, happy, and supportive social contact relieves stress faster and more efficiently than any other means of stress reduction. Historically and from an evolutionary perspective, new parents received help from those around them when caring for themselves and their infants after childbirth. In today’s world, new mothers often find themselves alone, exhausted, and lonely for supportive adult contact.
When you’re feeling depressed and vulnerable, it’s more important than ever to stay connected to family and friend – even if you’d rather be left alone. Isolating yourself will only make your situation feel even bleaker, so make your adult relationships a priority. Let your loved ones know what you need and how you’d like to be supported.
In addition to the practical help your friends and family can provide, they can also serve as a much-needed emotional outlet. Share what you’re experiencing – all of it – with at least one other person, preferably face to face. It doesn’t matter who you talk to, so long as that person is willing to listen without judgment and offer reassurance and support.
Even if you have supportive loved ones, you may want to consider seeking out other women who are dealing with the same transition into motherhood. It’s very reassuring to hear that other mothers share your worries, insecurities, and feelings. Good places to meet new moms include support groups for new parents or organizations such as Mommy and Me. Ask your pediatrician for other resources in your neighborhood.
One of the best things you can do to relieve or avoid postpartum depression is to take care of yourself. The more you care for your mental and physical well-being, the better you’ll feel. Simple lifestyle changes can go a long way towards helping you feel like yourself again.
Studies show that exercise, for some people, may be just as effective as medication. But don’t to overdo it: a 30-minute walk each day can work wonders. Stretching exercises such as those found in yoga have shown to be especially effective. Make certain that you’re cleared by your OB/GYN before you begin to exercise.
A full eight hours may seem like an unattainable luxury when you’re dealing with a newborn, but poor sleep makes postpartum depression worse. Do what you can to get plenty of rest – enlist the help of your partner or family members to catching naps when you can.
Make some time to relax and take a break from your parental duties. Find small ways to pamper yourself, like taking a bubble bath, savoring a hot cup of tea, or lighting scented candles. Get a massage. Splurge on a pedicure.
When you’re depressed, nutrition often suffers, because you may not have any appetite. As you know, what you eat has an impact on mood, as well as the quality of your breast milk, so do your best to eat well.
Sunlight lifts your mood – and prevents vitamin D deficiency – so try to get at least 10 to 15 minutes of sun per day.
More than half of all divorces take place after the birth of a child. For many people, the relationship with their partner is their primary source of emotional expression and social connection. The demands and needs of a new baby can get in the way and fracture this relationship unless couples put some time, energy, and thought into preserving their bond.
The stress of sleepless nights and responsibilities can leave you feeling overwhelmed and exhausted. And since you can’t take it out on the baby, it’s all too easy to turn your frustrations on your partner. Instead of finger pointing, remember that you’re in this together. If you tackle parenting challenges as a team, you’ll become an even stronger unit.
Many things change following the birth of a baby, including roles and expectations. For many couples, a key source of strain is the post-baby division of household and childcare responsibilities. It’s important to talk about these issues, rather than letting them fester. Don’t assume your partner knows how you feel or what you need.
It’s essential to make time for just the two of you when you can reconnect. But don’t put pressure on yourself to be romantic or adventurous (unless you’re both up for it). You don’t need to go out on a fancy date to enjoy each other’s company. Even spending 15 or 20 minutes together—undistracted and focused on each other— can make a big difference in your feelings of closeness and togetherness.
Help! My Loved One Has Postpartum Depression!
If your loved one is experiencing postpartum depression, the best thing you can do is to offer support. Give her a break from her childcare duties, provide a listening ear, and be patient, and understanding.
If your partner has PPD, remember that you also need to take care of yourself. Dealing with the needs of a new baby is hard for all involved. If your significant other is depressed, you are dealing with two major stressors.
Don’t wait, just offer help around the house. Chip in with the housework and childcare responsibilities. The person may not feel it is appropriate to ask for any help from anyone.
Encourage talking about feelings, which can be awkward, but is necessary for your loved one. Listen to your loved one without judging or offering solutions. Instead of trying to fix things, simply be there for your loved one to lean on.
Make sure your loved one takes time for themselves. Rest and relaxation are important. Encourage the parent to take breaks, hire a babysitter, or schedule some date nights.
Go for a walk together. Getting exercise can make a big dent in depression, but it’s hard to get motivated when you’re feeling low.
Additional Resources For Postpartum Depression:
Postpartum Health Alliance is a non-profit organization dedicated to raising awareness about perinatal mood and anxiety symptoms and disorders and providing support and treatment referrals to women and their families.
- If you are struggling or have questions, please call our warmline at 619-254-0023. Our trained volunteers can provide you with support and referrals.
- If you need immediate support please call the San Diego Access and Crisis Line at 1-888-724-7240. The toll-free call is available 24-hours a day, 7-days a week
Postpartum Depression International: source of great information about all types of Postpartum Mood Disorders and also offers women resources for where to go for local help. Call or Text our HelpLine
- They offer online support groups for mom’s and dad’s with PPD.
- Call 1-800-944-4773 (4PPD)
English and Spanish
- Text 503-894-9453
- Available 24 hours a day, you will be asked to leave a confidential message and a trained and caring volunteer will return your call or text. They will listen, answer questions, offer encouragement and connect you with local resources as needed.