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Your body and mind go through many changes during and after pregnancy. If you feel empty, emotionless, or sad all or most of the time for longer than 2 weeks during or after pregnancy, reach out for help. If you feel like you don’t love or care for your baby, you might have postpartum depression. Treatment for depression, such as therapy or medicine, works and will help you and your baby be as healthy as possible in the future.

What is Postpartum Depression? 

Postpartum depression is a serious mental illness that involves the brain and affects your behavior and physical health. If you have depression, then sad, flat, or empty feelings don’t go away and can interfere with your day-to-day life. You might feel unconnected to your baby, as if you are not the baby’s mother, or you might not love or care for the baby. These feelings can be mild to severe.

How do I know if I have Postpartum Depression? 

Some normal changes after pregnancy can cause symptoms similar to those of depression. Many mothers feel overwhelmed when a new baby comes home. But if you have any of the following symptoms of depression for more than 2 weeks, call your doctor, nurse, or midwife:

  • Feeling restless or moody
  • Feeling sad, hopeless, or overwhelmed
  • Crying a lot
  • Having thoughts of hurting the baby
  • Having thoughts of hurting yourself
  • Not having any interest in the baby, not feeling connected to the baby, or feeling as if your baby is someone else’s baby
  • Having no energy or motivation
  • Eating too little or too much
  • Sleeping too little or too much
  • Having trouble focusing or making decisions
  • Having memory problems
  • Feeling worthless, guilty, or like a bad mother
  • Losing interest or pleasure in activities you used to enjoy
  • Withdrawing from friends and family
  • Having headaches, aches and pains, or stomach problems that don’t go away

Some women don’t tell anyone about their symptoms. New mothers may feel embarrassed, ashamed, or guilty about feeling depressed when they are supposed to be happy. They may also worry they will be seen as bad mothers. Any woman can become depressed during pregnancy or after having a baby. It doesn’t mean you are a bad mom. You and your baby don’t have to suffer. There is help. Your doctor can help you figure out whether your symptoms are caused by depression or something else.

What causes Postpartum Depression?

Hormonal changes may trigger symptoms of postpartum depression. When you are pregnant, levels of the female hormones estrogen and progesterone are the highest they’ll ever be. In the first 24 hours after childbirth, hormone levels quickly drop back to normal, pre-pregnancy levels. Researchers think this sudden change in hormone levels may lead to depression.2 This is similar to hormone changes before a woman’s period but involves much more extreme swings in hormone levels.

Levels of thyroid hormones may also drop after giving birth. The thyroid is a small gland in the neck that helps regulate how your body uses and stores energy from food. Low levels of thyroid hormones can cause symptoms of depression. A simple blood test can tell whether this condition is causing your symptoms. If so, your doctor can prescribe thyroid medicine.

Other feelings may contribute to postpartum depression. Many new mothers say they feel:

  • Tired after labor and delivery
  • Tired from a lack of sleep or broken sleep
  • Overwhelmed with a new baby
  • Doubts about their ability to be a good mother
  • Stress from changes in work and home routines
  • An unrealistic need to be a perfect mom
  • Grief about loss of who they were before having the baby
  • Less attractive
  • A lack of free time

These feelings are common among new mothers. But postpartum depression is a serious health condition and can be treated. Postpartum depression is not a regular or expected part of being a new mother.

You may be more at risk of postpartum depression if you:

  • Have a personal history of depression or bipolar disorder
  • Have a family history of depression or bipolar disorder
  • Do not have support from family and friends
  • Were depressed during pregnancy
  • Had problems with a previous pregnancy or birth
  • Have relationship or money problems
  • Are younger than 20
  • Have alcoholism, use illegal drugs, or have some other problem with drugs
  • Have a baby with special needs
  • Have difficulty breastfeeding
  • Had an unplanned or unwanted pregnancy

What is the difference between Postpartum Depression and Baby Blues?

Many women have the baby blues in the days after childbirth. If you have the baby blues, you may:

  • Have mood swings
  • Feel sad, anxious, or overwhelmed
  • Have crying spells
  • Lose your appetite
  • Have trouble sleeping

The baby blues usually go away in 3 to 5 days after they start. The symptoms of postpartum depression last longer and are more severe. Postpartum depression usually begins within the first month after childbirth, but it can begin during pregnancy or for up to a year after birth.5

Postpartum depression needs to be treated by a doctor or nurse.

What is Postpartum Psychosis ?

Postpartum psychosis rare. It happens in up to 4 new mothers out of every 1,000 births. It usually begins in the first 2 weeks after childbirth. It is a medical emergency. Women who have bipolar disorder or another mental health condition called schizoaffective disorder have a higher risk of postpartum psychosis. Symptoms may include:

  • Seeing or hearing things that aren’t there
  • Feeling confused most of the time
  • Having rapid mood swings within several minutes (for example, crying hysterically, then laughing a lot, followed by extreme sadness)
  • Trying to hurt yourself or your baby
  • Paranoia (thinking that others are focused on harming you)
  • Restlessness or agitation
  • Behaving recklessly or in a way that is not normal for you

Call your doctor, nurse, midwife, or pediatrician if:

  • Your baby blues don’t go away after 2 weeks
  • Symptoms of depression get more and more intense
  • Symptoms of depression begin within 1 year of delivery and last more than 2 weeks
  • It is difficult to work or get things done at home
  • You cannot care for yourself or your baby (e.g., eating, sleeping, bathing)
  • You have thoughts about hurting yourself or your baby

The common types of treatment for postpartum depression are:

  • Therapy. During therapy, you talk to a therapist, psychologist, or social worker to learn strategies to change how depression makes you think, feel, and act.
  • Medicine. There are different types of medicines for postpartum depression. All of them must be prescribed by your doctor or nurse. The most common type is antidepressants. Antidepressants can help relieve symptoms of depression and some can be taken while you’re breastfeeding. Antidepressants may take several weeks to start working.The Food and Drug Administration (FDA) has also approved a medicine called brexanolone to treat postpartum depression in adult women.6 Brexanolone is given by a doctor or nurse through an IV for 2½ days (60 hours). Because of the risk of side effects, this medicine can only be given in a clinic or office while you are under the care of a doctor or nurse. Brexanolone may not be safe to take while pregnant or breastfeeding.Another type of medicine called esketamine can treat depression and is given as a nasal (nose) spray in a doctor’s office or clinic. Esketamine can hurt an unborn baby. You should not take esketamine if you are pregnant or breastfeeding.
  • Electroconvulsive therapy (ECT). This can be used in extreme cases to treat postpartum depression.

These treatments can be used alone or together. Talk with your doctor or nurse about the benefits and risks of taking medicine to treat depression when you are pregnant or breastfeeding.

 

Sources:

  1. Ko, J.Y., Rockhill, K.M., Tong, V.T., Morrow, B., Farr, S.L. (2017). Trends in Postpartum Depressive Symptoms — 27 States, 2004, 2008, and 2012(link is external). MMWR Morb Mortal Wkly Rep; 66: 153–158.
  2. Schiller, C.E., Meltzer-Brody, S., Rubinow, D.R. (2014). The Role of Reproductive Hormones in Postpartum Depression. CNS Spectrums; 20(1): 48–59.
  3. Sit, D.K., Wisner, K.L. (2009). The Identification of Postpartum Depression. Clinical Obstetrics and Gynecology; 52(3): 456–468.
  4. U.S. Preventive Services Task Force. (2016). Depression in Adults: Screening(link is external).
  5. Alhusen, J.L., Alvarez, C. (2016). Perinatal depression. The Nurse Practitioner; 41(5): 50–55.
  6. U.S. Food and Drug Administration. (2019). FDA approves first treatment for post-partum depression.
  7. Stein, A., Perason, R.M., Goodman, S.H., Rapa, E., Rahman, A., McCallum, M., et al. (2014). Effects of perinatal mental disorders on the fetus and child. Lancet; 384(9956): 1800–1819.
  8. Surkan, P.J., Ettinger, A.K., Hock, R.S., Ahmed, S., Strobino, D.M., Minkovitz, C.S. (2014). Early maternal depressive symptoms and child growth trajectories: a longitudinal analysis of a nationally representative US birth cohort(link is external). BMC Pediatrics; 14: 185.
  9. Benton, P.M., Skouteris, H., Hayden, M. (2015). Does maternal psychopathology increase the risk of pre-schooler obesity? A systematic review(link is external). Appetite; 87(1): 259–282.
  10. Korhonen, M., Luoma, I., Salmelin, R., Tamminen, T. (2014). Maternal depressive symptoms: Associations with adolescents’ internalizing and externalizing problems and social competence. Nordic Journal of Psychiatry; 68(5): 323–332.
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