Postpartum Depression: A Guide to Causes, Symptoms, Treatment, and More

Unfathomable love, joy, positivity, and excitement — these are the emotions you were prepared for and expected as a new mom. What about fear, anxiety, worry, frustration, exhaustion, and crying spells? Not so much.

Many new mothers feel like they're on an emotional rollercoaster. But while it's common to experience mild mood swings and depression a few weeks after birth, some women experience a more lasting and severe form of depression known as postpartum depression (PPD).

For most women experiencing postpartum depression symptoms, it's their first time feeling depressed, and they may not know how to go about it. The good news is that you can have your postpartum depression treated and managed, thus allowing the mother and child a quality life.

What Is Postpartum Depression?

Postpartum is the period after delivery, so PPD is depression that occurs after childbirth. Pregnancy and the postpartum period can be a particularly vulnerable time for women considering all the biological, emotional, social, and financial changes that occur during this time.

In fact, it's common for new moms to have mood swings. One minute your little one brings joy and happiness into your life; the next, you're worried and anxious about their well-being, breast milk flow or finances, relationship status, etc.

While it's normal to feel the baby blues during the first few days of giving birth, prolonged sadness, loneliness, worthlessness, restlessness, exhaustion, hopelessness, and anxiety are signs of severe postpartum depression.

If you're having symptoms of postpartum depression, you need to know you're not alone; 1 in 7 women experience postpartum depression. Also, there's no particular way to feel after giving birth, so your feelings of postpartum depression are valid and never your fault. Consider them part of the package of having a baby, just like the labor pains you experienced.

Is Postpartum Depression a Mental Illness?

Yes, postpartum depression is a serious mental health condition. It can affect your day-to-day life and even hinder you from feeling connected to your baby. No need to worry, though; postpartum depression treatments are available to help you manage your symptoms and feel better.

It’s important to note that postpartum depression may have overlapping symptoms with other illnesses. Luckily, the American Psychological Association (APA) gives specific guidelines under the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), recognizing PPD as a mental disorder.

Under DSM-5, postpartum depression is diagnosed when there’s a major depressive disorder with peripartum onset. The APA uses the term peripartum depression for this condition, but the term refers to the same mental health condition. Additionally, to distinguish from the "baby blues," a postpartum depression screening must reveal that the patient must have at least five depressive symptoms occurring simultaneously for at least two weeks. Furthermore, the symptoms should not be attributed to a substance or medical condition.

It is important to note that some women experience depressive symptoms early in their pregnancy, before giving birth. If that's you — and your symptoms are new, and you do not have a history of major depression or other mental health issues— then you may be dealing with perinatal depression.

How Do I Know If I Have Baby Blues or Postpartum Depression?

From the text above, we've seen two terms describing the mood changes pregnant and postpartum women can have: baby blues and postpartum depression.

Postpartum blues or baby blues happen to as many as 70-80% of new moms in the days following childbirth. Changes in hormone levels after birth combined with lack of sleep, isolation, stress, challenges with breastfeeding, and other postpartum complications and stressful life events can leave you feeling overwhelmed, lonely, cranky, impatient, restless, and exhausted.

Other symptoms of baby blues include:

• Sadness
• Anxiety
• Crying for no reason
• Having sudden mood changes
• Loss of appetite

While postpartum blues may be unpleasant, it doesn't need treatment from a healthcare or mental health provider and should subside in two weeks or so with proper support.

On the other hand, postpartum anxiety and postpartum depression often last longer and are more serious. 

It can start a few weeks after birth to up to a year. If your sadness, emptiness, postpartum depression, or anxiety are severe and last more than two weeks, you may want to see your healthcare provider.

Symptoms of postpartum depression can interfere with your mental health and ability to handle daily tasks, care for your baby, and enjoy your baby. 

They include:

• Severe anxiety and panic attacks
• Overwhelming tiredness or loss of energy
• Persistent crying
• Severe mood swings
• Changes in appetite
• Low self-esteem and self-confidence
• Trouble sleeping
• Hopelessness
• Restlessness
• Less interest and pleasure in activities you used to enjoy
• Lower libido
• Doubting whether you can care for yourself and your baby
• Intense irritability and anger
• Difficulty bonding with your baby
• Withdrawing from family and friends
• Fear that you're not a good mother
• Feelings of worthlessness, shame, guilt, or inadequacy
• Poor concentration or attention span
• Having less interest in the baby
• Thoughts of harming yourself or your baby
• Thinking about suicide

It can be scary to think that you don't love your child or even have thoughts of harming yourself or the baby. But remember, this doesn't mean you'll act on them. The sooner you seek treatment or talk to someone or a mental health provider, the faster you can get help. You can know whether you're suffering from baby blues or postpartum depression through clinical psychiatry.

Family physicians can also help pinpoint the symptoms and provide information to help treat depression.

What Is Postpartum Psychosis?

In rare cases, a woman may develop a severe form of PPD called postpartum psychosis. This condition is characterized by the sudden onset of psychotic symptoms such as:

• Hallucinations
• Delusions
• Thinking about hurting the baby or yourself
• Suicidal thoughts or actions
• Confusion and disorientation
• Having rapid mood swings
• Feeling paranoid
• Insomnia
• Extreme agitation and anxiety
• Bizarre behavior that is not normal for you

Women with certain mental illnesses like bipolar disorder or schizoaffective disorder are more likely to develop postpartum psychosis.

And unlike regular PPD, the increased risk factors of suicide or infanticide are real with postpartum psychosis. 

This condition should be considered a psychiatric emergency! Postpartum psychosis requires hospitalization to keep the mother and baby safe.

Prompt and appropriate treatment for postpartum psychosis is essential, especially if there is a prior history of co-existing mental illness or health conditions.

Who Is Affected by Postpartum Depression?

As mentioned earlier, 70% of new mothers experience baby blues, 15% experience postpartum depression, and 1 in 1,000 mothers experience postpartum psychosis. Even though you may feel like you are the "only one," it's a relatively common mental illness that happens after someone gives birth.

New fathers/partners, surrogates, and adoptive parents have also been the support groups found to experience PPD. These support groups often go through one or more changes that come with having a baby, including hormonal, physical, emotional, financial, and social changes.

And any of these changes can cause symptoms of postpartum depression.

What Causes Postpartum Depression

There's no specific reason some mothers develop postpartum depression, but genetics, hormonal changes, physical changes, emotional issues, and other stressful life events play a role.

Hormonal Changes

Estrogen and progesterone levels are pretty high during pregnancy. And after giving birth, they quickly drop back to normal levels. This rapid drop in hormone levels is believed to cause PPD.

Also, hormones produced by the thyroid and adrenal glands, including cortisol, aldosterone, adrenaline, and the thyroid hormone, can change after childbirth. These hormones regulate metabolism, blood pressure, stress levels, immune system, and energy levels, among other things. Therefore, a sudden change in these hormones can leave you with several symptoms, such as fatigue, weight changes, irritability, insomnia, rapid heartbeats, anxiety, and generally feeling depressed.

As if that wasn't enough, most new moms have trouble sleeping, which can contribute to decreased melatonin levels. This hormonal shift can also have a negative impact on your mood, thus contributing to PPD.

Lack of Sleep

New moms can forget about getting 8 hours of uninterrupted sleep every night. While babies sleep a lot, they generally don't stay asleep for more than 2-4 hours at any given time.

Sleep deprivation and insomnia can lead to exhaustion, irritability, shortened attention span, poor cognitive function, feeling overwhelmed, lack of energy, and more. Over time, any of these issues can contribute to PPD.

Anxiety

It's normal for new mothers to worry and feel anxious about many things, including their ability to care for their newborn and whether they will have enough breast milk. And this, too, can lead to feelings of depression.

Self-image

Postpartum involves many physical changes, including weight gain, stretch marks, virginal changes, growing and shrinking breasts, etc. All this can make other mothers feel less attractive and cause them to struggle with their sense of identity, which can lead to major depression.

What Factors Increase My Risk of Being Depressed After the Birth of My Child?

Any new mother can experience PPD; however, there is an increased risk if:

• You or your family have a history of clinical depression or bipolar disorder.
• You're experiencing social stressors like a financial struggle, lack of emotional support, an abusive relationship, etc.
• You're experiencing relationship or marital problems.
• You had depression during pregnancy.
• You had an unplanned or unwanted pregnancy.
• You are younger than 20 years.
• You had complications during pregnancy or birth, like premature birth, congenital disabilities, pregnancy loss, etc.
• You had multiple births.
• You have recently experienced stressful events like a breakup, divorce, death in the family, job loss, or illness.
• You have trouble breastfeeding or generating enough breast milk for your baby.
• You smoke, drink, or use harmful drugs.
• You have diabetes.
• You've had a baby with special needs or other health problems.

How to Treat Postpartum Depression

This condition is treated differently depending on the type of PPD and the severity of one's symptoms. The first line of treatment for mild to moderate cases is usually psychotherapy and participating in support groups for education and emotional support. Postpartum depression treatments may also include antidepressant therapy and anti-anxiety medications.

If you're experiencing severe postpartum depression or psychosis, you'll likely need to be hospitalized. Your doctor or psychiatrist will typically prescribe drugs to treat severe postpartum depression and postpartum psychosis. Electroconvulsive therapy (ECT) may be added for effective treatment if the situation is severe.

Having said that, you mustn't self-medicate or assume that you can't take antidepressant medicines because you're breastfeeding. Talk to your doctor about an appropriate treatment plan for your postpartum depression.

What Medications Can I Take for Postpartum Depression?

A couple of medications are effective for managing or reducing the symptoms of postpartum depression or PPD, starting with antidepressant medications. Antidepressant medications help to balance the chemicals in your brain that affect your mood.

Some common antidepressants prescribed for treating postpartum depression symptoms may include:

• Selective serotonin reuptake inhibitors (SSRIs), such as paroxetine (Paxil®), fluoxetine (Prozac®), and sertraline (Zoloft®);
• Tricyclic antidepressants (TCAs) such as amitriptyline (Elavil®) or imipramine (Tofranil®);
• Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta®) and desvenlafaxine (Pristiq®);
• Atypical antidepressants such as Bupropion (Wellbutrin® or Zyban®), trazodone (Desyrel®), and nefazodone (Serzone®); and/or
• IV medication containing brexanolone (Zulresso®).

Talking to your doctor before starting or stopping any PPD medication is essential. Also, remember that any medication the mother takes can be available in breast milk. But then again, no evidence suggests that antidepressants pose a significant risk to your nursing infant. It would be best to consult your doctor on the benefits and risks of taking antidepressants while breastfeeding.

Hormone Therapy for Postpartum Depression

The levels of estrogen and progesterone in the body drop quickly after childbirth. And research theorizes that these sudden hormonal changes play a significant role in women developing postpartum depression. It's safe to say that hormone therapy can help manage this condition. 

Your doctor may recommend wearing an estrogen patch on your skin to replace what your body lost. Several side effects come with hormone therapy, so talk to your doctor about what's safe and best for you and your baby.

Psychological and Psychosocial Treatments for Postpartum Depression

Mild to moderate cases of PPD can also be managed through postpartum depression counseling. This treatment involves discussing your feelings and concerns with a mental health professional. Your therapist, counselor, or social worker will help you understand your feelings and provide coping mechanisms.

Psychotherapy can take different forms, including:

Cognitive Behavior Therapy (CBT)

CBT is cognitive behavioral therapy, a structured and goal-oriented type of counseling. It involves working with your therapist to help identify your negative thoughts, behaviors, and pattern and set goals to begin to think and act differently. Cognitive behavioral therapy also involves improving communication skills and learning problem-solving skills to better cope with difficult situations in your life.

Interpersonal Therapy (IPT)

IPT is a form of psychotherapy that helps to relieve depression symptoms by improving social and interpersonal functioning. Your therapist will help you identify and deal with problems in your personal life, including finances, relationships, work-related issues, etc.

Coping and Support for Postpartum Depression

One of the most important things you can do to manage postpartum depression is to find someone you can talk to — a friend, family member, support group, or someone at a crisis hotline. If your symptoms are severe, professional talk therapy with a therapist, counselor, social worker, or minister/spiritual leader is extremely effective.

Here are other things you can do to help you cope with postnatal depression and reduce the risk factors of developing postpartum depression yourself:

• Ask for and accept help to care for your baby and do other household chores.
• Keep a daily diary to express your thoughts and frustrations.
• Celebrate the small achievements.
• Join a support group for people with similar experiences.
• Eat healthy foods and slowly introduce exercise.
• Get enough sleep and as much rest as possible.
• Build a support network of friends and family.
• If you can, avoid major changes after delivery, like moving house.
• Getting out in the sunshine and fresh air can significantly improve your mood.
• Do what you can to reduce stress.
• Practice mindfulness meditation to help calm an anxious mind.
• Don't drink alcohol or use street drugs. They can interact with the PPD medications you're taking and affect how your body works, thus triggering PPD.
• Find small ways to pamper yourself, like getting a massage, catching up on your favorite show, taking a bubble bath, etc.
• Be kind to yourself and practice positive affirmations for self-love.

Can Postpartum Depression Affect My Baby?

Yes, untreated postpartum anxiety and depression can hurt your baby. Untreated postpartum anxiety and PPD can make it hard for you to care for your child. How you feel can cause you to skip postpartum check-ups, vaccinations, and breastfeeding, and even find it hard to bond with your child. In severe cases of postpartum depression and postpartum psychosis, the increased risk of suicide or infanticide is real.

Researchers believe PPD can affect babies, both breastfeeding infants and throughout childhood, causing:

• Behavior issues like feeding and sleep problems,
• More crying or agitation,
• Delays in language development and difficulties learning,
• Shorter height,
• Higher risk factors for obesity,
• Problems dealing with stress and adjusting to social situations, and
• Mental health problems later in life.

When to See a Doctor for Symptoms of Postpartum Depression?

Many mothers feel reluctant or embarrassed to admit they are not emotionally or mentally okay because they think it's a sign of weakness. Imagine telling someone else you feel like you don't love your child. That can be hard!

Plus, for most young and first-time mothers, PPD is one of those things nobody tells you beforehand about having a child. So, you don't even know you need to see a doctor for your symptoms to begin with. But having your postpartum depression diagnosed and treated is essential for both the mother's and child's health.

Our depression screening test is anonymous and can be a good starting point for determining whether you have postpartum depression. But we still advise you to contact a healthcare provider as soon as you think things aren't right with your emotional and mental health during the postpartum period.

If you are in crisis, especially if you are experiencing any symptoms of postpartum depression, psychosis, thoughts of hurting your baby, or are thinking about suicide, find a helpline (list of international crisis centers). US citizens can call 911, or they can dial or text 988 to reach the National Suicide Prevention & Crisis Lifeline. 

There isn't a specific test that diagnoses PPD, but your doctor or mental health provider will ask you postpartum depression screening questions to assess if you have this condition. A commonly uses screening tool is the Edinburgh Postnatal Depression Scale. They may discuss your mental health conditions and family history, medication history, how you've been feeling since giving birth yourself, any stressful events you may be experiencing, other health conditions, and so on.

You must be completely honest with your answers to get an accurate assessment. The doctor might also order a blood test to rule out thyroid conditions since their symptoms can be similar to those of PPD.

Did We Answer Your Question About Postpartum Depression?

As a new mother, you're dealing with a lot of change, and the first thing you should do is give yourself some grace. Recognize that you may not be as calm or collected as usual.

If you're a friend, partner, or family to a new mother, this information will help you recognize signs of postpartum depression symptoms and how you can support your loved one.

There's a lot more to learn about this mental health condition than we can fit in a single article. But we have covered the basics of postpartum depression.

Experiencing PPD doesn't mean you're a bad mom or something is wrong with you; it also doesn't mean that you don't love your child.

Remember that many women have had depressive episodes after birth, but you don't have to suffer through it alone. Talk therapy, cognitive behavioral therapy, medication, eating healthy foods, self-care, joining a support group, and friends and family members can all help.

Seek the services of a mental health provider if you're experiencing chronic depression, postpartum anxiety, postnatal depression, or any other mental health conditions. Postpartum psychosis requires immediate treatment, usually in the hospital.

Not sure whether your postpartum depression is severe enough to require a mental health professional? An at-home depression screening can help.