The birth of a child can be a joyous and exciting time, but following childbirth, some women may experience postpartum disorders that can adversely affect a woman’s mental health. Mothers commonly experience what is called “the baby blues,” mood swings that are the result of high hormonal fluctuations that occur during and immediately after childbirth. They may also experience more serious mental health disorders such as postpartum depression, birth-related post-traumatic stress disorder or a severe but rare condition called postpartum psychosis.
In general, clinical depression occurs in approximately 15 to 25 percent of the population, and women are twice as likely as men to experience depression. Because women are most likely to experience depression during the primary reproductive years (25 to 45), they are especially vulnerable to developing depression during pregnancy and after childbirth. Women who develop these disorders do not need to feel ashamed or alone; treatment and support are available.
What are the postpartum blues or “baby blues?”
Postpartum blues are very common, occurring in up to 80 percent of new mothers. Characterized by mood swings, postpartum blues or “baby blues” are normal reactions that many mothers experience following childbirth. The onset of postpartum blues usually occurs three to five days after delivery, and should subside as hormone levels begin to stabilize. Symptoms generally do not last for more than a few weeks. If a person continues to experience moods swings or feelings of depression for more than two weeks after childbirth, the problem may be more serious.
What is postpartum depression (PPD)?
Postpartum depression (PPD) is a major form of depression and is less common than postpartum blues. PPD includes all the symptoms of depression but occurs only following childbirth. It can begin any time after delivery and can last up to a year. PPD is estimated to occur in approximately 10 to 20 percent of new mothers.
What are the symptoms of PPD?
Symptoms of PPD are the same as those for clinical depression and may include specific fears such as excessive preoccupation with the child’s health or intrusive thoughts of harming the baby. Given the stressful circumstances of caring for a new baby, it is understandable that new mothers may be more tired, irritable and anxious. But when a new mother is experiencing drastic changes in motivation, appetite or mood she should seek the help of a mental health professional. For a clinical diagnosis of postpartum depression to be made, symptoms of PPD generally must be present for more than two weeks following childbirth to distinguish them from postpartum blues.
What are the factors that contribute to PPD?
The causes of PPD are not quite clear but research suggests that the following factors may contribute to the onset of PPD:
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Hormonal changes: A woman experiences the greatest hormonal fluctuation levels after giving birth. Intense hormone fluctuations, such as decreased serotonin levels, occur after delivery and may play a role in the development of PPD.
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Situational risks: Childbirth itself is a major life change and transition, and big changes can cause a great deal of stress and result in depression. If a major event coincides with childbirth, a mother may be more susceptible than average to PPD.
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Life Stresses: Ongoing stressful circumstances can compound the pressures of having a new baby and may trigger PPD. For example, excessive stress at the office added to the responsibilities of being a mother can cause emotional strain that could lead to PPD. The nature of the mother’s relationship with the baby’s father and any unresolved feelings about the pregnancy might also affect a mother’s risk of getting PPD.
What treatments are available?
Taking antidepressant medication may help alleviate the symptoms of PPD and should be combined with ongoing counseling with a therapist trained in issues surrounding childbirth. Studies show that some antidepressant medications have no harmful effects on breastfeeding infants. Psychotherapy alone may also be used to treat PPD. New mothers should be encouraged to talk about their feelings or fears with others. Socializing through support groups and with friends can play a critical role in recovery. Exercise and good nutrition may improve a new mother’s mood and also aid in recovery. Caffeine should be avoided because it can trigger anxiety and mood changes.
Can PPD lead to other problems?
When a new mother has severe depression, the vital mother-child relationship may become strained. She may be less able to respond to her child’s needs. Several studies have shown that the more depressed a new mother is, the greater the delay in the infant’s development. A new mother’s attention to her newborn is particularly important immediately following birth because the first year of life is a critical time in cognitive development.
Is PPD preventable?
In most cases PPD is preventable; early identification can lead to early treatment. A major part of prevention is being informed about the risk factors and the medical community can play a key role in identifying and treating PPD. Women should be screened by their physician to determine their risk for acquiring PPD. Because social support is also a vital factor in prevention, early identification of mothers who are at risk can enable a woman to seek support from physicians, partners, friends, and coworkers.
What is birth-related post traumatic stress disorder (PTSD)?
After childbirth, women may also experience post traumatic stress disorder (PTSD). PTSD includes two key elements: (1) experiencing or witnessing an event involving actual or threatened danger to the self or others, and (2) responding with intense fear, helplessness or horror.
Symptoms of birth-related PTSD may include:
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Obsessive thoughts about the birth
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Feelings of panic when near the site where the birth occurred
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Feelings of numbness and detachment
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Disturbing memories of the birth experience
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Nightmares
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Flashbacks
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Sadness, fearfulness, anxiety or irritability
What is postpartum psychosis?
In rare cases, women may experience postpartum psychosis (PPP), a condition that affects about one-tenth of 1 percent of new mothers. Onset is quick and severe, and usually occurs within the first two to three weeks following childbirth. Symptoms are similar to those of general psychotic reactions such as delusions (false beliefs) and hallucinations (false perceptions), and often include:
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Physical symptoms: Refusal to eat, inability to cease activity, frantic energy.
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Mental symptoms: Extreme confusion, memory loss, incoherence.
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Behavioral symptoms: Paranoia, irrational statements, preoccupation with trivial things.
A woman who is diagnosed with PPP should be hospitalized until she is in stable condition. Doctors may prescribe a mood stabilizer, antipsychotic or antidepressant medications to treat postpartum psychosis. Mothers who experience PPP are highly likely to suffer from it again following their next pregnancy.
Resource for Postpartum Depression
provided by Maryville University
Having a baby is typically described as a time of joy. A time to celebrate the new little life that has been brought into this world. A time to be thankful for the family unit that has now been increased by one or more.
However, for some women, this life-altering event brings about feelings that aren’t quite as joyful, and begins a condition known as postpartum depression (PPD).
Postpartum Depression Defined
The National Institute of Mental Health (NIMH) defines PPD as a mood disorder that sometimes appears in women after giving birth. Additionally, they say that this disorder typically comes feelings of “extreme sadness, anxiety, and exhaustion,” sometimes to the point where everyday activities are difficult to complete.
According to the American Psychological Association (APA), as many as one in seven women suffer from PPD, a condition that can present itself anywhere from a few days up to several months post-delivery. It has no boundaries, either, because it can affect any new mother without regard to her background, ethnicity, socioeconomic status, or whether it is her first time or fifth time giving birth.
It’s important to note that feelings of sadness and anxiety directly after childbirth can occur without rising to the level of PPD. These are typically referred to as “postpartum blues.” So, what’s the difference?
Postpartum Depression Versus Postpartum Blues
One of the main differences is that the postpartum blues condition typically appears within 2-3 days of childbirth and disappears within a week or two, according to the American College of Obstetricians and Gynecologists (ACOG). This is different than PPD, which generally sets in anywhere from one to three weeks post-birth but can take up to one full year before it presents itself.
Also, PPD often requires some type of intervention to begin to resolve, while postpartum blues generally disappears on its own. Additionally, the feelings associated with postpartum blues—sadness, anxiety, and being upset with the baby or a loved one—are usually much less intense than the feelings associated with PPD. With the latter, the new mother’s emotions are typically fairly intense, possibly even reaching the point where they become totally debilitating.
Causes of Postpartum Depression
The ACOG says that there is no specific cause of PPD, but rather “a combination of factors.” Some are physical and others are more emotional or mental in nature.
For example, the new mother’s changes in hormones could act as a trigger for this mood disorder. Research has found that the reduction in estrogen and progesterone that occur after delivery not only contribute to depression, but they are also linked to other cognitive changes as well. These include memory formation and difficulties related to learning.
Another factor that can increase depression risk is a history of depression, unsure feelings about the pregnancy, longer hospital stays, and general feelings of fatigue after giving birth, according to the ACOG.
The mother’s life situation matters too, such as how much support she feels she has at home, whether she’s had an illness or loss in her family that she’s dealing with, or any other major life changes that have recently occurred. All of these situations can impact her emotional state post-delivery.
Postpartum Depression Symptoms
How does a new mother know if her postpartum blues is likely to go away on its own or if it’s at the level of being classified as PPD?
The APA says that while “warning signs are different for everyone,” some of the more common PPD symptoms include:
- Extreme changes in eating behaviors, whether it’s much more or less than usual
- Feelings of anxiety almost all of the time, and sometimes experiencing full-blown panic attacks
- Being excessively irritable or angry
- Having fears associated with not being able to properly care for the child
- Trouble getting and/or staying asleep, or sleeping too much
- A sudden loss of interest in activities you used to enjoy
- A lack of interest in caring for the child or spending time with family and friends
- Having “scary thoughts” that include hurting yourself or your child
Postpartum Depression Treatment Options
If you or someone you love is struggling with PPD, what can be done? Fortunately, there are many options.
The first involves understanding that there is nothing you did that brought about this level of depression. Or, as the APA states, you must realize that “postpartum depression is not your fault—it is a real, but treatable, psychological disorder.” In other words, don’t belittle yourself if you believe you have PPD because it isn’t a condition that appears due to something you did wrong or didn’t do pre or post-pregnancy. It just happens sometimes.
Therapy can also help. The NIMH says that two types of counseling or talk therapy that often provide positive results are cognitive behavioral therapy (CBT) and interpersonal therapy (IPT).
- CBT helps by increasing your awareness of your negative thoughts and behaviors, and then helps you work on changing them.
- IPT is more relationship focused. It gives you a greater understanding of issues that may exist with those around you so you can find effective ways to resolve them.
Another option is medication. According to Medicine Net, antidepressants can often help relieve the sometimes intense levels of depression that appear after giving birth, offering positive effects for two-thirds of the women who are prescribed them. Some of the most common antidepressants include fluoxetine (Prozac), sertraline (Zoloft), Paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), bupropion (Wellbutrin), venlafaxine (Effexor), duloxetine (Cymbalta), and desvenlafaxine (Pristiq), but there are also several others.
It typically takes anywhere from one to six weeks for these medications to build up in the body enough to provide an improvement in mood, so Medicine Net recommends giving it at least that amount of time before stopping or changing to a new medication regimen. Also, if the prescription is an MAOI (monoamine oxidase inhibitor), it should not be taken with other medications or foods that contain a high level of the compound tyramine, which is often found in wine, aged cheese, and cured meat, as this can impact its effectiveness.
DIY Postpartum Relief
In addition to therapy and medication, there are some things you can do at home to help provide relief from postpartum depression. Healthline outlines a number of them, many of which are relatively simple to incorporate into your life.
Increase your omega-3 intake
Research published in the journal Depression Research and Treatment explains that both pregnancy and breastfeeding contribute to lower levels of docosahexaenoic acid (DHA) in the new mother’s brain, a factor that has been correlated to increased feelings of depression. Eating more omega-3 fatty acids can help restore healthy DHA levels, which can then help alleviate the depression as a result.
The National Institutes of Health (NIH) report that adequate intakes of omega-3s for pregnant women is 1.4 grams daily and 1.3 grams for women who are lactating. Foods high in in these particular fatty acids include flaxseed (both seeds and oil), chia seeds, and English walnuts. Salmon, herring, sardines, mackerel, and rainbow trout are good sources of omega-3s too.
Practice self-care
Healthline says it’s also important to practice various forms of self-care if you are struggling with PPD. This may include taking long walks, napping when you can, and taking some time every so often just for you.
The main objective is to find things that you enjoy doing and making it a priority to add them into your schedule on a regular basis. This may involve asking family and friends to care for your little one so you can have some much-needed time alone. Though this may seem relatively minor, you may notice that you feel better relatively quickly.
Stay away from alcohol
It also helps to abstain from drinking if you have PPD because there is a high likelihood that the two combined can potentially make the depression worse. In fact, one study published in International Scholarly Research Notices found that 63.8 percent of the alcohol-independent participants suffered from depression, which means that, more often than not, the two will go hand in hand.
If this is difficult for you, it may help to find a dual-diagnosis treatment center can treat PPD and alcohol addition at once, giving you a greater chance of overcoming both.
Talk to people you trust
Talking helps as well, and not just to a therapist but also to your close family and friends. Share your thoughts and concerns with those you trust. Open up to them and let them help you through your birth-related depression.
Alternatively, you could join a PPD support group to talk to as well. This connects you with women who have also struggled with the same issue. Or, if you’re a spouse or family member of someone experiencing PPD, there are support groups for you, too.
PostpartumDepression.org says that benefits of this particular option include building a stronger social network, receiving emotional validation for how you feel, not being judged for your emotions, and developing a more thorough understanding of what postpartum depression is and how it affects you.
If you can’t find a group near you, you can always join one online. For example, the What to Expect website hosts a postpartum depression forum that has more than 5,000 members. You can either start your own discussion or chime in on someone else’s. Either way, it can help to connect with others who know what it’s like to live with PPD.
PPD is very real, but it is also very treatable. The key is to find the remedies that provide the most relief and make your recovery a priority. Both you and your baby deserve that, and so much more.
Other Resources
Postpartum Support International
www.postpartum.net
Provides information for new moms and dads, on-line list of support groups, chats and discussion boards, share a story section, bookstore, etc.
American Academy of Family Physicians
www.aafp.org
OBGYN.net
www.obgyn.net
