Postpartum Depression:

Symptoms and Treatments

Defining Perinatal Mood and Anxiety Disorders

Postpartum depression is a condition that causes a woman to experience intense feelings of sadness and hopelessness in the weeks after she gives birth. This occurrence can affect her ability to bond with her baby.1

It’s important to know that postpartum depression is slightly different from the term “baby blues”.1 According to the National Institutes of Health, an estimated 80 percent of women experience the baby blues. These are feelings of worry, sadness, and fatigue that may make a woman feel she isn’t good enough at caring for her baby. Unlike postpartum depression, a woman with the baby blues will usually have her symptoms go away in about one to two weeks after they start. She won’t typically need any extra therapy or medications during this time to feel better.

Postpartum Psychosis

The baby blues and postpartum depression are also different from a very rare, yet serious condition known as postpartum psychosis.2 This occurs when a woman experiences hallucinations or delusions after giving birth that put herself and her baby at risk. This condition is very rare and occurs in every 4 out of 1,000 new moms and usually takes place about two weeks after giving birth.3 If a woman has a history of bipolar disorder or schizoaffective disorder, she is at greater risk for postpartum psychosis.

Prevalence

An estimated 15 percent of women experience postpartum depression, according to the National Institutes of Health. This equals an estimated one in nine women who will experience postpartum depression after giving birth. While some women experience these symptoms almost immediately, others may not report symptoms until about one month or more after giving birth.

Serena Williams' Story

In August 2018, tennis star Serena Williams shared an Instagram post where she shared her experiences with postpartum depression. In the post, she said, “It’s totally normal to feel like I’m not doing enough for my baby.”

Williams is not alone in sharing her experiences with postpartum depression. Celebrities like Brooke Shields, Adele, Drew Barrymore, and Gwyneth Paltrow have described their struggles with postpartum depression.

Symptoms of Postpartum Depression

Symptoms can vary in moms with postpartum depression. They may not recognize the symptoms at first, thinking they’ll pass or that they only need to sleep more. However, postpartum depression symptoms will persist beyond two weeks. Some of the examples of these symptoms include:

Feeling sad or hopeless most of the time

Feeling so overwhelmed that they don’t know what to do

Feeling physical aches and pains with no known cause, such as headaches, stomach pains, or muscle pains

Having intense feelings of anger or fear

Having significant doubts about her abilities to care for herself or her baby

Lack of interest in doing things she used to like doing

Not eating enough or too much

Sleeping problems, such as not sleeping when the baby sleeps or oversleeping and having significant problems waking up

Withdrawing from a partner, friends, or family

At its most severe, postpartum depression can cause a woman to think about harming herself or her baby.

Causes and Risk Factors

Doctors can’t point to just one cause that leads to postpartum depression. Instead, they think it’s a lot of different factors that may contribute to the condition. Some of these causes include:

Changing Hormone Levels

After a woman has her baby, some key hormone levels drop. These include estrogen and progesterone. Doctors think the decreases in these levels can cause mood swings that lead to brain changes. They also know thyroid hormone levels decrease. Low thyroid levels can cause a woman to feel low in energy.

Having a Baby with Special Needs

If a woman has a baby that was born prematurely or has medical complications that may require extra care or a prolonged hospital stay, she is at greater risk for postpartum depression.

Lack of Emotional Support

If a new mom doesn’t have significant support from a spouse, partner, family, or friends, she may be at greater risk for postpartum depression.

Sleep Deprivation

The demands of a new baby along with not having time to recover from birth can lead to exhaustion. This affects any woman’s moods.

Previous History of Depression

If a woman has experienced depression or mental illness in the past, she is at greater risk for depression.

History of Substance Abuse Problems

If a new mom has a history of abusing drugs or alcohol, she may be at greater risk to experience postpartum depression.

What doctors do know is that women of all ages, races, and economic statuses have postpartum depression. The condition can come whether you’ve had an “easy” pregnancy or a difficult one.

Misconceptions

Only Women Get Postpartum Depression

One common misconception about postpartum depression is that only women experience it. According to WebMD, an estimated 10 percent of new fathers also experience postpartum depression. Unlike women, the condition often begins about three to six months after a baby is born.4 A partner is more likely to experience postpartum depression if his or her partner also suffers from postpartum depression.

It's Possible to Prevent Postpartum Depression

Another misconception about postpartum depression is that a woman can prevent it. This isn’t true. Women do not want to have postpartum depression. There isn’t anything they can do to keep postpartum depression from happening, but it’s possible to seek treatments that help overcome the condition.

Treatments

If a woman struggles with postpartum depression, there are several treatments a doctor can recommend to help her regain hope and energy.

Which Doctor Do I Talk To?

A woman will usually speak to her OB/Gyn first regarding her postpartum depression. This is often due to convenience – a woman often goes to a well-visit checkup at her doctor’s office about four to six weeks after giving birth. However, if she already has an established relationship with a mental health provider, she may be able to contact her mental health professional.

An OB/Gyn will usually recommend a counselor, psychiatrist, or psychologist who specializes in treating postpartum depression. Ob/Gyn’s are well-versed in postpartum depression and can usually identify experts as well as support groups that may help a woman get the help she needs.

Medications

A doctor may prescribe anti-depressant medications to reduce the effects of postpartum depression. An example is fluoxetine (Prozac).5 These medications affect neurotransmitters in a person’s brain, which can help lift a woman’s mood. However, these medications may take several weeks to be most effective. As a result, a woman will usually participate in talk therapy or other treatments while she is waiting for her anti-depressants to reach their maximum effectiveness.

The U.S. Food and Drug Administration (FDA) has also approved a medication called brexanolone, specifically to treat postpartum depression in women.6 This medication is given via an intravenous (IV) line. Another option is the medication esketamine. This medicine helps to reduce the incidence of postpartum depression but isn’t safe for breastfeeding moms or moms who are pregnant again.

Medication Effects on Breastfeeding

Some medications used to treat depression may be safe for women who are breastfeeding while others (such as esketamine) aren’t. The concern is that some women release the medications in their breast milk. Because babies don’t have the same advanced immune system and the ability to filter medications with their kidneys, they can have more severe side effects than adult women.

A woman should ask her doctor if the medications they prescribe to treat postpartum depression are safe to breastfeed with. Some women can also breastfeed their baby and then take the medication because the body may metabolize it before they feed again. She can discuss the medications she is taking and determine if it is better to breastfeed and take antidepressants or take antidepressants and refrain from breastfeeding.

Therapies

Doctors will usually use one or both of the following approaches to help a woman struggling with postpartum depression:

Cognitive Behavioral Therapy (CBT)

This treatment approach involves teaching a woman to recognize thoughts and behaviors that may be causing a woman to take on a negative view of herself.

Interpersonal Therapy (IPT)

This therapy approach may be beneficial for a woman and her partner or her family members as a means to enhance her personal relationships. Examples of some of the concerns a therapist may cover during IPT include social support, stressors, and how a couple can strengthen their relationship.

In rare and severe instances of postpartum depression, a doctor may recommend electroconvulsive therapy (ECT) treatment. This is a special treatment performed under anesthesia that can treat severe depression.

Tips You Can Use Now

While a woman should still seek professional help if she is struggling at home with postpartum depression, there are still approaches she can take at home to reduce her symptoms. Examples of these steps include:

Making efforts to sleep whenever possible. This includes trying to sleep whenever the baby sleeps.

Reaching out for help from a partner, friends, and family. Often, people want to help but don’t know how. Giving them a specific task, such as help around the house, can give them a way to help.

Trying whenever possible to keep from making life changes, such as moving, changing jobs, or engaging in other activities that are unnecessarily stressful.

Taking time to leave the house, even if it’s for a trip to the grocery store. Sometimes staying too cooped up can increase feelings of postpartum depression.

Finding Support

There are organizations that help moms struggling with postpartum depression. These include the National Women’s Health Information Center at womenshealth.gov and Postpartum Support International at postpartumsupport.net.

In addition, to support from national organizations, a woman can also ask her Ob/Gyn if there are support groups available in her area that she can access. Sometimes, having the support of her peers and hearing things from other moms can help a woman identify ways to better cope with her feelings.

Don't Leave Postpartum Depression Untreated

If left untreated, postpartum depression can continue for months to years. This represents wasted time for a mom to bond with her little one as well as significant time feeling sad and low. Being the child of a mom who struggles with postpartum depression can also cause several side effects. These include greater likelihood to experience language delays, behavior problems, and even increased risks for obesity.