Home Health Topics What Is Postpartum Depression? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Health Topics

What Is Postpartum Depression? Symptoms, Causes, Diagnosis, Treatment, and Prevention

February 4, 2020

493

Pregnancy and giving birth are intensely emotional experiences. And while these life-changing events can bring joy, they can also present challenges that make you feel sad, tired, and anxious.

As many as 50 to 75 percent of new mothers feel some degree of unhappiness, worry, and fatigue after having a baby. These so-called baby blues rarely last beyond a week or two, and typically go away on their own.

When symptoms last longer — or seem more serious — the diagnosis may be postpartum depression, a condition that can persist for months.

While postpartum depression can be debilitating, with time and treatment most women can recover and bond with their baby.

Any case of postpartum depression may result from a different combination of factors, but researchers believe that, in general, hormones, neurochemistry, and life circumstances explain why an estimated 1 in 8 women in the United States experience this mental health disorder.

And the true numbers may be even higher. As noted in an article published in April 2017 in Maternal Child and Health Journal, experts believe that postpartum depression is underreported.

The risk of postpartum depression is higher among people who have a history of mental health issues such as depression and anxiety, according to a January 2019 review published in the journal Frontiers in Neuroendocrinology.An earlier study, published in 2017 in the journal Depression & Anxiety, also found that the risk was more than 20 times higher for women with a history of depression.One episode of postpartum depression increases the likelihood that the person will have another.

Signs and Symptoms of Postpartum Depression

Symptoms of postpartum depression vary from person to person, and may include:

Severe anxiety and panic attacks
Depressed mood or severe mood swings
Fear of being a bad mother
Sleep problems, such as insomnia or excessive sleep
Appetite changes (hardly eating or eating much more than usual)
Recurrent thoughts of suicide or death
Intense irritability or anger
Difficulty bonding with the baby
Thoughts of harming yourself or the baby
Overwhelming fatigue or loss of energy
Restlessness
Diminished ability to think clearly, concentrate, or make decisions
Sense of guilt, shame, worthlessness, or inadequacy
Hopelessness
Excessive crying

Symptoms usually develop within the first few weeks after a woman gives birth but may begin earlier (during pregnancy, say, referred to as prepartum depression) or later (up to a year after giving birth). Note that formally speaking, the symptoms must begin within four weeks of giving birth; nevertheless, it's debatable whether this timeframe should be extended, because many people do not recognize their symptoms until later.

“If symptoms go beyond a two-week period, and the mother is still experiencing problems, that will usually lead to a diagnosis of postpartum depression,” says Diane Brown-Young, MD, a staff physician in the department of obstetrics and gynecology at the Cleveland Clinic and at the Willoughby Hills Family Health Center in Ohio.

Learn More About Signs and Symptoms of Depression

How Is Postpartum Depression Diagnosed?

Postpartum depression often goes unaddressed, in part because parents may feel shame for feeling down during what “should” be a time of joy. But a proactive approach to treatment is best for everyone concerned.

Trials in the United States have shown that routinely screening for depression in expectant and new parents can improve outcomes for families, according to a 2020 systematic review from the Cleveland Clinic.It’s important to follow up on any recommendations from your doctor after screening.

Screening for postpartum depression in pregnant and postpartum individuals is now recommended by the American College of Obstetricians and Gynecologists, the American Psychiatric Association, and the American Academy of Pediatrics. It is also covered by insurance, and can begin with a simple questionnaire that parents fill out in the waiting room.

That’s why it’s so crucial to open up about any feelings you may be experiencing during prenatal visits or during the typical six-week follow-up appointment with your ob-gyn after your baby is born.

Your baby’s pediatrician may make a provisional diagnosis of postpartum depression, and may refer you to a mental health professional. The American Academy of Pediatrics now recommends that pediatricians screen mothers at the one-, two-, four-, and six-month well-child visits.

Prognosis for Postpartum Depression

With treatment, symptoms of postpartum depression usually improve. In some cases, postpartum depression can become chronic depression, so it’s important to continue treatment even after you start to feel better.

Left untreated, postpartum depression can harm the mother’s health and could lead to sleeping, eating, or behavioral problems for the child. According to a study in a 2017 issue of Maternal and Child Health Journal, a mother’s mood disorder can lead to a range of emotional and behavioral problems for children at 8 years of age.Studies are ongoing.

Treatment and Medication Options for Postpartum Depression

Regardless of the extent of symptoms, it’s important to get proper treatment during this important time in your life and the life of your baby. The first step is talking to your healthcare provider.

One or more treatment options may help.

Talk Therapy for Postpartum Depression

A therapist, psychologist, or social worker can teach you strategies to change how depression makes you feel, think, and behave.

Medication for Postpartum Depression

Breastfeeding parents may be reluctant to take psychotropic (psychiatric) drugs, for fear of potential effects on their child. But given the potential long-lasting negative effects of untreated postpartum depression, the consensus among reproductive psychiatrists is that, for some women, taking medication is better for both mother and baby than forgoing treatment.

Each parent should make that decision personally, in consultation with their doctor, considering factors like medical history and circumstances.

There are a number of drugs to treat postpartum depression, starting with antidepressants. Your healthcare provider can prescribe one that is safe to take while breastfeeding. Note that these medicines may take several weeks to become effective.

In March 2019, the U.S. Food and Drug Administration (FDA) approved Zulresso (brexanolone) as the first medication specifically for postpartum depression. It is administered through an IV line continuously for two and a half days (60 hours). It may not be safe to take while pregnant or breastfeeding.

First Medication for Postpartum Depression Wins FDA Approval

In 2019, the FDA also approved the nasal spray Spravato (esketamine) for treatment-resistant depression in adults. Derived from ketamine, a widely used anesthetic, it is administered only at certified treatment centers. The drug works very quickly, usually within hours. It is not safe to take while pregnant or breastfeeding.

Electroconvulsive Therapy for Postpartum Depression

Known as ECT, electroconvulsive therapy helped some women with postpartum depression or psychosis, with a higher response rate in the postpartum group than those not postpartum, according to a report in the Journal of Affective Disorders published in 2018. Small electrical currents are passed through the brain, intentionally triggering a brief seizure and altering brain chemistry.

Strategies for Coping With Postpartum Depression

In addition to professional treatment, the following tips can help alleviate symptoms of postpartum depression.

Make healthy lifestyle choices. Although it is definitely a challenge to focus on yourself with a new baby, it’s important for people who have postpartum depression to take time to do things like eating healthy meals, exercising, getting enough sleep, and avoiding alcohol, which can exacerbate mood swings.

Practice self-care. Enlist a partner, friend, or other family member to watch the baby or hire a sitter, then get out of the house and do something for yourself.

Set realistic expectations. Treatment can help, but it may take some time before you feel like yourself again. In the meantime, don’t feel pressured to check off everything on your to-do list.

Say yes to caregiving help. Take people up on their offers to help. Your friends and family members can help around the house, watch the baby so you can sleep, run errands, or be there to listen when you need to talk.

Avoid isolation. Talk with your partner, friends, or family about how you’re feeling. You may want to join a support group with other mothers who’ve experienced postpartum depression and can share experiences and coping skills.

Prevention of Postpartum Depression

If you’re planning to become pregnant, or as soon as you do, it’s important to tell your doctor about any history of mental illness, especially previous episodes of postpartum depression. Your doctor can then be sure to check in with you throughout your pregnancy for signs or symptoms of depression.

Counseling and group therapy during pregnancy and after giving birth can be effective in preventing postpartum depression among at-risk mothers, according to a systemic review by the U.S. Preventive Services Task Force published in JAMA in February 2019.

Depending on risk factors, your doctor may recommend medication, either during pregnancy or immediately after you give birth.

Research and Statistics: How Many People Experience Postpartum Depression?

Worldwide, about 18 percent of women experience postpartum depression, according to a meta-analysis of almost 300 studies from 56 countries published in the journal Frontiers in Psychiatry in 2018.

Countries with higher rates of maternal and infant mortality, income inequality, and women of childbearing age working over 40 hours a week also have higher rates of postpartum depression.

The latest figures from the U.S. Centers for Disease Control and Prevention show that 1 in 8 women experience postpartum depression in the United States.With 3.7 million births occurring in the United States in 2019, the latest year for which data is available, that means nearly half a million women experience postpartum depression every year.

If left untreated, severe postpartum depression can lead to thoughts of harming oneself or the newborn. Alarmingly, the rate of suicide in women in the year before or after giving birth has nearly tripled, according to a study published in February 2021 in JAMA Psychiatry.

Resources We Love

If you are thinking about harming yourself or your baby, or if you are concerned about someone you love, get the support you need. These resources can help.

National Suicide Prevention Lifeline

800-273-TALK (8255) | TTY: 800-799-4889

The Lifeline provides 24/7 free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.

Substance Abuse and Mental Health Services Administration's National Helpline

800-662-HELP (4357) | TTY: 800-487-4889

The National Helpline offers free, confidential 24/7 information and referrals in English and Spanish to local mental health and substance use disorder treatment facilities, support groups, and community-based organizations.

Postpartum Support International (PSI)

800-944-4PPD (4773) for answers in English and Spanish to questions and information on resources in your area.

This organization raises awareness of the emotional changes women may experience during pregnancy and postpartum. It has dozens of resources for new and expecting mothers and fathers, including an online support group, bilingual helplines, and links to local providers.

NAMI, the National Alliance on Mental Illness

NAMI Helpline 800-950-NAMI (6264)

The nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness.

CDC: Maternal Depression

From the Maternal and Child Health Division of the U.S. Health Resources and Services Administration, these links provide great info: Depression During and After Pregnancy and La Depresión Durante y Despues del Embarazo: Un Informe Para Mujeres, Sus Familias y Amigas.

Additional Resources

MotherToBaby: Medications & More During Pregnancy & Breastfeeding

A service of the nonprofit Organization of Teratology Information Specialists, this site is dedicated to providing evidence-based information for mothers, healthcare professionals, and the general public about medications and other exposures during pregnancy and while breastfeeding.

Additional reporting by Paula Derrow and Monroe Hammond.

Editorial Sources and Fact-Checking

Postpartum Depression. Cleveland Clinic. January 1, 2018.
Depression During and After Pregnancy. Centers for Disease Control and Prevention. May 14, 2020.
Wilkinson A, Anderson S, Wheeler SB, et al. Screening For and Treating Postpartum Depression and Psychosis: A Cost-Effectiveness Analysis. Maternal and Child Health Journal. April 2017.
Sayres Van Niel M, Payne JL. Perinatal Depression: A Review. Cleveland Clinic Journal of Medicine. May 2020.
Payne JL, Maguire J. Pathophysiological Mechanisms Implicated in Postpartum Depression. Frontiers in Neuroendocrinology. January 2019.
Silverman ME, Reichenberg A, Savitz DA, et al. The Risk Factors for Postpartum Depression: A Population-Based Study. Depression & Anxiety. January 18, 2017.
Perinatal Depression. National Institute of Mental Health.
Postpartum Depression: Symptoms & Causes. Mayo Clinic. September 1, 2018.
Wynter K, Francis LM, Fletcher R, et al. Sleep, Mental Health, and Well-Being Among Fathers of Infants Up to One Year Postpartum: A Scoping Review. Midwifery. September 16, 2019.
Paulson JF, Bazemore SD. Prenatal and Postpartum Depression in Fathers and Its Association With Maternal Depression: A Meta-Analysis. Journal of the American Medical Association. May 19, 2010.
Davis RN, Davis MM, Freed GL, et al. Fathers' Depression Related to Positive and Negative Parenting Behaviors With 1-Year-Old Children. Pediatrics. April 2011.
Earls MF, Yogman MW, Mattson G, et al. Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice. Pediatrics. January 2019.
Postpartum Depression: Diagnosis & Treatment. Mayo Clinic. September 1, 2018.
Kersten-Alvarez LE, Hosman CMH, Riksen-Walraven JM, et al. Early School Outcomes for Children of Postpartum Depressed Mothers: Comparison With a Community Sample. Child Psychiatry & Human Development. April 2012.
Postpartum Depression. Office on Women’s Health. May 14, 2019.
Payne JL. Psychopharmacology in Pregnancy and Breastfeeding. Medical Clinics of North America. 2019.
Rundgren S, Brus O, Båve U, Landén M, Lundberg J, Nordanskog P, Nordenskjöld A. Improvement of Postpartum Depression and Psychosis After Electroconvulsive Therapy: A Population-Based Study With a Matched Comparison Group. Journal of Affective Disorders. August 2018.
U.S. Preventive Services Task Force. Interventions to Prevent Perinatal Depression. Journal of the American Medical Association. February 12, 2019.
What Is Postpartum Depression? American Psychiatric Association. October 2020.
Hahn-Holbrook J, Cornwell-Hinrichs T, Anaya I. Economic and Health Predictors of National Postpartum Depression Prevalence: A Systematic Review, Meta-Analysis, and Meta-Regression of 291 Studies From 56 Countries. Frontiers in Psychiatry. February 1, 2019.
Bauman BL, Ko JY, Coz S, et al. Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression — United States, 2018. Morbidity and Mortality Weekly Report (MMWR). May 15, 2020.
Closa-Monasterolo R, Gispert-Llaurado M, Canals J, Luque V, Zaragoza-Jordana M, Koletzko B, Grote V, Weber M, Gruszfeld D, Szott K, Verduci E, ReDionigi A, Hoyos J, Brasselle G, Escribano Subías J. The Effect of Postpartum Depression and Current Mental Health Problems of the Mother on Child Behaviour at Eight Years. Maternal and Child Health Journal. July 2017.
Lea Takács; Vít Kandrnal, Šárka Kaňková, František Bartoš; Jiří Mudrák. The Effects of Pre- and Postpartum Depression on Child Behavior and Psychological Development From Birth to Preschool Age: A Protocol for a Systematic Review and Meta-Analysis. British Medical Journal. June 19, 2020.
Ceballos M, Wallace G, Goodwin G. Postpartum Depression Among African-American and Latina Mothers Living in Small Cities, Towns, and Rural Communities. Journal of Racial and Ethnic Health Disparities. October 19, 2016.
Heck JL. Postpartum Depression in American Indian/Alaska Native Women: A Scoping Review. MCN: The American Journal of Maternal/Child Nursing. January–February 2021.
Seplowitz R, Miller H, Ostermeyer B, et al. Utilization of Psychiatric Services by Postpartum Women in a Predominantly Minority, Low-Socioeconomic-Status, Urban Population. Community Mental Health Journal. December 23, 2014.
Backes Kozhimannil K, Mah Trinacty C, Busch AB, et al. Racial and Ethnic Disparities in Postpartum Depression Care Among Low-Income Women. Psychiatry Services. June 2011.
Feldman N, Pattani A. Black Mothers Get Less Treatment For Postpartum Depression Than Other Moms. Kaiser Health News. December 6, 2019.
Zhang AY, Gary F. Discord of Measurements in Assessing Depression Among African Americans With Cancer Diagnoses. International Journal of Culture and Mental Health. January 1, 2013.