Postpartum depression (PPD)

Postpartum depression (PPD)

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I just had a baby but have been feeling down. Is it the baby blues or postpartum depression (PPD)?

Sometimes it can be hard to tell the difference between the baby blues, postpartum depression (PPD), and the normal stress and exhaustion of being a new parent.

That's because emotional ups and down are a normal part of parenting a newborn. However, some brand-new moms seem to linger on lows longer than others. And if you've been expecting the first weeks with your baby to be full of joy and bliss, you may feel upset and confused to experience the opposite. Rest assured, you're not alone: Up to 80 percent of new mothers go through the baby blues.

The baby blues typically begin a few days after delivery and go away on their own in a week or two. Symptoms of the baby blues include:

  • Tearfulness
  • Mood swings
  • Unhappiness
  • Irritability
  • Feeling overwhelmed
  • Trouble concentrating
  • Trouble sleeping
  • Worry
  • Self-doubt
  • Fatigue

However, you might be suffering from postpartum depression (PPD) if the above symptoms:

  • Last longer than two weeks
  • Are so powerful that they prevent you from being able to do your daily tasks – including caring for yourself and your baby

What is postpartum depression (PPD)?

PPD is a very common and treatable maternal mental health condition. An estimated 1 in 7 new mothers develops PPD, but many experts believe the number is even higher because so many women don't seek treatment or dismiss their concerns as the baby blues or the normal stress of being a new mom.

The difference between PPD and other depression is the timing: PPD occurs during the first year after childbirth. And PPD is linked to the unique hormonal changes that occur after childbirth. (See "What causes PPD?" below.)

Postpartum depression can begin in the days, weeks, or months after pregnancy – or even while you're still pregnant. In fact, about half of women with PPD have symptoms during pregnancy.

What are the symptoms of PPD?

The symptoms of PPD and depression that occur during other times in a woman's life are the same. Many of the symptoms of PPD and the baby blues (see above) are the same, too. But, again, the symptoms of PPD are more intense and longer-lasting than those experienced with the baby blues.

You could have PPD if you experience any of the following symptoms almost every day:

  • Extreme sadness, emptiness, or hopelessness
  • Crying all the time
  • Loss of interest or lack of enjoyment in your usual activities and hobbies
  • Trouble falling sleep at night, or trouble staying awake during the day
  • Loss of appetite or eating too much, or unintentional weight loss or weight gain
  • Overwhelming feelings of worthlessness or overpowering guilt
  • Restlessness or sluggishness
  • Difficulty concentrating or making decisions
  • Feeling that life isn't worth living
  • Severe mood swings
  • Difficulty bonding with your baby
  • Severe anxiety
  • Thoughts of harming yourself or your baby

Other possible signs you might be depressed include:

  • Being extremely irritable or angry
  • Avoiding friends and family
  • Worrying excessively about your baby
  • Worrying that you're not a good parent
  • Being uninterested in your baby, or unable to care for her
  • Feeling so exhausted that you're unable to get out of bed for hours

In rare cases, some women experience delusional thoughts or hallucinations, and may even harm their baby. This is called postpartum psychosis. If you suspect this might apply to you, seek help right away. See "Where can I get help for PPD?" below for resources.

I feel guilty and ashamed that I'm not happier. Does this mean I'm a bad mother?

No. PPD is a treatable mental health condition. It has nothing to do with your fitness as a parent. But it's very common for women with PPD to feel a sense of failure, guilt, or shame – and these emotions often prevent new moms from seeking help.

Many women with PPD also have thoughts like:

  • "I'm a bad mother."
  • "I feel guilty because I'm supposed to be happy."
  • "I should be able to control how I feel."
  • "I'm ashamed that I don't feel happy."
  • "I'm not bonding with my baby, so I'm probably not meant to be a mom."

Read real-life stories from moms who experienced PPD.

Where can I get help for PPD?

If you have symptoms of PPD – or have any concerns about how you feel after you have a baby – here are resources:

  • Postpartum Support International: Coordinators provide free, confidential advice and support, facts about PPD, and help finding local resources, such as therapists and support groups. You can also call (800) 944-4773.
  • Perinatal mood clinic: Some hospitals have a clinic for new moms staffed with trained mental health professionals familiar with PPD.
  • Trusted healthcare provider: Your provider can do a postpartum mood screening and refer you to a mental health professional for further evaluation and treatment, if needed. You can also take our postpartum depression quiz and share the results with your provider.
  • Postpartum Progress: This website provides in-depth information and support for pregnant and new moms with mental health conditions.

If you're thinking about harming yourself or your baby, call the National Suicide Prevention Lifeline at (800) 273-8255 immediately for free, confidential support.

Will my baby be taken away if I tell my doctor how I feel?

It's very rare that a baby will be taken away from a mother who's struggling with PPD, but this fear prevents moms with PPD from seeking help. However, there is the possibility of being hospitalized for treatment if your depression is severe or if you're thinking of hurting yourself or your baby. However, this does not mean you're unfit to care for your child. It means that you care enough about your family to get help.

How long does PPD last?

It varies from mom to mom. The timetable depends on many factors, including when symptoms start, how severe they are, whether you previously suffered from clinical depression, and how soon diagnosis and treatment take place.

Some women respond quickly to treatment, while other women continue to struggle with symptoms for months. There are also moms who suffer from maternal depression, even with medical treatment, for more than a year after giving birth. Women with untreated PPD may suffer from chronic depression even longer.

The best way to ensure the quickest recovery is to be evaluated by a mental health professional and implement a treatment plan as soon as possible.

What causes PPD?

PPD results from a combination of hormonal, environmental, emotional, and genetic factors that are beyond your control. Some women might feel somehow responsible for having PPD or blame themselves for being depressed, but depression doesn't happen because you're a bad mother or because of something you did or didn't do.

When you're pregnant, your estrogen and progesterone levels skyrocket. Within a day of giving birth, the levels drop to pre-pregnancy levels. That sudden shift – similar to the hormonal swings you might feel before your period but magnified – play a role in PPD.

For some women, a drop in thyroid hormone – which also happens after giving birth – can cause postpartum thyroiditis, with symptoms similar to those of depression. This condition usually shows up four to 12 months after delivery. If you reach out to your doctor about your depression, she can do a blood test to tell if your thyroid is causing your symptoms and prescribe thyroid medicine if necessary. Be sure to mention if thyroid disease runs in the family.

Other factors that contribute to the development of PPD include the physical exhaustion after giving birth, sleep deprivation, the emotional roller coaster of becoming a parent, and sleep deprivation.

What are the risk factors for PPD?

Every new mom is at risk for PPD, but some women have a higher risk. The strongest predictors of postpartum depression are:

  • Previous history of depression – this is the strongest indicator, with women who have been depressed in the past 20 times more likely to experience PPD
  • Depression or anxiety during pregnancy
  • Stressful life events during pregnancy or soon after giving birth
  • Traumatic childbirth experience
  • Preterm delivery
  • Baby in neonatal intensive care (NICU)
  • Lack of social support
  • Breastfeeding problems
  • Unresolved childhood trauma

Other risk factors include:

  • Unplanned or unwanted pregnancy
  • Baby born with birth defects or other medical problems
  • Multiple babies (such as twins or triplets)
  • Family history of psychiatric problems
  • Being single
  • Low socioeconomic status or financial instability
  • Domestic violence
  • Unemployment
  • Pregnancy complications
  • Pregestational or gestational diabetes

Remember that these risk factors don't actually cause PPD. Many women with multiple risk factors never experience clinical depression or anxiety, while others with just one risk factor (or even none) can end up with a diagnosis of PPD.

What is the treatment for PPD?

The treatment for PPD is the same as the treatment for depression that happens before or during pregnancy. The most common treatments are talk therapy, antidepressant medication, or both, depending on your symptoms. Seeing a therapist or psychiatrist, or taking medication, doesn't mean you're weak. It shows that you're willing to do what's necessary to keep you and your baby safe and healthy.

Talk therapy: Also called counseling or psychotherapy, talk therapy can be one-on-one with a therapist or in a group setting with other women going through a similar experience. In couples or family therapy, a therapist works with you and your partner or relatives.

Antidepressants: Prescription medications can help balance the brain chemicals that regulate your mood. Different types of antidepressants work in different ways – sometimes different ones are combined to improve results. You'll probably start to feel better after taking the medicine for three or four weeks. The response to different antidepressants can vary from person to person, so don't be discouraged if there's some trial and error to find the right medication and dose.

Antidepressants can cause side effects, but most resolve after a short time. If you experience side effects that interfere with your daily life, or if your depression gets worse, let your provider know right away.

Transcranial magnetic stimulation (TMS): Research indicates that this noninvasive brain stimulation technique may be effective for about half of those with PPD who haven't found help with medication. Magnetic fields (similar to those used in MRIs) are used to target areas of the brain that are related to depression. TMS is not appropriate for people at high risk for seizures but otherwise seems to be well tolerated.

Electroconvulsive therapy (ECT): Some women have very severe PPD that doesn't respond to talk therapy or medication. In this case, a healthcare provider may suggest electroconvulsive therapy. With ECT, small electrical currents are passed through the brain while the patient is under general anesthesia. Experts believe this electrical stimulation causes chemical changes in the brain that relieve depression symptoms.

Why is it important to seek treatment for PPD?

If you're diagnosed with postpartum depression, finding treatment that alleviates your PPD symptoms is important for your well-being and your baby's.

Feeling better can spark or rekindle the joy of motherhood. Untreated depression can be lonely, confusing, and even scary. Many moms with PPD feel ashamed and guilty. The good news is that PPD is very treatable, so you don't have to feel this way.

Treatment provides an opportunity to understand what's causing your depression, as well as the support you need to recover. A therapist can provide behavioral tools that can help you cope with your symptoms or teach you mindfulness exercises to aid in managing your mood. Also, having a therapist and healthcare provider who understand your condition can help you feel less alone.

It's also important to get treated for your baby's sake. Having a mother who has untreated PPD is associated with a variety of potential social, emotional, and behavioral problems for children, as well as possible language and learning delays.

Is it safe to take antidepressants while breastfeeding?

Some antidepressants are safe to take while breastfeeding, while others (such as benzodiazepines) are not. Be sure to tell your doctor that you're nursing before taking a prescription for an antidepressant. While the levels are very low, the medication does pass to your baby through breast milk.

Selective serotonin reuptake inhibitors (SSRIs) are considered the safest option and are frequently prescribed to breastfeeding women with depression. Other drugs for depression also appear to be safe, including serotonin norepinephrine reuptake inhibitors (SNRIs).

If you're wondering whether changes in your baby's eating, sleeping, or behavior might be caused by your medication, talk to your provider. (Continue taking your medication unless your provider tells you to stop.)

For details on specific medications, see our drug safety during breastfeeding chart.

What is postpartum anxiety?

Many women with PPD feel worried or anxious, but if you have persistent feelings of intense worry or panic that cause severe distress and keep you from doing your daily activities, you might have an anxiety disorder. Research indicates that about 15 percent of postpartum moms have an anxiety disorder at 1 to 24 weeks after the birth of their baby.

Treatment is available for postpartum anxiety disorders, so let your provider know right away if you have any feelings of overwhelming worry or panic. Common fears include:

  • Uncontrollable worry about sudden infant death syndrome (SIDS)
  • Fear that your baby will be taken away
  • Excessive worrying about being criticized for your parenting skills
  • Worry about not having the support of friends and family
  • Self-consciousness about your postpartum body
  • Fear of being intimate with your partner
  • Intrusive or unwanted thoughts about harm befalling your baby
  • Physical symptoms such as muscle tension, stomach discomfort, or trouble sleeping

How do I cope with PPD?

In addition to getting professional help, here are some ways to take care of yourself when you're dealing with PPD:

  • Be good to yourself. Make sure your own basic needs are met: Try to sleep and eat well, and do your best not to feel guilty. Having PPD doesn't mean that you're a bad mother or that you don't love your child. After you begin treatment, these feelings of guilt and despair should start to fade.
  • Don't demand too much of yourself. If you have depression or anxiety, it can be hard enough just to get out of bed and face the day. Be gentle with yourself, and take things one at a time.
  • Ask for support. Part of being a good mother is knowing when to ask for help, so don't be afraid to ask for it during this difficult time. Let your partner know about different ways to help, whether it's taking care of the baby, handling chores, or going with you to doctor appointments. Relatives or close friends may be able to help as well.
  • Share your feelings. Keep the lines of communication open with your partner and talk about what's going on. Call a sympathetic friend. Join a mothers' group or a PPD support group, or chat with moms about postpartum depression in the our site Community. You may be surprised by how many women are experiencing similar feelings.
  • Dress the part. Getting cleaned up on the outside can sometimes help you feel better inside. Have your partner or a friend watch your baby so you can take a shower or bath. Get some non-maternity clothes that make you feel good to boost your spirits.
  • Get some rest. The rigors of caring for a newborn 24/7 can leave you exhausted. Unfortunately, moms with postpartum mood conditions often can't sleep when they want to. Take breaks to rest, even if you just read or watch videos. Taking 10-minute naps is helpful too. If doable, consider hiring a postpartum doula or a sitter experienced with newborns, or ask a relative or friend to watch your baby for an hour or so. Note: Always put your baby on a safe sleep surface (such as his crib or bassinet) before you settle down to rest. Nodding off with your baby in your arms while on a couch or adult bed is a risk factor for sudden infant death syndrome (SIDS) and other types of sleep-related injuries and deaths.
  • Go outside. Put your baby in a stroller and take a walk around the block, or meet a friend at a nearby cafe. If even a brief excursion is too much for you right now, then just go outside, close your eyes, and take some deep breaths. Or sit in the sunshine for a few minutes.
  • Slow down. Don't feel like you have do chores while your baby sleeps – housework can wait. Instead of checking social media, try listening to music or an audiobook, or use a meditation app. If you're on maternity leave, don't stress about the work waiting for you at the office – you'll get back on track soon enough.

My partner has PPD. How can I make life easier for her?

What's most important is that your partner gets proper treatment. You can't fix PPD, but you can be there for her.

Your support is vital to her recovery, so offer your partner help whenever she needs it and don't judge her. You can talk to your partner's doctor, midwife, or therapist to get more information about the condition and better understand what she's going through.

The postpartum period is hard on partners too, so make sure you get rest and take care of yourself. After all, you're also busy tending to your baby's needs. And the adjustment to new parenthood can be even more difficult when your partner has PPD, especially if you expected life after the baby's birth to be a joyous time for your family.

Can men have postpartum depression, too?

Yes. According to the CDC, about 4 percent of dads experience depression in the first year after their child's birth, most often 3 to 6 months postpartum. At highest risk are those with:

  • A history of depression
  • Financial difficulties
  • Other children
  • Partner has suffered from depression

Learn more

Watch the video: Chrissy Teigen opens up about postpartum depression (May 2022).


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