Nearly 80% of new mothers experience what is referred to as the “baby blues.”¹ The baby blues appear a few days to a week after giving birth, and may manifest as moodiness, irritability, insomnia (problems falling and/or staying asleep), anxiety, or tearfulness.^{1, 2} Following childbirth, the body goes through significant changes, including a drop in hormone levels.³ Physical exhaustion from childbirth and caring for a new baby can be extreme and often take a toll on a mother’s well being.³ Emotionally, a mother may feel overwhelmed by the new responsibilities brought about by parenthood, and may have trouble transitioning into motherhood and the new lifestyle that comes with it.^{2, 3} She may also worry about the wellbeing of her child and wonder whether she is a good parent.³ Thankfully, these feelings are temporary, and symptoms usually subside within two weeks of their initial appearance.³ The baby blues is not considered an illness and thus does not require any medical treatment, although support and reassurance from loved ones as well as an adequate amount of  rest can help facilitate the process of recovery.³

But what if things do not get better? What if the mother feels like this for several weeks, or even months? She may be experiencing a complication of childbirth known as postpartum depression (PPD).^{1, 2} Unlike the baby blues, postpartum depression can last for months or even years, and symptoms can be so intense that they interfere with the mother’s ability to take care of her baby or handle daily tasks. Postpartum depression usually develops in the first few weeks following childbirth, but may appear up to six months later.² Without treatment, it can last for months or even years, and can have devastating effects on the mother and child’s wellbeing.² Thus, if you feel that you or a loved one may be exhibiting symptoms of postpartum depression, it is important to seek help from a medical or mental health professional as soon as possible.

Symptoms

Depression is not uncommon among women who have just given birth. In fact, studies show that 10 to 15%  of mothers experience postpartum depression, anxiety, or obsessive-compulsive disorder (OCD) following childbirth.¹ Symptoms begin anytime from 24 hours to several months after the child is born. When untreated, the depression can last anywhere from a few months to several years,² which is why it is so important to consult a doctor if the mother shows any symptoms of depression, including the following:

• Overwhelming feelings of sadness^{1, 2}
• Mood swings²
• Increased anger or irritability²
• Lack of interest or pleasure in activities that she once enjoyed²
• Sleep disturbances such as insomnia (inability to sleep) or hypersomnia (sleeping too much)²
• Weight loss
• Extreme fatigue or loss of energy²
• Agitation
• Indecisiveness²
• Loss of concentration
• Thoughts of death or suicide²
• Headaches, stomachaches, or muscle aches¹
• Excessive crying¹
• Trouble bonding with the baby¹
• Intense fear of being a bad mother²
• Feeling worthless, shameful, guilty, or inadequate²
• Severe anxiety or panic attacks²

Symptoms of postpartum anxiety include those listed below:

• Extreme anxiety and/or irritability^{1, 4}
• Restlessness and/or agitation^{1, 4}
• Shortness of breath^{1, 4}
• Chest pains/discomfort^{1, 4}
• Feeling of choking or smothering^{1, 4}
• Dizziness or lightheadedness^{1, 4}
• Tingling in extremities (hands and feet)^{1, 4}
• Trembling and/or shaking^{1, 4}
• Sweating^{1, 4}
• Hold and/or cold flashes^{1, 4}
• Fear of dying, going crazy and/or losing control^{1, 4}
• Stomach cramps, nausea, or headaches⁴
• Feelings of dread⁴
• Fear of judgment following a request for help⁴

Many people experience tough times or have hard days. With postpartum depression, however, symptoms are present most or all of the time for at least a few weeks. Untreated, postpartum depression can last for months or years, and can heavily interfere with a mother’s ability to go about life normally and complete daily tasks.⁴

One does not have to experience all or even most of the symptoms listed above to have postpartum depression. Depression affects everyone differently and can manifest in a variety of ways. For example, some people may be unable to sleep while others will sleep much more than is normal. Some find that they do not feel hungry; others have an extreme increase in appetite. If you feel that there is any chance you are depressed, it is important to seek help.⁴

Postpartum Psychosis

In rare cases, a mother can experience something called postpartum psychosis, a severe psychiatric condition that requires urgent attention. Without treatment, consequences can be devastating. It usually occurs within the first week after childbirth, and can lead to life-threatening thoughts and behaviors.² Symptoms can include the following:

• Confusion and disorientation²
• Sleep problems²
• Obsessive thoughts about the baby²
• Hallucinations such as hearing voices telling her to harm herself or her child²
• Delusions, like believing that her baby is the devil²
• Paranoia²
• Attempts to harm herself or her baby²

If the mother has a critical case of depressive symptoms paired with hallucinations or delusions, there is the rare possibility that she may have postpartum psychosis (present in .2% of postpartum females). This is a disorder that usually sets in within the first month after birth. The visual and/or auditory delusions often involve the infant, making this an emergency situation. Examples of these delusions include a mother believing her child is the devil, or the mother hearing voices telling her to harm her baby. If severe symptoms of sleeplessness, agitation, irritable mood and avoidance of the child and/or hallucinations or delusions occur, consult a doctor or emergency medical facility immediately. Due to the risk of harm to the mother and/or baby, immediate treatment is required for postpartum psychosis. In some situations, hospitalization and inpatient psychiatric care may be necessary.²

The treatment for postpartum psychosis is medication. A doctor may prescribe antidepressants, antipsychotics, mood stabilizers, or a combination of the three. Therapy or counseling is also strongly recommended.²

Treatment for postpartum psychosis can interfere with breastfeeding. Separation from the baby (in the case of hospitalization/inpatient care) will make it impossible to breastfeed. Many psychiatric medications are harmful to infants, and since everything the mother ingests enters her breast milk, breastfeeding can be extremely harmful to the baby. Despite these issues that may accompany treatment, it is vital for a mother to seek help and to follow her doctor’s treatment plan. A doctor can help work through these issues by exploring alternative treatments or medications, or by recommending alternative feeding methods.²

Causes and Risk Factors

Postpartum depression stems from a combination of hormonal, biochemical, environmental, psychological, and genetic factors. Physical and emotional changes during and after pregnancy are some of the most common causes. Depression could be a result of a variety of things²:

• The dramatic drop in estrogen and progestin levels after childbirth²
• The potential for thyroid hormones to drop sharply, leading to tiredness, sluggishness, and depressed feelings²
• Emotional issues, sometimes resulting from sleep deprivation or from feeling overwhelmed by the new responsibilities of parenthood²

Even though there is no way to pinpoint a single cause, there are several risk factors that could leave a mother predisposed to postpartum depression: 

• Periods of intense anxiety or depression during pregnancy^{1, 2}
• Personal history of depression or anxiety^{1, 2}
• Family history of depression or anxiety^{1, 2}
• Marital or relationship problems^{1, 2}
• A lack of social support²
• Stressful events such as financial problems, the loss of a job, or the death of a loved one²
• Low self esteem²
• Having a baby with health problems or special needs²
• Trouble breastfeeding²

Less predictive risk factors include those listed below:

• An unplanned or unwanted pregnancy¹
• Lack of a romantic partner¹
• Lower socioeconomic status¹

Postpartum depression has no specific cause. Rather, it is a combination of factors that contribute to depression, and these factors may vary from person to person.

Reaching Out for Help

Many depressed people feel embarrassed or ashamed of their feelings. It is important to keep in mind that depression is an illness just like any other, and is often caused by factors out of your control. Being depressed does not make you weak or selfish. You may be putting yourself at risk for further harm if you simply wait for the situation to improve; it is okay to acknowledge that there is a problem and to reach out for help. You may want to share your feelings with your partner or other loved ones. Sometimes just putting your feelings into words can help you greatly. However, treating clinical depression requires professional medical advice; therefore, you should call your doctor or medical provider, especially if your symptoms display any of the following characteristics:

• Are present for more than two weeks²
• Get worse over time²
• Make it difficult for you to take care of your baby or yourself^{1, 2}
• Make it difficult to go about your day normally or to accomplish simple everyday tasks^{1, 2}
• Lead to thoughts of harming yourself or your child^{1, 2}

It is vital to seek the advice of your physician or mental health care provider if you experience any of the aforementioned symptoms.

Preparing for Your Doctor’s Appointment:

In order to receive the best treatment possible, it is important to be open and honest with your doctor and to be proactive in your treatment. Prior to your appointment, make a written list of the following information:

• Your symptoms and how long you have had them²
• All medical issues – both physical and mental²
• All medications that you take or have taken recently, as well as their doses—including prescription and over-the-counter medications as well as vitamins or supplements²
• Your family’s medical history, if you have it²

In addition to this, you should keep a list of questions you might have for your doctor. Some questions you might want to address when you speak to your doctor can include those listed below:

• What is my diagnosis?²
• What are my treatment options?²
• What are the side effects of each treatment?²
• How long will the treatment last, and when should I start to feel better?²
• Is there a chance that the depression will recur if I have another baby? Is there any way to prevent a recurrence?²
• If I choose to use medication, is it safe for breastfeeding?²
• Are there any printed materials, websites, or other resources that could help me better understand my condition?²

It is important to be an active participant in your treatment. Being prepared for your doctor’s appointment assures that all of your issues will be addressed and can help you better understand your condition and its treatment.

What to expect from your doctor

Your doctor will ask you several questions to better understand your situation and make a diagnosis. Some of these questions should include the following:

• What are the symptoms, and when did they start?²
• Have these symptoms gotten better or worse over time?²
• Do they interfere with your ability to take care of your child?²
• Do you feel bonded with your child?²
• When given the chance, do you sleep well? Can you get out of bed when it is time to wake up?²
• What is your energy level like?²
• Have you noticed any changes in appetite?²
• Do you feel anxious, irritable, or angry? If so, how often?²
• Do you have thoughts of hurting yourself or your baby?²
• Do you have help taking care of your baby?²
• Do you have any other stressors in your life, like financial or relationship troubles?²
• Do you have any other medical conditions?²
• Do you or your family have a history of mental health conditions, such as depression, anxiety, schizophrenia, or bipolar disorder? What treatments, if any, helped them?²

Having an idea of what your doctor may ask you can help reduce any anxiety or reluctance that may be associated with sharing your feelings. In addition, it gives you time to think about your symptoms so that you are able to answer your doctor’s questions as completely and accurately as possible

Diagnosis

It is imperative that you are completely open and honest with your doctor. If your doctor does not have all of the necessary information, your treatment could be less effective, ineffective, or even dangerous. Remember that your doctor is not there to judge or berate you; they are there to help you. Tell them everything that you have noticed and experienced, even if you think it might not be relevant.²

To determine your diagnosis, your doctor will most likely give you a depression-screening questionnaire. They may also wish to perform blood tests to see if you have hypothyroidism (an underactive thyroid gland) or any other medical condition or imbalance that could be affecting your mood.²

Failing to seek treatment can have harmful effects and cause complications. It can interfere with mother-child bonding, and the mother’s negative mood and symptoms can cause familial problems. Not seeking treatment can hurt the mother long-term; it is bad to assume that things will simply get better on their own. Without treatment, postpartum depression can last for months or even longer, and in some cases can become long-term major depressive disorder. Even when treated, postpartum depression increases the risk for future major depressive episodes, so it is important to follow up with your doctor if you sense that something may be wrong. Depression in the mother can also affect her partner, or the other parent. It can take an emotional toll on everyone who is involved in the baby’s life, and can increase the risk of depression in the other parent (new parents already have an increased risk of depression). Babies of mothers with depression are more likely to have emotional or behavioral problems later in life. They may have problems eating or sleeping, may experience excessive crying, or may display characteristics of ADHD. The child may also have delays in language development.²

Severe depression or anxiety can sometimes lead to suicidal thoughts. If you feel too overwhelmed to go on, like there is no point in living, or that everyone would be better off without you, please talk to a friend or loved one. If you are in a situation where you are considering acting on your thoughts, please call 911 or your local emergency phone number for help as this is considered a medical emergency. You can also call your healthcare provider (either your primary health care provider or doctor, your obstetrician/gynecologist, or your mental healthcare provider) during business hours. Suicide hotlines can give you a place to share your feelings and talk to someone until you are out of the emergency situation. In the United States, the national suicide hotline can be reached at 1-800-273-TALK (1-800-273-8255). Many other countries also offer suicide hotlines; phone numbers for them can be found online. If there is no accessible suicide hotline in your country, there are some websites that offer live chats with professionals who are trained to help people through crisis situations.

Treatment

Treatment for postpartum depression can vary greatly from person to person. Treatment must be tailored to your specific symptoms, medical history, and lifestyle. Your treatment may be very different from that of a friend who also experienced postpartum depression; no two cases of depression are the same.

Baby blues will subside in a couple weeks on their own, but there are many ways for you to make the experience less unpleasant and perhaps even shorten its duration.² Making time for self-care will have a huge effect on how you feel.^{1, 2} Rest as much as possible, and do not be afraid to ask for help from friends, family, or other loved ones—having a baby is tough, and it is totally understandable to feel overwhelmed, especially at first!^{1, 2} You may take comfort in talking to other new mothers, who can help you feel less alone.¹ It is important to avoid mind-altering substances, including alcohol and recreational drugs, both for the sake of your baby and for yourself—if you are breastfeeding, these substances will be passed to your baby through your breast milk, and drug and alcohol abuse can worsen the symptoms of depression.²

For mild postpartum depression, the first choice of treatment is usually psychotherapy. Seeing a psychologist or therapist can give you a place to talk through issues and express your feelings. You will learn coping skills that you can use to help yourself feel better in times of distress. Your therapist or psychologist can also help you work through problems in your daily life and set feasible goals for yourself.²

For more moderate to severe forms of depression, antidepressants may be needed in conjunction with therapy.⁵ Although small amounts of the medication can be passed to a baby through breast milk, certain types of antidepressants are considered to be safe for breastfeeding mothers.^{1, 5} Selective serotonin reuptake inhibitors (SSRIs), such as Zoloft and Prozac, are considered to be the safest option and are usually prescribed before trying other medications, but selective serotonin-norepinephrine reuptake inhibitors (SNRIs) and most tricyclic antidepressants (with the exception of Doxepin) are also considered safe.^{1, 5} Benzodiazepines, which can be used to treat anxiety or panic disorder (which often present alongside depression), are not safe because they interfere with brain development.⁵ However, many antidepressants of the SSRI, SNRI, or tricyclic class are also used to treat anxiety. Some studies have claimed that babies whose mothers take antidepressants can be slightly more irritable or have trouble feeding or sleeping, but these issues are also found in babies whose mothers’ depression is left untreated.¹ The benefits of treatment to the mother and child often outweigh the slight risk posed by medication. If you notice changes in your baby’s behavior or habits after starting antidepressants, talk to your doctor, but do not stop taking your medication without your doctor’s approval.¹

Appropriate treatment usually helps postpartum depression subside within six months (if you are taking antidepressants, you should notice a change within eight weeks). It is tremendously important to continue your treatment even when you begin to feel better. Premature termination of treatment can lead to a relapse of symptoms. In some cases, postpartum depression can turn into chronic major depression. Stay in contact with your doctor, and voice your concerns if you feel that you are not getting better; there may be alternative treatments that could be more effective.²

Coping with Postpartum Depression

Aside from seeking medical care, one of the best ways to cope with PPD is by practicing self-care. Consistently getting enough sleep, eating well, and sticking to a routine can be surprisingly helpful when it comes to improving your mood. Do not put too much pressure on yourself or feel guilty about the way you are feeling. Your depression does not make you a bad person or mean that you do not love your child. Recognize the small milestones you reach, like making breakfast on a day where getting out of bed feels impossible, and give yourself the recognition you deserve.

Try to spend time outside every day. You can try to go for a walk with your baby and meet with a friend. Changing your environment and getting sunshine and social interaction can help tremendously. If going out and doing recreational activities is too difficult or tiring one day, just go outside and sit in the sun for a few minutes. Sun exposure is thought to increase levels of serotonin in the brain; low levels of serotonin are associated with depression.

Take it easy. Motherhood is hard, and childbirth and adjusting to being a parent can take a huge toll on you physically and mentally. Do not overexert yourself. Instead of doing chores while your baby is sleeping, lie down and relax or take a nap. Try turning off your phone every so often so that you can “disconnect” and not have to worry about anything other than yourself and your baby. Try not to add more stress to your life by doing work while you are on maternity leave; resting your mind is just as important as resting your body.

Make time for yourself and your partner/family. Do not isolate yourself—talk to your family, partner, and friends about your feelings. You do not have to go through this alone, and the people who love you will want to help you in any way they can. Do not be afraid to open up to loved ones and ask for help.  Support from others makes depression much easier to handle. Just having a friend to talk to when you are feeling down can help improve your mood. Consider joining a therapy group for new mothers – so many other people are feeling the same way that you do. A group will not only give you a place to express your feelings and work on coping skills, but will offer its own support system with people who you can relate to.

Most importantly, remember that taking care of yourself is the best way to take care of your baby. If you neglect your own health and happiness, you will not be able to give your full effort to parenting. The better you are feeling, the easier it will be to take care of your baby.

Untreated, postpartum depression can have devastating effects. In severe cases, it can make it difficult for a mother to care for herself or her family and, if symptoms are ignored, can become a long-term problem. Thankfully, postpartum depression is simply a complication of childbirth and can be treated if the symptoms are recognized and help is sought. If you are concerned that you or someone you care about may be suffering from post partum depression, please reach out to a medical professional for help. With treatment and support, things can get so much better.

References

1. “Postpartum Depression.” BabyCenter.com. Johnson & Johnson, November 2016. 9 January 2017.
2. “Postpartum Depression.” MayoClinic.org. Mayo Clinic, 11 August 2015. 9 January 2017.
3. “The Baby Blues.” BabyCenter.com. Johnson & Johnson, November 2016. 9 January 2017.
4. “The Symptoms of Postpartum Depression and Anxiety.” PostPartumProgress.org. Postpartum Progress Inc., n.d. 9 January 2017
5. “Depression and Breastfeeding.” Babycenter.com. Johnson & Johnson, October 2016. 9 January 2017.

Last Updated: 2 February 2017.