post-partum depression

Source: National Institute of Mental Health

Why do women get postpartum depression?

Having a baby can be one of the biggest and happiest events in a woman's life. While life with a new baby can be thrilling and rewarding, it can also be hard and stressful at times. Many physical and emotional changes can happen to a woman when she is pregnant and after she gives birth. These changes can leave new mothers feeling sad, anxious, afraid, or confused. For many women, these feelings (called the baby blues) go away quickly. But when these feelings do not go away or get worse, a woman may have postpartum depression. This is a serious condition that requires quick treatment from a health care provider.

What is postpartum depression? Are the "baby blues" the same thing as postpartum depression?

Postpartum depression (PPD) is a condition that describes a range of physical and emotional changes that many mothers can have after having a baby. PPD can be treated with medication and counseling. Talk with your health care provider right away if you think you have PPD.

There are three types of PPD women can have after giving birth:

The baby blues happen in many women in the days right after childbirth. A new mother can have sudden mood swings, such as feeling very happy and then feeling very sad. She may cry for no reason and can feel impatient, irritable, restless, anxious, lonely, and sad. The baby blues may last only a few hours or as long as 1 to 2 weeks after delivery. The baby blues do not always require treatment from a health care provider. Often, joining a support group of new moms or talking with other moms helps.
Postpartum depression (PPD) can happen a few days or even months after childbirth. PPD can happen after the birth of any child, not just the first child. A woman can have feelings similar to the baby blues - sadness, despair, anxiety, irritability - but she feels them much more strongly than she would with the baby blues. PPD often keeps a woman from doing the things she needs to do every day. When a woman's ability to function is affected, this is a sure sign that she needs to see her health care provider right away. If a woman does not get treatment for PPD, symptoms can get worse and last for as long as 1 year. While PPD is a serious condition, it can be treated with medication and counseling.
Postpartum psychosis is a very serious mental illness that can affect new mothers. This illness can happen quickly, often within the first 3 months after childbirth. Women can lose touch with reality, often having auditory hallucinations (hearing things that aren't actually happening, like a person talking) and delusions (seeing things differently from what they are). Visual hallucinations (seeing things that aren't there) are less common. Other symptoms include insomnia (not being able to sleep), feeling agitated (unsettled) and angry, and strange feelings and behaviors. Women who have postpartum psychosis need treatment right away and almost always need medication. Sometimes women are put into the hospital because they are at risk for hurting themselves or someone else.

What are the signs of postpartum depression?

The signs of postpartum depression include: The core symptoms also should include sadness, depression, and loss of energy.

Feeling restless or irritable.
Feeling sad or crying a lot.
Having no energy.
Having headaches, chest pains, heart palpitations (the heart being fast and feeling like it is skipping beats), numbness, or hyperventilation (fast and shallow breathing).
Not being able to sleep or being very tired, or both.
Not being able to eat and weight loss.
Overeating and weight gain.
Trouble focusing, remembering, or making decisions.
Being overly worried about the baby.
Not having any interest in the baby.
Feeling worthless and guilty.
Being afraid of hurting the baby or yourself.
No interest or pleasure in activities, including sex.

A woman may feel anxious after childbirth but not have PPD. She may have what is called postpartum anxiety or panic disorder. Signs of this condition include strong anxiety and fear, rapid breathing, fast heart rate, hot or cold flashes, chest pain, and feeling shaky or dizzy. Talk with your health care provider right away if you have any of these signs. Medication and counseling can be used to treat postpartum anxiety.

Who is at risk for getting postpartum depression?

Postpartum depression (PPD) affects women of all ages, economic status, and racial/ethnic backgrounds. Any woman who is pregnant, had a baby within the past few months, miscarried, or recently weaned a child from breastfeeding can develop PPD. The number of children a woman has does not change her chances of getting PPD. New mothers and women with more than one child have equal chances of getting PPD. Research has shown that women who have had problems with depression are more at risk for PPD than women who have not had a history of depression.

What causes postpartum depression?

No one knows for sure what causes postpartum depression (PPD). Hormonal changes in a woman's body may trigger its symptoms. During pregnancy, the amount of two female hormones, estrogen and progesterone, in a woman's body increase greatly. In the first 24 hours after childbirth, the amount of these hormones rapidly drops and keeps dropping to the amount they were before the woman became pregnant. Researchers think these changes in hormones may lead to depression, just as smaller changes in hormones can affect a woman's moods before she gets her menstrual period.

Thyroid levels may also drop sharply after giving birth. (The thyroid is a small gland in the neck that helps to regulate how your body uses and stores energy from foods eaten.) Low thyroid levels can cause symptoms that can feel like depression, such as mood swings, fatigue, agitation, insomnia, and anxiety. A simple thyroid test can tell if this condition is causing a woman's PPD. If so, thyroid medication can be prescribed by a health care provider.

Other things can contribute to PPD, such as:

Feeling tired after delivery, broken sleep patterns, and not enough rest often keeps a new mother from regaining her full strength for weeks. This is particularly so if she has had a cesarean (C-section) delivery.
Feeling overwhelmed with a new, or another, baby to take care of and doubting your ability to be a good mother.
Feeling stress from changes in work and home routines. Sometimes women think they have to be "super mom" or perfect, which is not realistic and can add stress.
Having feelings of loss - loss of identity (who you are, or were, before having the baby), loss of control, loss of a slim figure, and feeling less attractive.
Having less free time and less control over time. Having to stay home indoors for longer periods of time and having less time to spend with the baby's father.

How is postpartum depression treated?

It is important to know that postpartum depression (PPD) is treatable and that it will go away. The type of treatment will depend on how severe the PPD is. PPD can be treated with medication (antidepressants) and psychotherapy. Women with PPD are often advised to attend a support group to talk with other women who are going through the same thing. If a woman is breastfeeding, she needs to talk with her health care provider about taking antidepressants. Some of these drugs affect breast milk and should not be used.

What can I do to take better care of myself if I get postpartum depression?

The good news is that if you have PPD, there are things you can do to take care of yourself.

Get good, old-fashioned rest. Always try to nap when the baby naps.
Stop putting pressure on yourself to do everything. Do as much as you can and leave the rest! Ask for help with household chores and nighttime feedings.
Talk to your husband, partner, family, and friends about how you are feeling.
Do not spend a lot of time alone. Get dressed and leave the house - run an errand or take a short walk.
Spend time alone with your husband or partner.
Talk to your health care provider about medical treatment. Do not be shy about telling them your concerns. Not all health care providers know how to tell if you have PPD. Ask for a referral to a mental health professional who specializes in treating depression.
Talk with other mothers, so you can learn from their experiences.
Join a support group for women with PPD. Call a local hotline or look in your telephone book for information and services.

For More Information...

You can find out more about postpartum depression by contacting the National Women's Health Information Center (NWHIC) at 1-800-994-9662 or the following organizations:

National Institute of Mental Health
Phone Number(s): (301) 443-4513, (301)-496-9576

Depression After Delivery, Inc.
Phone Number(s): (800) 944-4773
Internet Address: http://www.depressionafterdelivery.com/

Postpartum Education for Parents
Phone Number(s): (805) 564-3888
Internet Address: http://www.sbpep.org

American Psychological Association
Phone Number(s): (800) 374-2721
Internet Address: http://www.apa.org

American College of Obstetricians and Gynecologists (ACOG)
Phone Number(s): (800) 762-2264
Internet Address: http://www.acog.com

This information was abstracted from a fact sheet developed by the Office on Women's Health.

This FAQ has been reviewed by Peter J. Schmidt, M.D. of the National Institute of Mental Health, National Institutes of Health
July 2002