Postpartum depression is a feeling of extreme sadness and loss of interest in usual activities during the first year after delivery and lasting more than 2 weeks.
Women who have had depression previously are more likely to develop postpartum depression.
Women feel extremely sad, cry, feel irritable and have rapid mood swings, and may lose interest in daily activities and the baby.
Women should see their doctor if they continue to have symptoms for more than 2 weeks or if they have thoughts about harming themselves or the baby.
A combination of psychotherapy and antidepressant medications is recommended for women with postpartum depression.
Many women have postpartum "baby blues," which may include mood swings or feelings of sadness. However, postpartum blues typically lasts 2 to 3 days and a maximum of up to 2 weeks and is usually relatively mild. In contrast, postpartum depression lasts 2 or more weeks and is disabling, interfering with activities of daily living.
About 7% of women are affected. Very rarely, an even more severe disorder called postpartum psychosis develops.
Causes of Postpartum Depression
The causes of sadness or depression after delivery are unclear, but the following may contribute or increase the risk:
Depression that was present before or developed during pregnancy
Postpartum depression in a previous pregnancy
Previous episodes of sadness or depression that occurred during certain times of the month (related to the menstrual cycle) or while taking oral contraceptives
Close relatives who have depression (family history)
Stresses such as having relationship stress, having financial difficulties, or parenting with no partner
Lack of support from a partner or family members
Problems related to the pregnancy (such as a preterm delivery or a baby with birth defects)
Complicated feelings about the current pregnancy (for example, because it was unplanned or the woman considered ending the pregnancy)
Problems with breastfeeding
The sudden decrease in levels of hormones (such as estrogen, progesterone, and thyroid hormones) that occurs after delivery and lack of sleep may contribute to developing postpartum depression. Also, a gene that makes a woman more susceptible to postpartum depression may be involved.
If women have had depression before they became pregnant, they should tell their doctor or midwife. Such depression often evolves into postpartum depression. Depression during pregnancy is common and is an important risk factor for postpartum depression.
Symptoms of Postpartum Depression
Typically, symptoms of postpartum depression develop during the first 3 months after delivery, but they may start later. Symptoms may begin gradually or more suddenly. Postpartum depression interferes with women’s ability to care for themselves and the baby.
Symptoms of postpartum depression may include
Extreme sadness
Frequent, uncontrollable crying
Mood swings
Irritability and anger
Less common symptoms include
Extreme fatigue
Sleep problems (too much or too little)
Headaches and body aches
Loss of interest in sex and other activities
Anxiety or panic attacks
Loss of appetite or overeating
Difficulty functioning
Lack of interest in or unreasonable worries about the baby
A feeling of being incapable of caring for the baby or of being inadequate as a mother
Guilt about having these feelings
Fear of harming the baby
Suicidal thoughts
Women may not bond with their baby. As a result, the child may have emotional, social, and cognitive problems later.
Partners may also become depressed, and depression in any parent may cause stress.
Without treatment, postpartum depression can last for months or years. About 1 in 3 or 4 women who have had postpartum depression have it again.
Postpartum psychosis is rare. It involves suicidal or violent thoughts, hallucinations, or bizarre behavior. Sometimes postpartum psychosis includes a desire to harm the baby.
If a parent is having thoughts of harming self or the baby, medical attention should be sought immediately.
Diagnosis of Postpartum Depression
A doctor's evaluation, based on specific diagnostic criteria
Early diagnosis and treatment of postpartum depression are important for women and their baby. Women should see their doctor if they continue to feel sad and have difficulty doing their usual activities for more than 2 weeks or if they have thoughts about harming themselves or the baby. If family members and friends notice symptoms, they should talk with the woman and encourage her to talk to a doctor.
When women go for their postdelivery visit, doctors may ask them to fill out a questionnaire designed to identify depression. If women are depressed, doctors may also do blood tests to determine whether a disorder, such as a thyroid disorder, is causing the symptoms.
Treatment of Postpartum Depression
Psychotherapy
Treatment of postpartum depression includes psychotherapy and antidepressants.
Women who have postpartum psychosis may need to be hospitalized, preferably in a supervised unit that allows the baby to remain with them. They may need antipsychotic medications as well as antidepressants.
Women who are breastfeeding should consult with their doctor before taking any of these medications to determine whether they can continue to breastfeed (see Medication and Substance Use During Breastfeeding). Many of antidepressants allow women to continue breastfeeding.
