Postpartum depression is a fairly common mental health and mood disorder that affects 15 to 20 percent of moms after giving birth. It can range in severity and type, and depending on the woman and other factors, can be resolved within weeks or months or can last significantly longer.
Postpartum depression is still a widely misunderstood disorder. There is no shame in being diagnosed with it. In fact, you cannot control whether or not you will get postpartum depression.
In the same way that you could get a urinary tract infection or the flu, you cannot avoid or prevent postpartum depression.
Symptoms of postpartum depression, also referred to as PPD, can show up within weeks, months, or even past a year after giving birth. If you find that you have symptoms, call your doctor the same way that you would with any other medical health issue.
While postpartum depression can be an added layer of complication to postpartum recovery, by communicating openly with your healthcare provider, you can set a plan to find relief and support.
What is Postpartum Depression?
Many women experience what is commonly referred to as the “baby blues.” Most moms feel sad, worried, or even down the first few days or weeks after giving birth. This is because birth is a major event, and the hormonal changes that occur in the body in the first few days to weeks after having your baby are intense.
Nearly 80 percent of women will feel those baby blues to some degree, but they tend to fade after one to two weeks and don’t become consistent or pervasive.
Postpartum depression is not the baby blues. They happen for different reasons, have different symptoms, and PPD lasts significantly longer. But some women can have the baby blues first, followed by an onset of postpartum depression.
Postpartum depression (and any mental health disorders) still has a lot of stigma in today’s society. However, people can no more control their mental health than they can other aspects of health.
A postpartum depression diagnosis simply means that there are things going in your brain, with neurotransmitters and other neurological factors, that need to be rebalanced.
While only tragic cases of postpartum depression make the news headlines, when those words are mentioned, people tend to associate them with that: a mother who harms her children. These cases are always tragic, but are few and far between. They are not the norm for women experiencing PPD.
Around 15 percent of moms who give birth will get postpartum depression to one degree or another. Of those women, around 20 percent have thoughts of self-harm, and a little over 20 percent had previously undiagnosed mental health disorders.
The bottom line is that if you get diagnosed with PPD, it does not automatically mean you will harm yourself or your children. However, understanding that these can be risks associated with the condition should make it a top priority to communicate your scary thoughts—and anything else in your mind—with your healthcare provider.
They are trained to help you, and they are familiar with your diagnosis. They will not write you off as a bad mother or send you home without help.
In many cases of PPD, more than 25 percent of women had symptoms of depression before they got pregnant and nearly 35 percent started noticing symptoms during pregnancy.
It’s important to communicate with your healthcare provider about feelings of depression or other changes to your mental health, because in most cases they don’t simply go away on their own.
What are the Symptoms of Postpartum Depression?
Symptoms of postpartum depression can vary from one mom to the next. You may not have every one on this list, but noticing a pattern of them or generally not feeling yourself can be a good indicator that something is going on.
Check in with your OBGYN or other healthcare provider if you suspect that you might have PPD.
Common symptoms of postpartum depression include:
- Feeling sad a lot, with or without reason
- Exhaustion but an inability to sleep from racing mind or restlessness
- Excessive sleeping without feeling rested
- Excessive appetite or no appetite at all
- Aches, pains, or general malaise without actual sickness
- Frequent mood swings, irritability, or anger—sometimes with or without reason
- A lack of control over your circumstances, mood, or thoughts
- Poor memory or focus
- Lack of concentration and trouble making decisions
- Reduced interest in previous favorite activities
- A disconnected feeling from yourself, your baby, your spouse, and your surroundings
- Feeling hopeless, overwhelmed, scared, and burnt out
- Feelings of guilt that may or may not be tied to actual events or circumstances
- Feelings of fear and shame, perhaps even over how you feel, that might keep you from speaking up about how you’re feeling
- Feelings of fear that speaking up will make someone take your baby away or judge you for being a bad mother
- Thoughts of harming yourself or your baby, or neglecting yourself or your baby
Why Do Some Women Get Postpartum Depression & Others Don’t?
It’s not clear why some women get postpartum depression and others don’t, but some facts are known.
Some women are more sensitive to hormonal changes than others. Women who have experienced bad PMS, for example, may be sensitive, and may also have a more extreme reaction to the massive drop of hormones after giving birth. Other hormonal factors that could influence a woman’s chances of developing PPD include:
- Thyroid disease or disorders
- Higher levels of cortisol, the stress hormone
- Insulin and glucose disorders
While all moms are short on sleep, some women will also handle the lack of sleep worse than others, and this can be a contributing factor to postpartum depression. Nutrient deficiencies that existed before or during pregnancy, or that set in after delivery, can also contribute.
There are other factors that can increase a woman’s risk for PPD. These include:
- A family or personal history of depression or other mood disorders
- Recent emotional or mental trauma, like divorce, death of a loved one, or abuse
- Social isolation or lack of support
- Health problems in mom, baby, or both
- Financial stress
- Work stress
- Giving birth to multiples
- Premature birth
- Drug or alcohol misuse
Postpartum depression can occur with any pregnancy. Even if you did not have it after your first or second, you could still develop it with a subsequent pregnancy. If you did have it with a previous pregnancy, your odds of getting PPD again are higher.
How is Postpartum Depression Diagnosed?
Most women will receive assessments to fill out regarding their feelings or thoughts. Sometimes these are given before leaving the hospital, but postpartum depression won’t have set in within a few days.
Women are also assessed at their six-week postpartum check-up, yet in many cases, PPD has already shown itself for up to a month before this.
If at any time you start to notice feelings or thoughts associated with postpartum depression, call your OBGYN or healthcare provider and schedule an appointment. There are no invasive tests to be run, and most of it will happen as a result of a conversation.
Fear can stop many women from bringing these intrusive or scary thoughts up to their healthcare provider, but it is important to remember: no one is looking to take your baby away from you.
While the thoughts and fears can tell you this, it’s important to communicate what’s going on in your head before it becomes severe or problematic.
Your healthcare provider is trained to help you. If you feel at any point that they are not taking your concerns seriously, or are not offering assistance, you can get a second opinion.
Additionally, finding a trained therapist to speak with about your postpartum depression or fearful thoughts can also help you find a way forward.
Different Kinds of Postpartum Depression
Postpartum depression doesn’t always look the same. There are different manifestations. Some women have more than one, but others will not realize that they’re dealing with PPD because the symptoms aren’t classic.
1. Postpartum Depression
This is associated with the symptoms list above and would be identified as depression, sadness, overwhelm, and/or anger. Depression can often manifest as anger, at yourself or others.
2. Postpartum OCD
While most moms are focused on keeping their babies safe and clean, some moms experience PPD in a way that sends their brains into OCD, or obsessive-compulsive disorder.
It’s not very common, impacting only one to three percent of moms with PPD. If you find that you’re constantly afraid about something bad happening to your baby, and your solution is to obsessively perform tasks or check-ins to ensure that this does not happen, you might have postpartum OCD.
This could look like:
- Constant cleaning, reorganizing, and fearing germs and contact from strangers or the outside world
- Checking the baby frequently during sleep
- Feeling the need to constantly pray for your baby’s safety
- Spending excessive amounts of time researching questions or concerns about baby’s health
3. Postpartum Anxiety
Postpartum anxiety is actually more common than PPD, impacting as many as one in every six women who have a baby. New mom stress is normal, but pervasive feelings or thoughts of anxiety over anything and everything is not.
Panic attacks could happen, whether or not you have a history of them. Postpartum anxiety can also occur in women who previously had anxiety disorders. Women can experience PPD and postpartum anxiety at the same time, too.
4. Postpartum Psychosis
The most extreme type of postpartum depression, postpartum psychosis is very rare. This occurs most commonly in women with diagnosed or undiagnosed mental disorders that existed before pregnancy.
This form of PPD is associated with a detachment from reality with thoughts that can be extreme or even hallucinations. It is most commonly associated with bipolar disorder.
If you have a history of bipolar disorder, it’s important to work with your healthcare providers to avoid complications from postpartum psychosis. Postpartum psychosis is a medical emergency and if you identify as being disconnected from reality, or your partner or other family members notice this, call 911.
Do not wait to see if things go back to normal.
How is Postpartum Depression Treated?
Most forms of PPD are treated with antidepressants, like any other type of depression. However, not all cases with need medication. It depends on how severe your symptoms are, how well you feel that you can cope, and your healthcare provider’s assessment of your medical history.
Selective serotonin reuptake inhibitors, or SSRIs, are the most common prescription for postpartum depression since they have the fewest side effects. Others may be used at the discretion of your healthcare provider.
Most antidepressants take a few weeks before they start working, so the sooner you communicate your feelings to your provider, the better.
Some doctors will also use hormone therapy to decrease symptoms of PPD, to gently ease the mom from the high pregnancy hormone levels into a better balance. This treatment could depend on whether the mother is breastfeeding or not.
How to Find Support for Postpartum Depression
The first place of support for PPD is at your OBGYN or healthcare provider’s office. After you have communicated with them and sought help, there are many other ways to ease the mental burden and stress of having postpartum depression.
Consider the following:
- Ask friends or family members who have also gone through PPD. Talking to someone who has been through it can be helpful.
- Find an online or in-person support group for PPD. Look for one here.
- Read a book on PPD, and ask your partner to as well. This Isn’t What I Expected by Karen Kleiman is a good place to start.
- Postpartum Support International has many resources for PPD.
Can You Prevent Postpartum Depression?
It is not possible to prevent postpartum depression from developing. However, you can address some risk factors to lessen chances of occurrence or severity. These may not always be effective, though, as numerous factors could contribute to a woman’s development of PPD.
Ways to lessen the severity or occurrence of postpartum depression include:
- Communicate with your OBGYN during pregnancy if you were depressed before or notice symptoms developing during pregnancy.
- Let your OBGYN know if you had PPD after a previous pregnancy.
- Setting up a support network before giving birth, so you can avoid as much overwhelm or isolation as possible.
- Do your best to prepare for a healthy diet postpartum and don’t rely on fast foods or convenience items.
- Make a plan to get plenty of sleep, especially in the first two to four weeks after giving birth. Arrange for family members or childcare to come so that you can take a nap daily, or have your partner help with feedings whenever possible.
While you can’t avoid postpartum depression, being proactive can help to minimize the feelings of fear and confusion when symptoms do develop.
Aimee McNew, MNT, CNTP, is a certified nutritionist who specializes in women’s health, thyroid problems, infertility, and digestive wellness. She ate her way back to health using a Paleo diet, lost 80 pounds, and had a healthy baby after numerous miscarriages. She focuses on simple nutrition practices that promote long-lasting results.