About Postpartum Depression

What is Postpartum Depression?

Postpartum depression, also known as perinatal depression or PPD, is a type of perinatal mood and anxiety disorder (PMAD). PPD is a mood disorder that develops during the postpartum period, or the first year after welcoming a new baby. Birthing mothers, as well as non-birthing parents, including fathers, non-birthing partners, and adoptive parents, can all experience PPD. While we recognize that all parents can be impacted by PPD, for the purposes of this article, we focus on the experience of birthing mothers.

On average, 1 in 7 new mothers experience PPD. Approximately 10% of women develop depression during pregnancy. For others, depression may not develop until after they give birth.

Signs and Symptoms of PPD

The main sign of PPD is a sad mood that lasts most days, nearly all day, for at least two weeks. 

A mother with PPD will also experience other symptoms such as:

• Tearfulness
• Irritability
• Loss of interest in activities and hobbies that were previously enjoyable
• Changes in sleeping patterns, such as difficulty falling or staying asleep, or sleeping more than usual
• Lack of energy
• Changes in weight or appetite
• Not wanting to see or speak to other people
• Feeling disconnected from her baby
• Extreme feelings of guilt, shame, or worthlessness
• Lack of hope for the future
• Changes in movement, such as being very restless or lethargic
• Difficulty focusing or making decisions
• Thoughts of hurting herself or her baby
• Suicidal thoughts

The term postpartum depression has been used to refer to many different PMADs. Unfortunately, this has led to more stigma and confusion for new mothers. For example, it has been confused with postpartum psychosis by the media. Postpartum psychosis is a serious mental health concern that involves hallucinations, delusions, and a loss of touch with reality. It’s important to note that experiencing PPD or another PMAD does not mean that you are a bad mother. With the right treatment, you can and will get better.

Is it postpartum depression or the baby blues?

Many people confuse PPD with the baby blues and vice versa. The baby blues are temporary mood changes that occur in the first few weeks after giving birth. They are common, with roughly 50 to 80% of new mothers experiencing them. The baby blues are not considered a mental health condition. 

Symptoms of the baby blues include:

• Sadness
• Crying
• Worry
• Irritability
• Difficulty sleeping
• Low energy

The baby blues are caused by the hormonal shifts that occur after childbirth. Symptoms typically begin within a few days of giving birth, peak around day five, and then improve over the following weeks.

The baby blues differ from PPD in the following ways:

• Symptoms are mild
• Mothers can function and care for themselves and their babies
• Symptoms improve on their own by one month postpartum
• Sadness, worry, and irritability come and go, rather than persist all day

PPD, on the other hand, is a mental health condition that persists. Symptoms are distressing and can make it difficult for a mother to keep up with caring for herself and her baby. 

Postpartum depression vs. postpartum anxiety

Postpartum depression and postpartum anxiety (PPA) are similar but yet different conditions. The main symptom of PPD is sadness, while the main symptoms of PPA are worry and fear. For mothers with PPA, worries and fears often center around the baby. 

The symptoms of PPA include:

• Worry or fear that is hard to control
• Irritability
• Restlessness
• Fatigue
• Difficulty sleeping
• Poor concentration

Many women with PPD also experience PPA, but it is possible to have one without the other.

Causes of PPD

Experts believe that PPD is caused by a combination of factors, rather than one specific thing. The rapid change in hormones after giving birth plays a large role in the onset of depression. Within days of giving birth, estrogen and progesterone levels decrease while oxytocin and prolactin levels increase. Some women are more sensitive to these hormonal changes. Discontinuing breastfeeding can also cause a hormonal shift that can lead to depression. Research has found that genetics also play a role in PPD. Having a close family member who experienced PPD increases a person’s risk. The stress of caring for a newborn and lack of sleep may also make mothers more vulnerable to depression. A new mother’s life completely changes overnight, which can be very difficult to cope with, especially if she lacks a good support system. 

Risk factors

Risk factors increase the chances of experiencing a condition. Risk factors for PPD include:

• Having an unplanned pregnancy
• Experiencing depression during pregnancy
• History of severe PMS symptoms
• Having a risky pregnancy
• Experiencing birth complications
• History of sexual abuse
• Lack of social support
• Conflict with spouse/partner
• Domestic violence

The more risk factors that you have, the more you should be aware of the possibility of experiencing PPD. But you can also experience PPD without having any of the risk factors above. Keep reading to learn more about treatment options and ways to cope with your symptoms.

Treatment

Postpartum depression is treatable. There is no reason to suffer when help is available. Treatment for PPD typically involves therapy, social support, and, in some cases, medication.

Therapy

Therapy is the recommended treatment for new mothers with depression. Different types of therapy are effective in treating PPD:

• Cognitive behavioral therapy (CBT): CBT helps you understand the connection between your thoughts, feelings, and behaviors. During CBT, your therapist helps you change negative thought patterns and replace them with alternative ones.
• Interpersonal therapy (ITP): The focus of ITP is addressing underlying relationship issues that are contributing to depression. It also helps you navigate role changes and unresolved grief.
• Psychodynamic therapy: This type of therapy brings unconscious feelings to the surface. This helps you build insight into yourself and your patterns, which can lead to positive change.
• Supportive therapy: In supportive therapy, the therapist focuses on building rapport with you and using the therapeutic relationship to help you cope with problems. Supportive therapists draw on a lot of empathy and validation.

Some of these therapies, like ITP, are time-limited, meaning they take place over a specific number of sessions. Others, like psychodynamic therapy, are open-ended. You and your therapist should decide together what length of therapy is best for you. Therapy can be offered individually (one-on-one with a therapist) or in a group setting with other postpartum mothers. Couples or family therapy may also be beneficial if you and your partner are struggling with issues in your relationship. 

Medication

Medication is another treatment option for moderate to severe PPD symptoms. Medication may be recommended along with therapy to help manage symptoms. There are medications specifically for PPD, as well as other types of antidepressants and mood stabilizers that may be prescribed. Some medications are considered safe for pregnant and breastfeeding mothers. A psychiatric provider who has experience and training in working with postpartum mothers can talk to you about whether medication is right for you. They can discuss the pros and cons and what to expect. 

Social support

Social support is a critical component of treating PPD. Mothers who are experiencing depression may find themselves avoiding social situations. They may feel very overwhelmed or fear that they will be judged. Mothers with PPD may need some encouragement when it comes to seeking and accepting help. If you’re experiencing PPD, there are several ways that social support can help you. Sharing your thoughts and feelings with a non-judgemental friend or family member can relieve some of the overwhelming feelings you are experiencing. If you don’t have a support system available, joining a support group for new mothers or attending a mommy-and-me class are great ways to connect with other mothers. Keep in mind that you may need to push yourself to connect with other people. Avoid going more than a day without speaking with a supportive person. It may be hard to open up, but the benefits are worthwhile.

Coping with PPD

Self-care by itself will rarely make your postpartum depression go away, but it is an important part of the healing process. Creating time for self-care is challenging when you're sleep-deprived and living on a newborn’s schedule. Your self-care routine is going to look drastically different during this time, but trying to incorporate some positive activities for yourself can be very beneficial. Here are some ways to cope with PPD:

• Do something that you enjoy: Consider how you could do some of the hobbies or activities that you find pleasurable again. This will help you feel like yourself and show you that you can still have fun as a parent.
• Spend time outdoors: If possible, go for a walk or sit outside and breathe in fresh air. Spending time in nature has been shown to help reduce stress, anxiety, and depression.
• Do a form of exercise that you enjoy: Exercise, or any form of movement, offers significant benefits for your physical and mental health. Once you are cleared to exercise, try to find ways to incorporate some form of movement into your routine. Try walking, stretching, or finding another way to exercise with your baby. Even 10 minutes a day is beneficial.
• Remember that becoming a parent is a transition that takes time: Parenthood is a journey. It takes time to get to know your baby and build confidence in this new role. Be patient with yourself as you learn how to navigate new territory.