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Postpartum Depression Fast Facts

To be diagnosed, postpartum depression must occur no later than one month after a mother gives birth, but the disorder may begin during pregnancy. Postpartum depression is difficult to diagnose because many of its symptoms, to a lesser severity, are common in women after giving birth.

Postpartum blues, or “baby blues,” a less serious condition that is a risk factor for postpartum depression, is experienced by up to 85% of mothers within 10 days of giving birth.

The onset of postpartum depression may be related to sensitivity to hormonal fluctuations that occur naturally after giving birth. Antidepressants can be used to treat postpartum depression, but breastfeeding mothers should consult their health care providers about the risks and benefits of these medications.

Postpartum depression may affect as many as 15% of all new mothers.

What is Postpartum Depression?

Postpartum depression is a mood disorder that affects women soon after they give birth, and in some cases, the disorder can set in even during pregnancy. The disorder is characterized by anxiety, sadness, sleep difficulties, fatigue, or other signs of a low mood. The symptoms are so severe that they interfere with the mother’s daily functioning and her ability to care for her child, and the symptoms persist for an extended period of time. The symptoms differ in their severity and duration from common and normal postpartum mood swings.

Symptoms of Postpartum Depression

Symptoms of postpartum depression are often similar to those of major depression, but they occur close to the time of birth, and unlike the less severe symptoms of postpartum blues, they don’t go away quickly.

The most common symptoms of postpartum depression include:

  • Feelings of extreme sadness, pessimism, or emotional disengagement
  • Feelings of anxiety or fear without a specific cause
  • Irritability
  • Rapid changes in mood
  • Outbursts of anger or frustration
  • Disruptions in sleep habits, including oversleeping or insomnia (even when the baby is sleeping)
  • Changes in appetite, including overeating or not eating enough
  • Headaches or other aches and pains without specific causes
  • Fatigue or restlessness
  • Mental fogginess or difficulty focusing
  • Loss of enjoyment from activities that used to be pleasurable
  • Avoidance of social situations or family activities
  • Fears about the ability to care for the baby
  • Lack of emotional attachment to the baby
  • Thoughts of suicide or of harming the baby

Postpartum Psychosis

Postpartum psychosis is a rare disorder that usually manifests in the first week after birth. Its symptoms are much more severe than those of postpartum depression and include:

  • Mental confusion
  • Hallucinations or delusions
  • Paranoid thoughts
  • Agitation and extreme restlessness
  • Compulsion to harm the baby or yourself

Postpartum psychosis is much more dangerous than postpartum depression, and a mother who experiences these symptoms should seek professional help immediately.

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

What Causes Postpartum Depression?

Doctors and researchers have not yet determined exactly what causes postpartum depression, and it’s likely that there are several factors that lead to the onset of the disorder in most cases. Causes also likely vary from mother to mother. The most likely causes include:

  • Hormonal changes. During pregnancy, a woman’s body produces high levels of the hormones estrogen and progesterone. After birth, the level of these hormones drops quickly, and the change in hormone levels is a likely cause of changes in mood and energy levels. Some women may be more than typically sensitive to the hormonal changes, leading to postpartum depression.
  • Environmental factors. Life after childbirth is physically stressful, and new mothers are likely to suffer from too little sleep, inadequate nutrition, and other strains that cause fatigue and physical aches and pains. Under this stress, new mothers may be more vulnerable to the mood fluctuations that characterize postpartum depression.

Emotional factors. Major life changes that come in the wake of childbirth may also induce emotional stress that can exacerbate the physical stresses the mother is experiencing.

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

Is Postpartum Depression Hereditary?

Researchers have not yet identified a definitive link between the onset of postpartum depression and a family history of the disorder, but there is some evidence that there may be a genetic or familial connection to the disorder.

  • One study found that women with a sister who had experienced postpartum depression were almost four times as likely to develop the disorder as compared to women with no affected sibling.
  • Another study found that 42% of women with a family history of postpartum depression developed the disorder after their first pregnancy. In contrast, the study found that only 15% of women without a family history developed the disorder.
  • Studies of twins have found a significant heritability rate, ranging from 25% to 54%. This suggests that there could be a genetic basis for the development of the disease, and research is ongoing to identify a specific gene or genes that may be responsible.

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

How Is Postpartum Depression Detected?

Spotting postpartum depression early is not easy because the symptoms of the disorder mimic the less serious symptoms of common postpartum blues, and the physical symptoms often have discernible causes that are a normal part of having a new baby. However, if the symptoms are recognized and addressed early enough, it may be possible to prevent them from progressing beyond a relatively mild state into full-blown postpartum depression. Early diagnosis also helps to rule out the unlikely possibility of postpartum psychosis.

The early indications of postpartum depression include:

  • Persistent sadness or low mood. Hormonal changes after childbirth can cause mood swings even under normal circumstances, but sadness that lasts for weeks or that grows more intense over time may be a warning sign for postpartum depression.
  • Disruption in sleep patterns. Having a new baby in the house is obviously disruptive to the sleep patterns of a new mother, but if you have trouble sleeping even when the baby is asleep or being cared for by someone else, or if you want to sleep much more than is necessary, take note.
  • Mental fogginess. Postpartum depression can get in the way of your ability to focus, to make decisions, or to engage emotionally with your everyday routine.
  • Withdrawal from pleasurable activities. Like major depression, postpartum depression can make you want to stay away from social situations or interactions with loved ones. It can also make it difficult to take part in activities you used to enjoy.
  • Worries about your parenting abilities. Doubts about your ability to handle the responsibilities of motherhood are normal, but if these worries are persistent and frequent, they may be a danger sign.

Thoughts of harming yourself or your baby. These thoughts can be a sign of severe postpartum depression or even postpartum psychosis. If you have them, you should seek professional medical help immediately.

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

How Is Postpartum Depression Diagnosed?

Diagnosis of postpartum depression typically begins with a physical assessment followed by a psychological assessment. Doctors will usually make an effort, first, to rule out medical conditions that could be causing the physical and mental symptoms. After these potential physical conditions have been ruled out will the diagnostic process move on to possible psychological causes.

Diagnostic steps may include:

  • A physical exam. This exam will be aimed at ruling out physical conditions that could be causing the symptoms.
  • Blood and laboratory tests. These tests will look at the patient’s blood chemistry for issues such as thyroid function that could be causing depressive symptoms. Screenings for drugs and alcohol may also be conducted to rule out symptoms that may be caused by substance abuse.
  • Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

The results of the psychological assessments will be compared to the diagnostic criteria for postpartum depression in the Diagnostic and Statistical Manual of Mental Disorders. The DSM does not recognize postpartum depression as a disorder distinct from major depression, so the diagnostic process will look for symptoms of depression that occur during pregnancy or within four weeks after childbirth.

A mental health professional will look for these indications of depression:

  • Depressed mood
  • Loss of interest in pleasurable activities
  • Change in weight or appetite
  • Sleep disruptions
  • Lethargy or restlessness
  • Fatigue
  • Feelings of worthlessness or guilt
  • Problems with concentration or decision-making
  • Recurrent thoughts of death or suicide, or a suicide attempt

The professional will also look for signs that the symptoms have caused impairment, that they’re persistent and frequent, and that they aren’t consistent with another disorder, such as bipolar disorder.

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

How Is Postpartum Depression Treated?

The treatment prescribed for postpartum depression depends on factors such as the severity of the symptoms, the medical history of the patient, and the presence of any underlying physical conditions that are contributing to the symptoms of the disorder. Often, the treatment for postpartum depression includes antidepressant medication, psychotherapy, or both.

Medication

Antidepressants, including popular selective serotonin reuptake inhibitors (SSRIs), are often used to treat postpartum depression. In general, these medications are considered safe for new mothers to use, but breastfeeding mothers should be aware that some level of the medication may be transmitted to the baby in breast milk. You should discuss the potential risks of the medication with your doctor, especially if you’re breastfeeding, and weigh the risks against the benefits before you begin treatment.

In addition to SSRI antidepressants, which may take weeks to have an effect, a new fast-acting drug called brexanolone has recently been approved for use in moderate to severe cases of postpartum depression. The drug is given via an intravenous infusion in a supervised setting and typically takes effect in less than three days.

Psychotherapy

The most common therapeutic approaches used to treat postpartum depression are cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). CBT focuses on helping the patient to identify a pattern of harmful thoughts and to construct strategies and solutions for dealing with them that don’t interfere with functionality. IPT helps the patient to understand the challenges in interpersonal relationships and find solutions to the problems.

Treatment for Postpartum Blues

The common symptoms of postpartum blues may be helped by paying attention to them and taking steps to lessen their impact. New mothers should make every effort to get as much rest as possible, to get help from loved ones, to make time for self-care, and to avoid alcohol and other recreational drugs. If symptoms persist or get worse, seek professional help.

Treatment for Postpartum Psychosis

In the unlikely event that the symptoms rise to the level of postpartum psychosis, treatment is much more aggressive and usually requires hospitalization. Medications used include antipsychotics, mood stabilizers, and benzodiazepines. In some cases, typically when other treatments have not been effective, electroconvulsive therapy (ECT) is used to help to control symptoms.

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

How Does Postpartum Depression Progress?

With early detection and proper treatment, the prognosis for postpartum depression is good, with most sufferers seeing a reduction or elimination of symptoms after following a treatment plan. Without treatment, however, symptoms may increase in severity and persistence.

In many cases, relatively mild symptoms that fit the definition of postpartum blues progress to symptoms of postpartum depression. Untreated postpartum depression may progress to a major depressive episode that fits the definition of clinical depression and last for months or longer.

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

How Is Postpartum Depression Prevented?

Some women are especially at risk of developing postpartum depression. For example, women who have experienced the disorder at least once have about a 50% chance of experiencing it again during subsequent pregnancies. Women who have experienced major depression outside of pregnancy also seem to be at increased risk, too; some research suggests that women who have experienced depression, in general, have between a 30% and 50% chance of experiencing depressive episodes during pregnancy or soon after giving birth.

Some preventative treatments have shown promise in preventing the onset of the disorder in women at risk.

  • Preventative medication. One study looked at the effectiveness of prophylactic treatment with SSRI antidepressants in women with a history of postpartum depression. The study results suggested that the treatment was effective at preventing a recurrence of the disorder.
  • Behavioral techniques. A therapeutic technique called Practical Resources for Effective Postpartum Parenting (PREPP) has also shown preventative promise. The approach encourages behaviors that help the mother to get rest, decrease the fussiness of the baby, and strengthen the bond between mother and child.

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

Postpartum Depression Caregiver Tips

As is the case with major depression and other depressive disorders, those who care for sufferers of postpartum depression are at risk for developing depression themselves. Caregivers for someone with postpartum depression should consider these tips to help the sufferer and themselves to deal with the disorder:

  • Learn as much as possible about the disorder.
  • Do what you can to help. Find out what needs to be done around the house, and volunteer to do some of it–laundry, dishes, running errands, taking care of the baby while mom sleeps, etc. Sometimes the best thing you can do is just be around, to do the little things as they come up or just to listen.
  • Don’t expect the sufferer to simply get better on their own.
  • Seek out appropriate professional treatment for the sufferer.
  • Do everything possible to support the sufferer in the pursuit of treatment.
  • Be supportive of the sufferer and acknowledge any improvements.
  • Find a support group for caregivers.

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

Postpartum Depression Brain Science

Decades ago, researchers discovered that some of the chemicals produced when the body breaks down hormones such as progesterone seem to help neurons in the brain function properly. The researchers also discovered that the level of one of these compounds, called allopregnanolone, fluctuated in women during their menstrual cycle and during pregnancy. Specifically, a woman’s allopregnanolone level increases during pregnancy and then drops after childbirth. This led scientists to suspect that allopregnanolone played a role in postpartum blues and depression.

The result of the research was the development of brexanolone, a drug that mimics allopregnanolone and that shows promise in alleviating the symptoms of postpartum depression. Brexanolone was approved by the FDA as a treatment for moderate to severe postpartum depression in March 2019.

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

Postpartum Depression Research

Scientists are working on several research projects to expand on what is known about Postpartum Depression.  The research will improve knowledge about the factors that increase the risk for Postpartum Depression, as well as the causes, and best treatments, and will aid people living with Postpartum Depression and their caregivers.

We are currently gathering the information required to support projects such as Preventing Postpartum Depression (PREPP), Healthy Lifestyle Intervention for High-Risk Minority Pregnant Women (A-RCT) and Preventing Postpartum Depression With Intranasal Oxytocin (IN-OXT).

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

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