Postpartum Depression

• Postpartum Depression Overview
• Postpartum Depression Causes
• Postpartum Depression Symptoms
• When to Seek Medical Care
• Exams and Tests
• Postpartum Depression Treatment
• Self-Care at Home
• Medical Treatment
• Medications
• Other Therapy
• Next Steps
• Follow-up
• Prevention
• Outlook
• Support Groups and Counseling
• For More Information
• Web Links
• Synonyms and Keywords
• Authors and Editors

Postpartum Depression Overview

You've just had a baby, one of the most important and happiest events in your life. "What could make a woman happier than a new baby?" you wonder. So why are you so sad?

We don't know for sure, but you are not alone. As many as 80% of women experience some mood disturbances after pregnancy ("postpartum"). They feel upset, alone, afraid, or unloving toward their baby, and guilt for having these feelings.

For most women, the symptoms are mild and go away on their own. But 10-20% of women develop a more disabling form of mood disorder called postpartum depression. 

• The "baby blues" are a passing state of heightened emotions that occurs in about half of women who have recently given birth.
  • This state peaks 3-5 days after delivery and lasts from several days to 2 weeks.

  • A woman with the blues may cry more easily than usual and may have trouble sleeping or feel irritable, sad, and "on edge" emotionally.

  • Because baby blues are so common and expected, they are not considered an illness.

  • Postpartum blues do not interfere with a woman's ability to care for her baby.

  • The tendency to develop postpartum blues is unrelated to a previous mental illness and is not caused by stress. However, stress and a history of depression  may influence whether the blues go on to become major depression.

• Postpartum depression is depression that occurs soon after having a baby. Some health professionals call it postpartum nonpsychotic depression.
  • This condition occurs in about 10-20% of women, usually within a few months of delivery.

  • Risk factors include previous major depression, psychosocial stress, inadequate social support, and previous premenstrual dysphoric disorder (see premenstrual syndrome for more information).

  • Symptoms include depressed mood, tearfulness, inability to enjoy pleasurable activities, trouble sleeping, fatigue, appetite problems, suicidal thoughts, feelings of inadequacy as a parent, and impaired concentration.

  • If you experience postpartum depression, you may worry about the baby's health and well-being. You may have negative thoughts about the baby and fears about harming the infant (although women who have these thoughts rarely act on them).

  • Postpartum depression interferes with a woman's ability to care for her baby.

  • When a woman with severe postpartum depression becomes suicidal, she may consider killing her infant and young children, not from anger, but from a desire not to abandon them.

• Postpartum (puerperal) psychosis is the most serious postpartum disorder. It requires immediate treatment.
  • This condition is rare. A woman with this condition experiences psychotic symptoms within 3 weeks of giving birth. These include false beliefs (delusions), hallucinations (seeing or hearing things that are not there), or both.

  • This condition is associated with mood disorders such as depression, bipolar disorder, or psychosis.

  • Symptoms can include inability to sleep, agitation, and mood swings.

  • A woman experiencing psychosis can appear well temporarily, fooling health professionals and caregivers into thinking that she has recovered, but she can continue to be severely depressed and ill even after brief periods of seeming well.

  • Women who harbor thoughts of hurting their infants are more likely to act on them if they have postpartum psychosis.

  • If untreated, postpartum psychotic depression has a high likelihood of coming back after the postpartum period and also after the birth of other children.

Postpartum Depression Causes

No specific cause of postpartum depression has been found.

• Hormone imbalance is thought to play a role.
  • Levels of the hormones estrogen, progesterone, and cortisol fall dramatically within 48 hours after delivery.

  • Women who go on to develop postpartum depression may be more sensitive to these hormonal changes.

• Other known risk factors
  • Mental illness before pregnancy

  • Mental illness, including postpartum depression, in the family  

  • Postpartum mental disorder after an earlier pregnancy

  • Conflict in the marriage, loss of employment, or poor social support from friends and family

  • Pregnancy loss such as miscarriage or stillbirth
    • The risk of major depression after miscarriage is high for women who are childless. It occurs even in women who were unhappy about being pregnant.

    • The risk for developing depression after miscarriage is highest within the first few months after the loss.

• Childbirth is a time of great change for a woman. The adjustment to these changes can contribute to depression.
  • Physical changes after delivery
    • Many changes occur after delivery, including changes in muscle tone and difficulty losing weight.

    • Many new mothers are very tired after giving birth and in the weeks afterwards.

    • Soreness and pain in your perineal area (area around the birth canal) makes many women uncomfortable. Physical recovery after cesarean delivery may take even longer than after vaginal delivery.

    • Changes in hormones can affect mood.

  • Common emotional changes after delivery
    • Feelings of loss of an old identity, feeling trapped at home

    • Feeling overwhelmed with responsibilities of motherhood

    • Feeling stress from changes in routine

    • Feeling fatigue because of broken sleep patterns

    • Feeling less attractive physically and sexually

• A mother's age and the number of children she has had do not relate to her likelihood of getting postpartum depression.