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Postpartum Depression

What Is Postpartum Depression?

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. Many women experience some mood disturbances in the time after pregnancy (known as the postpartum period). They may feel anxious, upset, alone, afraid, or unloving toward their baby, and experience some guilt for having these feelings.

For most women, the symptoms are mild and go away on their own. But statistics indicate that some women develop a more prominent and disabling form of mood disorder called postpartum depression (PPD).

Charlotte Perkins Gilman, a prominent American writer and sociologist, wrote about her own struggles with postpartum depression in the 19th and 20th centuries. Tragic, infamous cases that involved a claim of postpartum depression or psychosis include those of mothers Andrea Yates and Susan Smith, each of whom killed their children.

  • 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 three to five days after delivery and lasts from several days to two 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, expected, and go away without treatment or without interfering with the mother's ability to function, 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 significant, often called clinical depression that occurs soon after having a baby. Some health professionals call it postpartum nonpsychotic depression.
    • This condition occurs in some of women, usually within a few months of delivery.
    • Risk factors for postpartum depression 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, thoughts of suicide, 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 three 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.

What Are Postpartum Depression Causes and Risk Factors?

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 afterward.
      • Soreness and pain in the 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.
  • Men whose partners suffer from postpartum depression have been found to be at higher risk for developing a similar condition or other mental health problems at that time.
Last Reviewed 11/21/2017

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Postpartum Depression - Symptoms

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Postpartum Depression Treatment Overview

Early treatment of postpartum depression (PPD) is important for you, your baby, and the rest of your family. The sooner you start, the more quickly you will recover, and the less your depression will affect your baby. Babies of depressed mothers can be less attached to their mothers and lag behind developmentally in behavior and mental ability.1

Treatment choices for postpartum depression include:

  • Counseling for both you and your partner. Cognitive-behavioral therapy helps you take charge of the way you think and feel. Interpersonal counseling is also a good treatment choice for postpartum depression. (You may find a counselor who offers both cognitive-behavioral therapy and interpersonal counseling.) Interpersonal counseling focuses on relationships and the personal changes that come with having a new baby. It gives you emotional support and helps with problem solving and goal setting. For your partner, counseling may help with the demands of having a new baby. It can also help your partner support you.


Read What Your Physician is Reading on Medscape

Postpartum Depression »

During the postpartum period, up to 85% of women experience some type of mood disturbance.

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