Postpartum depression

  • Definition
    • Postpartum depression is moderate to severe depression in a woman after she has given birth. It may occur soon after delivery or up to a year later. Most of the time, it occurs within the first 3 months after delivery.

  • Alternative Names
    • Depression - postpartum; Postnatal depression; Postpartum psychological reactions

  • Causes
    • The exact causes of postpartum depression are unknown. Changes in hormone levels during and after pregnancy may affect a woman's mood. Many non-hormonal factors may also affect mood during this period:

      • Changes in your body from pregnancy and delivery
      • Changes in work and social relationships
      • Having less time and freedom for yourself
      • Lack of sleep
      • Worries about your ability to be a good mother

      You may have a higher chance of postpartum depression if you:

      • Are under age 20
      • Currently use alcohol, take illegal substances, or smoke (these also cause serious health risks for the baby)
      • Did not plan the pregnancy, or had mixed feelings about the pregnancy
      • Had depression, bipolar disorder, or an anxiety disorder before your pregnancy, or with a past pregnancy
      • Had a stressful event during the pregnancy or delivery, including personal illness, death or illness of a loved one, a difficult or emergency delivery, premature delivery, or illness or birth defect in the baby
      • Have a close family member who has had depression or anxiety
      • Have a poor relationship with your significant other or are single
      • Have money or housing problems
      • Have little support from family, friends, or your spouse or partner
  • Symptoms
    • Feelings of anxiety, irritation, tearfulness, and restlessness are common in the week or two after pregnancy. These feelings are often called the postpartum or "baby blues." They almost always go away soon, without the need for treatment.

      Postpartum depression may occur when the baby blues DO NOT fade away or when signs of depression start 1 or more months after childbirth.

      The symptoms of postpartum depression are the same as the symptoms of depression that occurs at other times in life. Along with a sad or depressed mood, you may have some of the following symptoms:

      • Agitation or irritability
      • Changes in appetite
      • Feelings of worthlessness or guilt
      • Feeling like you are withdrawn or unconnected
      • Lack of pleasure or interest in most or all activities
      • Loss of concentration
      • Loss of energy
      • Problems doing tasks at home or work
      • Significant anxiety
      • Thoughts of death or suicide
      • Trouble sleeping

      A mother with postpartum depression may also:

      • Be unable to care for herself or her baby
      • Be afraid to be alone with her baby
      • Have negative feelings toward the baby or even think about harming the baby (Although these feelings are scary, they are almost never acted on. Still you should tell your doctor about them right away.)
      • Worry intensely about the baby, or have little interest in the baby
  • Exams and Tests
    • There is no single test to diagnose postpartum depression. Diagnosis is based on the symptoms you describe to your health care provider.

      Your provider may order blood tests to screen for medical causes of depression.

  • Treatment
    • A new mother who has any symptoms of postpartum depression should contact her provider right away to get help.

      Here are some other tips:

      • Ask your partner, family, and friends for help with the baby's needs and in the home.
      • DO NOT hide your feelings. Talk about them with your partner, family, and friends.
      • DO NOT make any major life changes during pregnancy or right after giving birth.
      • DO NOT try to do too much, or to be perfect.
      • Make time to go out, visit friends, or spend time alone with your partner.
      • Rest as much as you can. Sleep when the baby is sleeping.
      • Talk with other mothers or join a support group.

      The treatment for depression after birth often includes medicine, talk therapy, or both. Breastfeeding will play a role in what medicine your provider recommends. You may be referred to a mental health specialist. Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are types of talk therapy that often help postpartum depression.

      Support groups may be helpful, but they should not replace medicine or talk therapy if you have postpartum depression.

      Having good social support from family, friends, and coworkers may help reduce the seriousness of postpartum depression.

  • Outlook (Prognosis)
    • Medicine and talk therapy can often successfully reduce or eliminate symptoms.

  • Possible Complications
    • Left untreated, postpartum depression can last for months or years.

      The potential long-term complications are the same as in major depression. Untreated postpartum depression may put you at risk of harming yourself or your baby.

  • When to Contact a Medical Professional
    • Call your provider if you have any of the following:

      • Your baby blues DO NOT go away after 2 weeks
      • Symptoms of depression get more intense
      • Symptoms of depression begin at any time after delivery, even many months later
      • It is hard for you to perform tasks at work or home
      • You cannot care for yourself or your baby
      • You have thoughts of harming yourself or your baby
      • You develop thoughts that are not based in reality, or you start hearing or seeing things that other people don't

      DO NOT be afraid to seek help right away if you feel overwhelmed and are afraid that you may hurt your baby.

  • Prevention
    • Having good social support from family, friends, and coworkers may help reduce the seriousness of postpartum depression, but may not prevent it.

      Women who had postpartum depression after past pregnancies may be less likely to develop postpartum depression again if they start taking antidepressant medicines after they deliver. Talk therapy may also be helpful in preventing depression.

  • References
    • American Psychiatric Association. Depressive disorders. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013:155-233.

      Nonacs RM, Wang B, Viguera AC, Cohen LS. Psychiatric illness during pregnancy and the post-partum period. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 31.

      Siu AL, US Preventive Services Task Force (USPSTF), Bibbins-Domingo K, et al. Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016;315(4):380-387. PMID: 26813211