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Postpartum Depression

by Julie S. Moldenhauer, MD

Postpartum depression is a feeling of extreme sadness and related psychologic disturbances during the first few weeks or months after delivery.

  • Women who have had depression are more likely to develop postpartum depression.

  • Women feel extremely sad, cry, become irritable and moody, and may lose interest in daily activities and the baby.

  • A combination of counseling and antidepressants can help.

The baby blues—feeling sad or miserable within 3 days of delivery—is common after delivery. Women should not be overly concerned about these feelings because they usually disappear within 2 weeks. Postpartum depression is a more serious mood change. It lasts for weeks or months and interferes with daily activities. About 10 to 15% of women are affected. Very rarely, an even more severe disorder called postpartum psychosis develops.

The causes of sadness or depression after delivery are unclear, but the following may contribute or increase the risk:

  • Depression that was present before or developed during pregnancy

  • Postpartum depression in a previous pregnancy

  • Previous episodes of sadness or depression that occurred during certain times of the month (related to the menstrual cycle) or while taking oral contraceptives

  • Close relatives who have depression (family history)

  • The sudden decrease in levels of hormones (such as estrogen, progesterone, and thyroid hormones) that occurs after delivery

  • Stresses such as having marital problems, having an unemployed partner, having financial difficulties, or having no partner)

  • Lack of support from a partner or family members

  • Problems related to the pregnancy (such as a preterm delivery or a baby with birth defects)

  • Ambivalence about the current pregnancy (for example, because it was unplanned or the woman considered ending the pregnancy)

If women have had depression before they became pregnant, they should tell their doctor or midwife. Such depression often evolves into postpartum depression. Depression during pregnancy is common and is an important risk factor for postpartum depression.

Symptoms

Symptoms may include.

  • Extreme sadness

  • Frequent crying

  • Mood swings

  • Irritability

Less common symptoms include

  • Extreme fatigue

  • Sleep problems (too much or too little)

  • Loss of interest in sex and other activities

  • Anxiety or panic attacks

  • Loss of appetite or overeating

  • Difficulty functioning

  • Lack of interest in or unreasonable worries about the baby

  • Feelings of inadequacy or hopelessness

  • Guilt about having these feelings

Women may not bond with their baby. As a result, the child may have emotional, social, and cognitive problems later.

In postpartum psychosis, depression may be combined with suicidal or violent thoughts, hallucinations, or bizarre behavior. Sometimes postpartum psychosis includes a desire to harm the baby.

Fathers may also become depressed, and marital stress may increase.

Without treatment, postpartum depression can last for months or years. About one in three or four women who have had postpartum depression have it again.

Diagnosis

Early diagnosis and treatment are important for women and their baby. Women should see their doctor if they continue to feel sad and have difficulty doing their usual activities for more than 2 weeks after delivery or if they have thoughts about harming themselves or the baby. If family members and friends notice symptoms, they should talk with the woman and encourage her to talk to a doctor.

Doctors may ask women to fill out a questionnaire designed to identify depression. They may also do blood tests to determine whether a disorder, such as a thyroid disorder, is causing the symptoms.

Treatment

If women feel sad, support from family members and friends is usually all that is needed. But if depression is diagnosed, professional help is also needed. Typically, a combination of counseling and antidepressants (see Table: Drugs Used to Treat Depression) is recommended.

Women who have postpartum psychosis may need to be hospitalized, preferably in a supervised unit that allows the baby to remain with them. They may need antipsychotic drugs (see Table: Antipsychotic Drugs) as well as antidepressants.

Women who are breastfeeding should consult with their doctor before taking any of these drugs to determine whether they can continue to breastfeed (see Taking Drugs While Breastfeeding). Many of these drugs (such as sertraline and paroxetine) allow women to continue breastfeeding.

Resources In This Article

Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • CRINONE
  • PAXIL
  • ZOLOFT