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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.

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