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 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:

• Depression or another psychologic disorder that was present before or developed during pregnancy
• Close relatives who have depression (family history)
• The sudden decrease in levels of hormones (such as estrogen, progesteroneSome Trade Names
  CRINONE ENDOMETRIN
  , and thyroid hormones)
• Stresses of having and caring for a baby (such as difficulties during labor and delivery, lack of sleep, fatigue, loss of freedom, and feelings of isolation and incompetence)
• Lack of social support
• Marital discord
• Other significant life stressors such as financial difficulties or a recent move

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 frequent crying, mood swings, and irritability as well as feelings of extreme sadness. Less common symptoms include extreme fatigue, difficulty concentrating, sleep problems, loss of interest in sex and other activities, anxiety, appetite changes, and feelings of inadequacy or hopelessness. Women have difficulty functioning. They may have no interest in their baby.

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 months or years, and women may not bond with their infant. As a result, the child may have emotional, social, and cognitive problems later. 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.

Preventing Depression After Delivery
Women can take steps to combat feelings of sadness after having a baby: Getting as much rest as possible—for example, by napping when the baby naps Not trying to do everything—for example, by not trying to keep a spotless house and make home-cooked meals all the time Asking for help from family members and friends Talking to someone (husband or partner, family members, or friends) about their feelings. Showering and dressing each day Getting out of the house frequently—for example, to run an errand, meet with friends, or take a walk Spending time alone with their husband or partner Talking with other mothers about common experiences and feelings Joining a support group for women with depression

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 Mood Disorders: 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 Schizophrenia and Delusional Disorder: 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 options that allow continuation of breastfeeding are available.

Last full review/revision November 2008 by Julie S. Moldenhauer, MD