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Postpartum Depression

(Depression After Delivery)

By

Julie S. Moldenhauer

, MD, Children's Hospital of Philadelphia

Last full review/revision May 2020| Content last modified May 2020
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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.

  • 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.

  • A combination of psychotherapy and antidepressants is recommended for women with postpartum depression.

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.

Causes

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

  • Baby blues

  • 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)

  • 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)

  • Problems with breastfeeding

The sudden decrease in levels of hormones (such as estrogen, progesterone, and thyroid hormones) that occurs after delivery and lack of sleep may contribute to developing postpartum depression. Also, a gene that makes a woman more susceptible to postpartum depression may be involved.

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

Typically, symptoms of postpartum depression develop gradually over 3 months, but they may begin more suddenly. Postpartum depression interferes with women’s ability to care for themselves and the baby.

Symptoms of postpartum depression may include

  • Extreme sadness

  • Frequent, uncontrollable crying

  • Mood swings

  • Irritability and anger

Less common symptoms include

  • Extreme fatigue

  • Sleep problems (too much or too little)

  • Headaches and body aches

  • 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

  • A feeling of being incapable of caring for the baby or of being inadequate as a mother

  • Guilt about having these feelings

  • Fear of harming the baby

  • Suicidal thoughts

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.

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

  • Recognizing that fatigue, difficulty concentrating, and doubts about being a mother are normal in new mothers and that these effects usually pass

Diagnosis

  • A doctor's evaluation

Early diagnosis and treatment of postpartum depression 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.

When women go for their postdelivery visit, doctors may ask them to fill out a questionnaire designed to identify depression and anxiety. If women are depressed, doctors may also do blood tests to determine whether a disorder, such as a thyroid disorder, is causing the symptoms.

Did You Know...

  • Women should see their doctor immediately 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.

Treatment

  • Psychotherapy

  • Antidepressants

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 psychotherapy and antidepressants is recommended.

Exercise, phototherapy (light therapy), massage, and omega-3 fatty acid supplements may also help. Phototherapy involves sitting a specific distance from a light box that provides light at the recommended intensity. People should remain in front of the light for at least 30 minutes, but they should not look directly at the light. Phototherapy can be done at home.

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 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.

Drugs Mentioned In This Article

Generic Name Select Brand Names
ZOLOFT
PAXIL
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