Postpartum Depression (PPD): Symptoms, Treatment & More - Verywell Health

Postpartum depression (PPD) is depression that occurs after childbirth. It is a type of perinatal mood disorder—a mood disorder that starts during pregnancy or within a year of giving birth. PPD often begins within the first month of giving birth but can strike any time within the first year.

Many people expect having a new baby to be a joyous time, but it can also be a time of emotional and social changes and tremendous stress.

PPD is very common: As many as 1 in 8 new mothers develop PPD, and rates are even higher among adolescent and low-income mothers. It is important that mothers and their loved ones keep a lookout for the signs and symptoms of depression.

PPD is sometimes confused with the baby blues—mild moodiness, crying spells, and bouts of sadness that often occur shortly after birth. Up to 80% of new parents experience the baby blues. The rapid drop in pregnancy hormones after birth, exhaustion, and nervousness about caring for a new baby can all cause these feelings.

Symptoms of the Baby Blues

Symptoms of the baby blues include:

• Moodiness
• Crying spells 
• Irritability 
• Fatigue
• Periods of sadness
• Worry about your baby or being a mother
• Difficulty sleeping

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Critically, the baby blues tend to be mild. Feelings of sadness or irritability come and go, do not affect normal daily functioning, and generally fade within one to two weeks.

If the blues last for more than two weeks, or intensify, you may have PPD.

Men With Postpartum Depression

Depression after having a baby doesn't only affect mothers. An estimated 10% of men also develop depression sometime during the first year after the birth of a child.

Symptoms

Having a baby is a time of social, emotional, and sometimes financial upheaval. It always requires some adjustment. In addition, caring for a newborn is a round-the-clock job—one that can be overwhelming and stressful. Newborns also wake throughout the night, and a lack of sleep can make you feel tired, moody, grumpy, and mentally and physically depleted.

Some amount of stress, sadness, and fatigue while caring for a new baby are normal. But if these feelings are impairing your ability to perform your normal daily tasks or to take care of your baby (such as feeding, changing, and bathing your baby), or making you feel like you do not love or care for your newborn, you may have PPD.

Postpartum depression can manifest in a variety of ways. Not everyone will have the exact same signs and symptoms.

Common Symptoms of PPD

Common symptoms include:

• Feelings of sadness or emptiness
• Loss of pleasure in activities you normally enjoy
• Sleeping too much or too little, trouble falling asleep or staying asleep
• Feeling sluggish or lethargic
• Feeling restless or agitated
• Loss of appetite, or rapid weight loss or weight gain
• Periods of uncontrolled crying
• Not feeling bonded to your baby
• Difficulty concentrating and thinking clearly, indecisiveness
• Feelings of excess guilt or worthlessness
• Thoughts of death, suicide, or harming yourself or your baby

These symptoms mean you may have PPD and need medical help. The good news is that PPD is highly treatable. With prompt treatment, most women recover.

Untreated PPD can linger and intensify and can have a serious impact on you and your baby. So if you suspect you or a loved one has PPD, don't wait. Don't hope your depression will go away on its own. Seek help right away.

Diagnosis

The American College of Obstetricians and Gynecologists recommends that obstetricians screen women for symptoms of depression during pregnancy and at their six weeks postpartum visit. The American Academy of Pediatrics similarly recommends pediatricians screen mothers for symptoms of depression throughout their babies' first year.

Despite these guidelines, the diagnosis of PPD is often missed or delayed.

Sometimes busy doctors can forget to screen mothers for depression, or screen them only in a cursory manner. Sometimes women fail to disclose their feelings because they feel ashamed. They may feel they are failing to live up to society's or their own ideals of motherhood, and depression itself can cause and exacerbate feelings of shame, guilt, and failure.

Do not let shame keep you from asking for help. Having PPD is an illness and not your fault. Talk to your doctor or your baby's pediatrician at one of your regularly scheduled visits. If a visit is not coming up, schedule a consultation with a health professional. This could be your primary care physician, obstetrician, or a psychiatrist. 

To aid in your diagnosis, your doctor may:

• Ask you questions about your symptoms and feelings, including your physical and mental health, and your family history of depression
• Perform a physical exam
• Ask you to fill out a questionnaire about how you have been feeling over the past week 
• Do a blood draw to test for physical problems such as low thyroid hormone and anemia, which can mimic the symptoms of depression

If your exam indicates you may have PPD, your doctor will refer you to a psychiatrist or other mental health professional who can help put together a treatment plan.

Causes

Experts do not fully understand why some women develop postpartum depression while others do not. Social, economic, genetic, and hormonal factors all appear to contribute. The greatest risk factor is having had clinical depression in the past.

Genetics also play a role: Women with a personal or family history of perinatal mood disorders are at elevated risk for developing them.

Many other factors also raise the risk of PPD. These include:

• Family history of mood disorders, especially of perinatal mood disorders
• Prior episodes of clinical depression
• Anxiety or depression during pregnancy
• A stressful marriage or relationship or experiencing domestic abuse
• Lack of support from friends and family members
• Difficult infant temperament
• Recent stressful life events, such as divorce, separation, or job loss
• Pregnancy complications or giving birth prematurely
• Stress of childcare
• Financial strain
• Traumatic birth
• Being single
• Unplanned or unwanted pregnancy
  

Types

Depression With Anxiety

PPD is often accompanied by a major uptick in anxiety. About two-thirds of women with PPD also experience clinical levels of anxiety. Anxiety can manifest as irrational or nonstop worries about being a mother or about the baby. These worries can interfere with a person's ability to function normally and to fall asleep or stay asleep. Some women will develop postpartum anxiety without being depressed.

Postpartum Psychosis

Rarely, women experience a serious condition called postpartum psychosis. Postpartum psychosis affects only 1 to 2 women out of 1,000 and usually develops within a few weeks of giving birth.

Women with postpartum psychosis may experience:

• Insomnia
• Confusion
• Excess energy or agitation
• Delusions (believing things that are untrue)
• Hallucinations (seeing things or hearing voices that do not exist)
• Paranoia and extreme suspiciousness of those around them
• Racing thoughts and speech

Women with postpartum psychosis are at high risk of harming themselves or their children. It is a medical emergency, requiring immediate medical attention. If you suspect you or your loved one has postpartum psychosis, call 911 or head to the nearest emergency room.

Treatment

PPD is a horrible thing for a mother to go through, but fortunately, highly effective treatments exist, and most women recover with prompt treatment.

The treatment plan will depend on personal preferences and the severity of the depression. Treatment often involves a combination of antidepressants and therapy.

Therapy

Therapy (sometimes called counseling or talk therapy) can help women identify problematic thoughts and behaviors, develop ways of coping with stressful situations, and build a more positive outlook. Evidence-based approaches include cognitive behavioral therapy and interpersonal therapy.

Cognitive behavioral therapy (CBT) is a type of therapy that focuses on recognizing unhelpful patterns of thoughts, reactions, and behaviors and teaching people more productive ways of thinking and responding to stressful or difficult circumstances.

Interpersonal therapy (IPT) is based on the idea that relationships and life events affect your mood, and your mood in turn affects your relationships and life course. It is often used to help treat postpartum depression. IPT focuses on improving your communication skills in the context of your relationships, building up a social support network, and setting realistic expectations.

Antidepressants

Your doctor or therapist may recommend you take an antidepressant in addition to taking part in psychotherapy. Antidepressants help improve mood and decrease stress by rebalancing levels of certain brain chemicals like serotonin.

Antidepressants generally need one to two weeks to start working and may take six to eight weeks to take full effect; they need to be taken for at least four to nine months to avoid a relapse. After this time, if you wish to stop taking your antidepressant, you can work with your doctor or therapist to gradually taper off of your medication. Do not stop taking your medication abruptly.

Antidepressants do pass through the breast milk. If you are breastfeeding, your doctor will help you choose an antidepressant with a low risk of side effects for your baby. 

If antidepressants and psychotherapy fail to alleviate your symptoms and your depression is severe, your doctor may recommend electroconvulsive therapy (ECT) or brexanolone (Zulresso), a new infusion-based therapy. Brexanolone is the first and only Food and Drug Administration–approved therapy specifically for severe PPD.

Alternative Therapies

Alternative and complementary therapies like massage, yoga, and acupuncture may lift your mood and help you cope with stress. Multiple studies have shown that exercise in particular benefits women with PPD.

Coping

Having a new baby is a round-the-clock job. Many mothers find caring for a new baby overwhelming and exhausting. This period is also a time of social, emotional, and sometimes financial upheaval.

Some actions that may lift your mood and help you cope are:

• Accepting help when it's offered
• Enlisting support from friends and family
• Joining a support group or a social group for new moms
• Asking someone to watch the baby so you can have a break
• Taking time to exercise or get outside for a walk
• Trying to get as much sleep as you can
• Taking time each day to engage, however briefly, in activities that you enjoy or that help you relax, like yoga, meditation, or chatting with a friend on the phone

A Word From Verywell

The period after giving birth can bring a tumult of emotions—joy, elation, sadness, anxiety, and exhaustion. The stress of caring for a newborn 24/7 while experiencing disrupted sleep can be exhausting and overwhelming. Giving birth can also cause huge shifts in your identity and social roles, your body, and your relationships. These abrupt changes can be disorienting and distressing. All of these feelings are normal.

But if you find that feelings of sadness or emptiness are consuming much of your thoughts and daily interactions, or that you cannot function normally or care for your baby, seek help.

Depression after giving birth is incredibly common. It is an illness and no one's fault. The most important thing you can do for yourself and for your baby is to get professional help right away. The sooner you get help, the sooner you place yourself on the road to recovery.

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