Medically reviewed by Vicky Davis, FNP
Written by Our Editorial Team
Last updated 4/26/2021
The delivery of a fresh bundle of joy can produce quite the bundle of emotions. From exhaustion and happiness, to anxiety and sadness.
This mixed bag of emotions is commonly experienced by new mothers in a condition known as "baby blues". It features mood swings, irritability, crying, insomnia, impatience, and perceived vulnerability.
These blues usually begin 1-3 days after birth and can last around 10 days to a few weeks. Less easy to shake off, however, is a postnatal mood disorder known as postpartum depression.
Postpartum depression (PPD) is a severe mood disorder that may accompany the delivery of a child. Around one in seven women will experience this condition following delivery. PPD can severely impact the relationship between mother and baby.
However, beyond an affected bond, this condition can lead to an inability to breastfeed, dangerous parenting practices, and marital challenges.
Postpartum depression may also compromise the psychological and physical development of the child, and may even lead to physical harm to the child in certain cases.
However, despite the potential severity of this condition, PPD in new mothers is largely underdiagnosed, with nearly half of the cases going undetected.
We’ll be highlighting the signs to look out for in a suspected case of postpartum depression. We’ll also take a look at the causes and possible treatment methods to manage this condition.
Postpartum depression is a type of depression that is commonly noticed following the birth of a child. However, it may occur at any trimester during pregnancy. This condition may produce extreme feelings of worry and anxiety over being able to care for the child, hopelessness, or simply being unable to cope with life following the baby’s birth.
While it is commonly observed in new mothers, this condition may also be experienced by fathers, with an estimated eight percent to 10 percent of new fathers experiencing postpartum depression.
PPD may be observed within a few months to a year after childbirth. Its symptoms may last around six months within 25 percent to 50 percent, although studies have shown that depression may be present three years after childbirth.
Our article on maternal depression covers all mood disorders including PPD.
Any mother may experience postpartum depression — however, it has most commonly been observed in adolescent mothers, women who give birth to premature babies, as well as those who live in urban areas.
But while we know this much about those affected by PPD, it’s a little less clear how this condition comes to affect them at all.
Postpartum depression is believed to result from genetic, hormonal, psychological, and social factors.
While a lot is still to be determined about the causes of PPD, there is a chance this condition is an inheritable disorder.
In particular, genes that may affect the production of the neurotransmitters — serotonin, dopamine, and norepinephrine have been linked with postpartum depression. One example is the 5-HTTLPR gene.
This gene may prevent the activities of these neurotransmitters which are known to regulate the mood and happiness in the body. Where dopamine, serotonin, or norepinephrine are deficient in the body, there is an increased risk of developing depression. This can lend support to the genetic link with PPD, although more research is required.
To accommodate the growth of a tiny human, the body has to undergo a number of drastic changes. One of such changes is an increase in reproductive hormones like progesterone, estrogen, prolactin, estradiol, and glucocorticoids. In addition to their roles in promoting immunity, milk production, fetal growth, etc — these hormones also play key roles in emotions, arousal, brain function, motivation, etc.
After delivery, a dramatic drop in these hormones occurs which can trigger postpartum depression.
The risk of developing postpartum depression is higher in mothers who experience sexual, physical, or verbal abuse in their homes. Likewise, there is a higher likelihood of developing postpartum depression where partners are unsupportive.
Where a pregnancy is marked by very minimal physical activity, or poor eating and sleeping habits, there is an increased risk for developing postpartum depression.
Other factors that may increase the risk of postpartum depression include smoking during pregnancy, risky births that require hospitalizations or emergency surgery, premature births, and low hemoglobin.
The signs and symptoms of postpartum depression are essentially the same as depression. This condition is usually diagnosed where at least 5 symptoms of depression are present, and no other condition is identified.
The following signs may indicate a case of postpartum depression:
Depressed mood for extended periods during the day
A long-running loss of interest in activities
Feelings of worthlessness
Thoughts of suicide
Thoughts of death
Changes in weight
These symptoms can be incredibly distressing and may hinder a mother’s proper care and attention to her child and herself.
Where symptoms of postpartum depression are observed and a proper diagnosis has been made, the following methods are usually a first resort in treating this disorder:
Psychotherapy is one of the most effective ways to manage postpartum depression and one of several types of therapy. It is especially useful as a first option for breastfeeding mothers who are worried about the impact of medication when nursing.
Interpersonal therapy can help mothers deal with the massive changes motherhood will bring to their marital, personal, and social relationships. It works to strengthen social support and improve communication with peers and loved ones.
Cognitive behavioral therapy can help the new mother worn down by negative thoughts to identify how these thought patterns affect their wellbeing. This therapy then teaches ways to change negative thoughts about themselves and their abilities as a parent. This can eventually cause a shift in their behavior.
Early cognitive behavior therapy is also useful for mothers who are at risk of developing PPD.
Medication for postpartum depression. Combined with therapy, antidepressants are an effective way to manage mild to moderate degrees of postpartum depression. Selective serotonin reuptake inhibitors (SSRIs) are usually the first resort and may be upgraded to selective norepinephrine reuptake inhibitors (SNRIs) where they fail to manage symptoms.
There is very little risk involved in using selective reuptake inhibitors when breastfeeding, however, discussing with a healthcare professional is always advisable before beginning treatment.
This is a non-invasive procedure that employs magnetic waves to activate nerve cells. This treatment is a safe alternative for mothers worried about medication exposure for their children.
TMS helps to stimulate nerve cells that are underperforming as a result of major depressive disorder. It requires repeated sessions several times a week to be effective and has proven to be well tolerated.
In severe cases of postpartum depression, such as where the mother refuses to eat or drink, contemplates suicidal thoughts, as well as thoughts of harming her child — ECT may be effective in improving symptoms.
This treatment involves targeted current sent to certain parts of the brain to induce a seizure, this provides relief from mental disorders. Electroconvulsive therapy is a safe treatment method suitable for lactating mothers.
Postpartum depression is a severe condition that can not only hinder the precious bonding moments between mother and baby, but may also lead to harm to either one of them.
PPD may develop due to biological, psychological, or social factors, and is a popular condition faced by many new mothers.
A number of safe and effective treatment methods are available to manage this condition, with psychotherapy and medication at the forefront. For the treatment best suited for you and your baby, however, consulting with a healthcare professional is always recommended.