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Reviewed by Kristin Hall, FNP
Written by Our Editorial Team
The delivery of a fresh bundle of joy can produce quite a bundle of emotions. From exhaustion and happiness to anxiety and mood swings, new mothers may never know what to expect after they’re expecting.
This mixed bag of emotions commonly known as the “baby blues” can bring mood swings, irritability, crying, insomnia, impatience and perceived vulnerability at any point in the first year of motherhood. But while these blues typically only last a few weeks, less easy to shake off is a postnatal mood disorder known as postpartum depression (PPD).
Now usually referred to as peripartum or perinatal depression, postpartum depression is a severe depressive disorder that can come with a new baby. Around one in seven women will experience this condition, which can severely impact the relationship between mother and baby, making diagnosis and treatment crucial.
Below, we’ve covered the signs of postpartum depression, as well as treatment options from postpartum depression medication to psychotherapy and more.
Several mental disorders can occur during pregnancy and the perinatal period (the initial weeks right before and after giving birth, although it can last up to a year), including postpartum depression.
In addition to postpartum depression, many women may experience anxiety disorders and other mental health issues. Our article on maternal depression covers all the mood disorders new moms and new parents might experience, including PPD.
There are three degrees of postpartum mood disorders: “baby blues,” postpartum depression (PPD) and postpartum psychosis.
But what is peripartum depression and how can you differentiate between PPD vs. baby blues? The main difference is that while postpartum blues typically consist of a mildly depressed mood and other depression symptoms, PPD symptoms are much more severe.
There’s also a difference between how long postpartum depression lasts and how long women will have the baby blues — the latter lasts a few weeks at most, while PPD can last much longer.
Postpartum depression signs are most often seen within six weeks after childbirth, and may last around six months for 25 to 50 percent of affected women. However, a National Institutes of Health (NIH) study has shown that, for some people, depression symptoms may be present three years after childbirth.
But what causes postpartum depression?
Any mother can develop this mood disorder, but certain factors may put some women at a higher risk than others.
While it’s uncertain how exactly they affect women, postpartum depression is thought to result from these risk factors:
Genetics. PDD may be an inherited disorder, caused by genes that may affect the production of the neurotransmitters — particularly, serotonin, dopamine and norepinephrine, which are all linked with depression.
Hormones. To be able to grow a whole human, the body has to undergo many drastic changes — such as an increase in reproductive hormones like progesterone, estrogen, prolactin and more. After delivery, a dramatic drop in hormone levels occurs, which can trigger postpartum depression.
Social factors. The risk of developing postpartum depression is higher in mothers who experience sexual, physical or verbal abuse in their homes, or if they have unsupportive partners or family members.
Lifestyle factors. Stressful life events, such as a recent death of a loved one or a family illness, can lead to an increased risk of postpartum depression.
Obstetric factors. Other factors that may increase the risk of postpartum depression include smoking during pregnancy, risky births that require hospitalizations or emergency surgery, health conditions during pregnancy and giving birth prematurely.
Psychological factors. If you have a personal or family history of depression, bipolar disorder, postpartum depression or premenstrual dysphoric disorder (PMDD), you’re at an increased risk of developing PDD.
Many postpartum depression symptoms are the same as symptoms of major depression, such as a persistent low mood that has been present for at least two weeks.
Look out for these signs of postpartum depression:
Trouble sleeping (insomnia)
Fatigue or loss of energy
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
Not only can these postpartum depression symptoms be distressing, but they can also hinder a mother from giving both herself and her child the attention they need.
This depressive disorder can be overwhelming. Fortunately, once you get a proper diagnosis, there are treatment options available, such as medication, psychotherapy and more.
If you’ve recently given birth and are experiencing any of the above symptoms of PPD, your healthcare provider may suggest that you undergo a postpartum depression screening. Many use the Edinburgh Postnatal Depression Scale to screen for postpartum depression.
From there, they may recommend one of the following postpartum depression treatments.
Also known as talk therapy, psychotherapy is one of the most effective ways to manage postpartum depression. One of several types of therapy, it’s especially useful as a first option for breastfeeding mothers who are worried about whether medication can be passed to their baby through breast milk.
Cognitive behavioral therapy can help you identify negative thoughts and how these thought patterns affect your well-being, as well as teach you how to change negative thoughts about yourself and your abilities as a parent.
Although it’s not technically a type of therapy, your doctor may also recommend that you join a support group of other mothers experiencing similar symptoms of postpartum depression.
Combined with therapy, antidepressants are an effective way to manage postpartum depression. Selective serotonin reuptake inhibitors (SSRIs) are usually the first line of medication, but if those fail to manage your symptoms, your doctor may recommend a selective norepinephrine reuptake inhibitor (SNRI) next.
A newer postpartum depression medication called brexanolone is also available. It was approved by the FDA (Food and Drug Administration) in 2019 specifically for this mood disorder.
There’s very little risk involved in using certain antidepressant medications when breastfeeding. Still, discussing your concerns with your OB/GYN or healthcare provider is always advisable before starting a new medication.
This is a non-invasive procedure that employs magnetic waves to stimulate nerve cells that are underperforming due to major depressive disorder. Although it sounds like something out of a sci-fi movie, transcranial magnetic stimulation (TMS) could be a safe alternative treatment if you’re worried about medication exposure for your newborn.
TMS requires repeated sessions several times a week to be effective and has proven to be well-tolerated, especially for those who don’t respond to antidepressant medication or therapy.
Another science fiction-sounding treatment, electroconvulsive therapy is recommended for severe cases of postpartum depression, such as when the mother contemplates suicidal thoughts or thoughts of harming her child.
This treatment involves sending targeted currents to certain parts of the brain to induce a seizure, which can provide relief from mental illness. Electroconvulsive therapy is a safe treatment method suitable for lactating mothers.
Having feelings of doubt and anxiety as a mother is normal, especially if you’re a first-time parent. But as one of the many mental disorders that can accompany pregnancy and childbirth, postpartum depression (PPD) is a serious mood disorder that can greatly impact not only your mental health but also your relationship with your child.
What is PPD? One of three types of postpartum mood disorders, postpartum depression has more severe symptoms and lasts longer than the typical baby blues or feelings of sadness and anxiety following childbirth.
Symptoms of PPD are very similar to those of depression, such as a persistent low mood, fatigue, loss of interest in activities, sleep issues, poor concentration and suicidal thoughts.
Postpartum depression treatments can include the use of antidepressant medications and psychotherapy, either separately or in combination, as well as alternative treatments like transcranial magnetic stimulation or electroconvulsive therapy.
While dealing with a serious mood disorder during what is supposed to be a happy time can be difficult, there are several treatments and postpartum depression resources available.
Mental health services and online therapy are both good places to start if you’re interested in working with a mental health professional to navigate the postpartum period. Or you can get connected with a licensed psychiatrist through our online psychiatry services.
There are also hotlines you can call, such as the Postpartum Support International HelpLine for both English and Spanish speakers and the 988 Suicide & Crisis Lifeline for depression and mental health crises.
Kristin Hall is a board-certified Family Nurse Practitioner with decades of experience in clinical practice and leadership.
She has an extensive background in Family Medicine as both a front-line healthcare provider and clinical leader through her work as a primary care provider, retail health clinician and as Principal Investigator with the NIH.
Certified through the American Nurses Credentialing Center, she brings her expertise in Family Medicine into your home by helping people improve their health and actively participate in their own healthcare.
Kristin is a St. Louis native and earned her master’s degree in Nursing from St. Louis University, and is also a member of the American Academy of Nurse Practitioners. You can find Kristin on LinkedIn for more information.
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