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Depression is a common problem during and after pregnancy. About 13 percent of pregnant women and new mothers have depression. Most new mothers experience the "baby blues" after delivery (4 out of 5, or 50%-80%). This may include sadness, crying, anxiety, feeling overwhelmed, irritability, loss of joy, etc., but it only lasts a couple of weeks and usually passes on it's own.
About one out of every 10 of these women will develop a more severe and longer-lasting depression after delivery. One in 1,000 women develops a more serious condition called postpartum psychosis.
Postpartum Depression (PPD) is a complex mix of physical, emotional, and behavioral changes that happen in a woman after giving birth. PPD is a form of Major Depression that has its onset within four weeks after delivery. The diagnosis of postpartum depression is based not only on the length of time between delivery and onset, but also on the severity of the depression.
Symptoms of postpartum depression are similar to what happens normally following childbirth. They include lack of sleep, appetite changes, excessive fatigue, decreased libido, and frequent mood changes. However, these are also accompanied by the symptoms of major depression -- depressed mood; loss of pleasure; feelings of worthlessness, hopelessness, and helplessness; and thoughts of death or suicide.
There is no single cause. Rather, pregnancy and postpartum depression likely result from a combination of factors:
Depression is a mental illness that tends to run in families. Women with a family history of depression are more likely to have depression.
Changes in brain chemistry or structure are believed to play a big role in depression.
Stressful life events, such as the birth of a baby, death of a loved one, caring for an aging family member, abuse, and poverty, can trigger depression.
Hormonal factors unique to women may contribute to depression in some women. We know that hormones directly affect the brain chemistry that controls emotions and mood. We also know that women are at greater risk of depression at certain times in their lives, such as puberty, during and after pregnancy, and during perimenopause. Some women also have depressive symptoms right before their period.
So hormonal changes may trigger symptoms of postpartum depression. When you are pregnant, levels of the female hormones estrogen and progesterone increases greatly. In the first 24 hours after childbirth, hormone levels quickly return to normal. Researchers think the big change in hormone levels may lead to depression. This is much like the way smaller hormone changes can affect a woman’s moods before she gets her period.
Levels of thyroid hormones may also drop after giving birth. The thyroid is a small gland in the neck that helps regulate how your body uses and stores energy from food. Low levels of thyroid hormones can cause symptoms of depression. A simple blood test can tell if this condition is causing your symptoms. If so, your doctor can prescribe thyroid medicine.
Other factors may play a role in postpartum depression. You may feel:
tired after delivery
tired from a lack of sleep or broken sleep
overwhelmed with a new baby
doubts about your ability to be a good mother
stress from changes in work and home routines
an unrealistic need to be perfect mom
loss of who you were before having the baby
less attractive
a lack of free time
stress between you and your spouse/partner family or co-parent
intrusion or criticism from in-laws or others
guilt about spending time with the baby if you have older children
isolation from friends and co-workers
Certain factors may increase your risk of depression during and after pregnancy:
a personal history of depression or another mental illness
a family history of depression or another mental illness
a lack of support from family and friends
anxiety or negative feelings about the pregnancy
problems with a previous pregnancy or birth
marriage or money problems
stressful life events
young age
substance abuse
Women who are depressed during pregnancy have a greater risk of depression after giving birth.
If you take medicine for depression, stopping your medicine when you become pregnant can cause your depression to come back. Do not stop any prescribed medicines without first talking to your doctor. Not using medicine that you need may be harmful to you or your baby.
What is the difference between “baby blues,” postpartum depression, and postpartum psychosis?
The "baby blues," which occur in most women in the days right after childbirth and are considered more or less normal. A new mother has sudden mood swings, such as feeling very happy and then feeling very sad. She may cry for no reason and can feel impatient, irritable, restless, anxious, lonely, and sad. She may lose her appetite or have trouble sleeping. The baby blues may last only a few hours or as long as one to two weeks after delivery. The baby blues do not usually require treatment from a health care provider. Often, joining a support group of new moms or talking with other moms.
Postpartum depression (PPD) can happen a few days or even months after childbirth. PPD can happen after the birth of any child, not just the first child. A woman can have feelings similar to the baby blues -- sadness, despair, anxiety, irritability -- but she feels them much more strongly than she would with the baby blues. She can also have thoughts of hurting the baby or herself, feel no attachment to the baby, or have thoughts or images of the baby being in danger.
PPD often keeps a woman from doing the things she needs to do every day. When a woman's ability to function is affected, she needs to see her health care provider. If a woman does not get treatment for PPD, symptoms can get worse and last for as long as one year. While PPD is a serious condition, it can be treated with medication and counseling.
Postpartum psychosis is a very serious mental illness, though rare. It occurs in about 1 to 4 out of every 1,000 births. It usually begins in the first 2 weeks after childbirth. Women who have bipolar disorder or another mental health problem called schizoaffective disorder have a higher risk for postpartum psychosis. This illness can happen quickly, often within the first three months after childbirth. Women can lose touch with reality, having auditory hallucinations (hearing things that aren't actually happening, like a person talking) and delusions (strongly believing things that are clearly irrational). Visual hallucinations (seeing things that aren't there) are less common. Other symptoms include insomnia (not being able to sleep), feeling agitated (unsettled) and angry, and strange feelings and behaviors. Women who have postpartum psychosis need treatment right away and almost always need medication. Sometimes women are put into the hospital because they are at risk for hurting themselves or someone else.
The baby blues most often go away within a couple of weeks. If they don't, you may have postpartum depression. Seeing a psychotherapist (and possibly a medical doctor too) for an evaluation of what you need is important.
What should I do if I have symptoms of depression during or after pregnancy?
Call a psychotherapist who specializes in treating depression if:
your baby blues don’t go away after 2 weeks
symptoms of depression get more and more intense
strong feelings of sadness or anger come on 1 or 2 months after delivery
it is hard for you to performs tasks at work or at home
you cannot care for yourself or your baby
you have thoughts of harming yourself or your baby
feeling extremely anxious, scared, and panicked most of the day.
Some women don’t tell anyone about their symptoms. They feel embarrassed, ashamed, or guilty about feeling depressed when they are supposed to be happy. They worry they will be viewed as unfit parents.
Any woman may become depressed during pregnancy or after having a baby. It doesn’t mean you are a bad or “not together” mom. You and your baby don’t have to suffer. There is help.
Here are some tips that have helped other mothers:
Rest as much as you can. Sleep when the baby is sleeping.
Don’t try to do too much or try to be perfect.
Ask your partner, family, and friends for help.
Make time to go out, visit friends, or spend time alone with your partner.
Discuss your feelings with your partner, family, and friends.
Talk with other mothers so you can learn from their experiences.
Join a support group. Ask your doctor about groups in your area.
Don’t make any major life changes during pregnancy or right after giving birth. Major changes can cause unneeded stress. Sometimes big changes can’t be avoided. When that happens, try to arrange support and help in your new situation ahead of time.
Eat plenty of protein at every meal and avoid sugar, especially eaten without protein. Also avoid artificial flavoring, coloring and preservatives.
Drink a cup of water (no substitutes) every waking hour (if breastfeeding).
How is depression treated?
The good news is postpartum depression can be treated with medication, which can help relieve symptoms of depression and counseling to resolve the non-chemical sources of the depression.
If you are depressed, your depression can affect your baby. Getting treatment is important for you and your baby. If you want to consider taking medication, talk with your doctor about the benefits and risks of taking medicine to treat depression when you are pregnant or breastfeeding.
What can happen if depression is not treated?
Untreated depression can hurt you and your baby. Some women with depression have a hard time caring for themselves during pregnancy. They may:
eat poorly
not gain enough weight
have trouble sleeping
miss prenatal visits
not follow medical instructions
use harmful substances, like tobacco, alcohol, or illegal drugs
Depression during pregnancy can raise the risk of:
problems during pregnancy or delivery
premature birth
having a low-birth-weight baby
Untreated postpartum depression can affect your ability to parent. You may:
lack energy
have trouble focusing
feel moody
not be able to meet your child’s needs
As a result, you may feel guilty and lose confidence in yourself as a mother. These feelings can make your depression worse.
Researchers believe postpartum depression in a mother can affect her baby. It can cause the baby to have:
delays in language development
problems with mother-child bonding
behavior problems
increased crying
It helps if your partner or another caregiver can help meet the baby’s needs while you are depressed.
All children deserve the chance to have a healthy mom. And all moms deserve the chance to enjoy their life and their children. If you are feeling depressed during pregnancy or after having a baby, don’t suffer alone. Please tell a loved one and call your doctor or counselor/therapist right away.
If you are experiencing postpartum blues, or depression, please get support. You may need physical support to get more sleep and to take better care of yourself, and you may also need emotional support. You may be able to find a group of women going through what you are, and that might be the best choice for you. Postpartum depression is especially painful, and potentially dangerous, because it can include feelings of anger or numbness toward the baby. Since most women find these feelings to be unforgivable, they don’t want to admit to them, and then don’t get the help they need. Women who have a history of depression have a very good chance of getting postpartum depression. If this is you, please get help now! Ignoring these depressed thoughts and feelings can be dangerous to you, the baby, and your family.
If you want to speak to a therapist about this, call me or write to me so we can figure out together what will bring you relief as quickly as possible.
