What Is It?

Postpartum refers to the period immediately after childbirth. Symptoms of depression that occur during this period are known as postpartum depression. Other symptoms of mood disorder such as sleeplessness, irritability and anxiety, also can occur.

Postpartum depression is not the same as the “baby blues,” a much more common condition that affects as many as three-quarters of new mothers. Because of hormonal changes that occur in the weeks after delivery, new moms often are emotionally sensitive and tend to cry easily. The baby blues is not a serious problem and it almost always goes away within a few weeks.

Postpartum depression is a different matter. It may begin at any time in the first two to three months after giving birth. The mother feels sad or hopeless and sometimes guilty or worthless. She is unable to concentrate, and unable to take any interest in anything, even the baby. In some cases, the mother may feel overwhelmed by the baby’s needs and become intensely anxious. This may lead to persistent troubling thoughts or obsessions about the baby’s well-being and compulsive repetitive actions, such as checking on the baby constantly or phoning the pediatrician repeatedly to ask questions.

In a rare form of this disorder, which occurs once in a thousand births, the mother becomes psychotic, that is, she is unable to recognize reality. This condition sometimes is called postpartum psychosis. The mother may have hallucinations (altered perceptions, like hearing or smelling things that are not there) or delusions (false beliefs, such as the idea that her baby is possessed by the devil). This condition is extremely dangerous for both the mother and the baby, and once it has happened, it is highly likely to recur if the mother has another child.

Postpartum depression affects about one in 10 new mothers. A woman is at greater risk if she has:

• A previous history of depression, including depression during pregnancy
• A troubled marriage
• Very few supportive family members or friends
• Difficulty caring for her new infant, especially if the child has serious medical problems

Teen-age mothers, especially those who are poor ones, have a particularly high risk of postpartum depression.

Fewer than half of women with postpartum depression seek treatment for the problem. Some new mothers are unaware that postpartum depression is a real, treatable illness. Others believe that they are expected to feel happy at this time, and are so embarrassed about their symptoms that they do not ask for help.

A woman with postpartum depression can have any of the following symptoms:

• Feeling depressed, with tearfulness or crying spells
• Feeling anxious, sometimes with obsessions and compulsions, often about the baby’s welfare or about being able to carry out responsibilities as a mother
• Feeling hopeless, worthless or guilty
• Feeling irritable or burdened
• Losing interest or pleasure in all activities, including pleasure in being a mother
• Changes in appetite (either overeating or not eating enough)
• Sleep problems (for example, difficulty falling asleep or waking especially early)
• Appearing slowed or agitated
• Extreme exhaustion beyond the normal fatigue caused by caring for a newborn
• Poor concentration or indecisiveness
• Persistent thoughts about death, including suicide
• Difficulty caring for the baby

These symptoms may develop in the first days after birth or as late as three months later.

Primary-care doctors often screen for postpartum depression by asking questions about the mother’s quality of life. If you are a new mother, your doctor may ask about your emotions, your sleep and your appetite. If your primary-care doctor or obstetrician/gynecologist believes you have symptoms of postpartum depression, and these symptoms have lasted for several weeks without improvement, he or she may offer you an antidepressant or refer you to a psychiatrist. An evaluation by a psychiatrist includes questions about what you’re feeling and thinking, and how you are managing your day-to-day life. If your doctor is concerned that some of your symptoms may be caused by a medical illness, he or she may order blood tests to check for such conditions as anemia or an underactive thyroid.

Usually, symptoms of postpartum depression last for a few weeks before the condition is diagnosed. Without treatment, symptoms can last for months. With treatment, most women feel better within a few weeks.

If you are pregnant, you may be able to decrease your risk of postpartum depression by preparing yourself before the birth for the changes in lifestyle that motherhood will bring. Talk to other mothers and to your doctor about what it’s like to care for an infant. Clear your work schedule and social commitments for the postpartum period to allow yourself plenty of hassle-free time with your newborn. Also, don’t hesitate to ask for help from your partner and others who care about you.

Often, postpartum depression is difficult to combat without antidepressant treatment. If you have a previous history of depression or postpartum depression, you should talk with your doctor before the birth about the possibility of starting antidepressant medication soon after your baby is born.

As with other types of depression, a combination of psychotherapy and medication is most helpful. If a mother is exhibiting signs of psychosis, she needs immediate medical attention.

The most commonly prescribed antidepressants are in the group known as selective serotonin reuptake inhibitors (SSRIs). They include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and citalopram (Celexa). If you are breast-feeding, an important concern is the possibility of passing medication to the newborn. Fortunately, most antidepressants pass to milk in low concentrations and are unlikely to have much effect on the baby. The best approach is to discuss the choices with your doctors to assess the risks and the benefits in your situation.

A number of psychotherapy techniques may be helpful depending on the factors at the root of your depression, such as stresses, the quality of family or other social support, and personal preference. Education about depression and support is important for every woman with postpartum depression. Various types of psychological therapy are available. Cognitive behavioral therapy is designed to examine and to help correct faulty, self-critical thought patterns. Psychodynamic, insight-oriented or interpersonal psychotherapy can help a person sort out conflicts in important relationships or explore past events or issues that may have contributed to the symptoms. Couples therapy can help the mother and father together figure out how to manage possible areas of disagreement or how best to organize child care and muster support.

You may begin to feel relief right after starting treatment, but it usually takes at least two to six weeks before a clear improvement can be seen. You may need to try a few different approaches to psychotherapy or medication before you find the most helpful method of help. Persistence is extremely important.

If you are a new mother, contact your doctor if you develop any symptoms of postpartum depression, especially anxiety, feelings of intense sadness or hopelessness, or difficulty sleeping. Call your doctor immediately if you have thoughts about harming yourself or the baby, or if you feel that you can no longer cope with caring for your new baby.

Since most mothers with postpartum depression recover completely, the prognosis is excellent. This is especially true if the illness is diagnosed and treated early. About 50 percent of women who recover from postpartum depression develop the illness again after future pregnancies. To decrease this risk, some doctors suggest that women with a history of postpartum depression should start antidepressants immediately after the baby is delivered, before they have a chance to sink into depression.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.