Postpartum depression

Postpartum depression

I just had a baby. Why do I feel so down?

If you're a brand-new mom who expected to be full of joy at this point, it can be upsetting and confusing when you're actually feeling the opposite. Rest assured, you're not alone: Anywhere from 40 to 80 percent of new mothers go through the baby blues – an emotional state of tearfulness, unhappiness, worry, self-doubt, and fatigue. The baby blues typically begin a few days after delivery and go away on their own in a week or two.

However, if your feelings seem unusually intense and last longer than two weeks straight, you may be wondering whether you have a more serious condition. This might come as a surprise, but you could have postpartum depression (PPD).

What is postpartum depression?

Sometimes it can be hard to tell the difference between clinical depression and the normal stress and exhaustion of new parenthood. But if your feelings of sadness or despair are so powerful that they prevent you from being able to do your daily tasks – such as caring for yourself and others – you could have PPD. 

About 10 percent of new mothers develop PPD, but some experts believe the number is even higher because many women don't seek treatment. If you're struggling, see your healthcare provider right away for a mental health screening.

According to the American Psychiatric Association, postpartum depression can begin in the weeks after pregnancy or even before. (About half of women with PPD have symptoms during pregnancy.)

If your provider thinks you have depression any time after you give birth, you may be referred to a counselor and prescribed antidepressant medication, if necessary, or referred to a psychiatrist for treatment. Whether you're diagnosed with depression before, during, or after pregnancy, getting treatment is important.

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What are the symptoms of postpartum depression?

The symptoms of PPD and depression that occurs before or during pregnancy are the same. You could have PPD if you experience five or more of the following symptoms almost every day, for most of the day, for at least two consecutive weeks:

  • Extreme sadness, emptiness, or hopelessness
  • Crying all the time
  • Loss of interest or lack of enjoyment in your usual activities and hobbies
  • Trouble falling sleep at night, or trouble staying awake during the day
  • Loss of appetite or eating too much, or unintentional weight loss or weight gain
  • Overwhelming feelings of worthlessness or overpowering guilt
  • Restlessness or sluggishness
  • Difficulty concentrating or making decisions
  • Feeling that life isn't worth living

Other possible signs you might be depressed include:

  • Being irritable or angry
  • Avoiding friends and family
  • Worrying excessively about your baby
  • Being uninterested in your baby, or unable to care for her
  • Feeling so exhausted that you're unable to get out of bed for hours

In rare cases, some women with PPD experience delusional thoughts or hallucinations and may harm their baby.

Note: If you have thoughts about hurting yourself or your baby, this is an urgent health matter. Contact your provider immediately.

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What causes depression after childbirth?

PPD results from a combination of hormonal, environmental, emotional, and genetic factors that are beyond your control. Some women might feel somehow responsible for having PPD, but depression doesn't happen because of something you did or didn't do.

You may also be more likely to have PPD if you had depression or anxiety during pregnancy, or if you had the baby blues after delivery. Other factors that contribute to the development of PPD include the physical exhaustion after giving birth, the emotional adjustment of becoming a parent, and sleep deprivation.

What's the difference between PPD and depression?

One difference is the timing: Depression is called PPD when it occurs during the period after childbirth. And unlike depression that's not related to pregnancy, PPD is linked to the unique hormonal changes that occur after childbirth. Researchers think that sudden changes in hormone levels after delivering a baby can trigger depression in women who are more sensitive to shifts in estrogen and progesterone.

How is postpartum depression treated?

The treatment for PPD is the same as the treatment for depression that happens before or during pregnancy. If you have mild symptoms, your provider may recommend watchful waiting with regular check-ins. If your symptoms are more severe, your provider may recommend talk therapy, antidepressant medication, or both.

Talk therapy, also called counseling or psychotherapy, can be one-on-one with your therapist or in a group setting with other women going through a similar experience. In family or couples therapy, a therapist works with you and your partner or relatives.

Antidepressants balance the brain chemicals that regulate your mood. Talk with your provider about the different types of antidepressants – some are combined for best results. You'll probably start to feel better after taking the medicine for three or four weeks.

Antidepressants can cause side effects, but most will resolve after a short time. If you experience side effects that interfere with your daily life, or if your depression gets worse, let your provider know right away.

Some women have very severe PPD that doesn't respond to talk therapy or medication. In this case, a healthcare provider may suggest electroconvulsive therapy (ECT). In this treatment, small electrical currents are passed through the brain while the patient is under general anesthesia. Experts believe this electrical stimulation causes chemical changes in the brain that relieve depression symptoms.

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Is it safe to take antidepressants while breastfeeding?

It is generally considered safe to take antidepressants while nursing. The medication does pass to your baby through breast milk, but the levels are very low.

Selective serotonin reuptake inhibitors (SSRIs) are considered the safest option and are frequently prescribed to breastfeeding women with depression. Other drugs for depression also appear to be safe, including serotonin norepinephrine reuptake inhibitors (SNRIs) and most tricyclic antidepressants (TCAs).

According to a few studies, the breastfed babies of moms who take antidepressants might be slightly more irritable or have some difficulty feeding or sleeping. However, the babies of moms with untreated depression can also have these same problems.

If you're wondering whether changes in your baby's eating, sleeping, or behavior might be caused by your medication, talk to your provider. (Continue taking your medication unless your provider tells you to stop.)

Why is it important to seek treatment?

Untreated depression can be lonely, confusing, and even scary if your condition gets worse. The good news is that it's very treatable, so you don't have to feel this way.

Treatment provides the support you need to keep you from slipping into a deep depression that's harder to get out of. Also, having a therapist and health care provider who understand your condition can help you feel less alone. And feeling better means you can bond more easily with your baby and be able to take better care of her.

If your provider has recommended watchful waiting, it's important to continue seeing her for regular appointments while you're experiencing symptoms, so you can begin talk therapy or medication if you start to feel worse.

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How do I cope with postpartum depression?

In addition to getting professional help, here are some ways to take care of yourself when you're dealing with PPD:

Be good to yourself

Make sure your own basic needs are met: Try to sleep and eat well, and do your best not to feel guilty. Having PPD doesn't mean you're a bad mother or don't love your child. After you begin treatment, these feelings of guilt and despair should start to fade.

Don't demand too much of yourself

If you have clinical depression or anxiety, it can be hard enough just to get out of bed and face the day. Be gentle with yourself, and take things one at a time.

Ask for support

Part of being a good mother is knowing when to ask for help, so don't be afraid to ask for it during this difficult time. Let your partner know about different ways to help, whether it's taking care of the baby, handling chores, or going with you to doctor appointments. Relatives or close friends may be able to help as well.

Share your feelings

Keep the lines of communication open with your partner and talk about what's going on. Call a sympathetic friend. Join a mothers' group or a PPD support group, or chat with moms about postpartum depression in the BabyCenter Community. You may be surprised by how many women are experiencing similar feelings.

Pamper yourself

Taking care of your physical self can sometimes help you feel better inside. Have your partner or a friend watch your baby so you can take a shower or a relaxing bath. Put on makeup if you usually wear it. Go on a shopping trip just for yourself and buy something new for your post-baby wardrobe. Wear a favorite outfit on especially difficult days to give yourself a boost.

Get some rest

The rigors of caring for a newborn 24/7 can leave you exhausted. Unfortunately, moms with postpartum mood conditions often can't sleep when they want to. But it's still important to take breaks to rest, even if you just read a magazine or watch TV. Taking 10-minute naps is helpful too. Consider hiring a postpartum doula or a sitter experienced with newborns, or asking a relative or friend to watch your baby for an hour or so each day.

Slow down

Resist the temptation to do the laundry or other chores while your baby sleeps – the housework can wait. Have food delivered, or ask your partner to pick up takeout on the way home. Resist the urge to check your email or phone, and relax with a book and a cup of chamomile tea instead. If you're on maternity leave, don't stress about all the work waiting for you at the office – you'll get back on track soon enough.

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