Postpartum depression (PPD)

What is postpartum depression?

Postpartum depression (PPD) is a common and treatable maternal mental health disorder that affects moms after the birth of their baby. Hormone fluctuations and major life changes make it very normal to feel down after you give birth, but PPD is more than just the baby blues. Postpartum depression involves extreme sadness and anxiety, along with a loss of energy, changes in eating patterns, difficulty sleeping, and a lack of connection with your baby.

Postpartum baby blues, which nearly 80 percent of moms experience in the first few weeks after delivery, tend to fade away. PPD stays with you longer, and your sadness and anxiety gets more intense and pervasive.

The difference between PPD and "regular" depression is the timing: Postpartum depression typically occurs during the first year after your baby is born, and it's linked to the unique hormonal changes that occur after childbirth. PPD can begin in the days, weeks, or months after pregnancy – some new moms may even begin to experience depression during pregnancy.

One important thing to remember: Postpartum depression has nothing to do with your fitness as a parent. Even so, it's normal for women with PPD to feel a sense of failure, guilt, or shame – and these emotions often prevent them from seeking help.

Many women with postpartum depression have thoughts like:

• "I'm a bad mother."
• "I feel guilty because I'm supposed to be happy."
• "I should be able to control how I feel."
• "I'm ashamed that I don't feel happy."
• "I'm not bonding with my baby, so I'm probably not meant to be a mom."

You're not a bad mom if you feel this way, and nothing you've done has caused this. PPD is a common – and treatable – condition that affects both first-time moms those with other children.

PPD is just one of a few postpartum mood and anxiety disorders that can affect new moms. Up to one in four women develops one of these disorders within the first six months of delivering.

• Postpartum anxiety, which involves excess worry about everyday events.
• Postpartum panic disorder (PD), which produces intense bouts of fear.
• Postpartum obsessive-compulsive disorder (OCD), which leads to performing persistent, repetitive behaviors (like repeatedly locking the front door) in response to intrusive worries about harm coming to your baby.
• Postpartum posttraumatic stress disorder (PTSD), which involves feelings of extreme anxiety, panic attacks, and flashbacks following a traumatic childbirth.
• Postpartum rage, which involves intense anger at your children, partner, or yourself.
• Postpartum psychosis, which is a very rare but extreme mood disorder that leads to confusion, hallucinations or delusions, and a high risk of causing harm to your baby. It requires immediate medical treatment.

If you're struggling with feelings of persistent sadness or other worrying symptoms, reach out to your healthcare provider right away so they can help you get support.

How common is postpartum depression?

It's very common: An estimated 1 in 8 moms develop PPD, according to the CDC. Many experts believe this number is even higher because so many women don't seek treatment, or dismiss their concerns as the baby blues or the normal stressors of being a new mom.

The risk is even higher for new moms of color: Around 1 in 5 Black, Native American, and Asian women may experience symptoms of postpartum depression. Experts connect these disparities to the obstacles that women of color face regarding maternal mental health, including a greater stigma surrounding mental illness and a distrust of the healthcare system. Postpartum depression is also more prevalent in transgender men who keep their reproductive organs and give birth.

What are the symptoms of postpartum depression?

Many of the most common postpartum depression symptoms look the same as regular depression symptoms.

You may have postpartum depression if you experience any of these symptoms almost every day:

• 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
• Severe mood swings
• Difficulty bonding with your baby
• Severe anxiety
• Thoughts of harming yourself or your baby

Other possible signs you might be depressed include:

• Being extremely irritable or angry
• Avoiding friends and family
• Worrying excessively about your baby
• Worrying that you're not a good parent
• Being uninterested in your baby, or unable to care for them
• Feeling so much postpartum fatigue that you're unable to get out of bed for hours

If you think you might have PPD, this postpartum depression screening can help you self-assess. It's similar to what your provider uses to screen you for depression at your postpartum checkups. It doesn't take the place of a medical visit, but it might help you decide to reach out.

What causes postpartum depression?

Postpartum depression stems from a combination of hormonal, environmental, and genetic factors that are all beyond your control. There's nothing you do or don't do that causes PPD.

When you're pregnant, your estrogen and progesterone levels skyrocket. Within a day of giving birth, these hormones drop to pre-pregnancy levels. That sudden shift – similar to the hormonal swings you might feel before your period but magnified – play a role in PPD developing.

For some women, a drop in your thyroid hormone levels – which also happens after giving birth – can cause postpartum thyroiditis, with symptoms similar to those of depression. This condition usually shows up four to 12 months after delivery. Your provider can do a blood test to tell if your thyroid is causing your symptoms and prescribe thyroid medicine if necessary. It's helpful to let your provider know if thyroid disease runs in your family.

Other factors that contribute to the development of PPD include physical exhaustion after giving birth, sleep deprivation, and the emotional roller coaster of becoming a parent.

How long does postpartum depression last?

This varies from mom to mom. The timetable depends on many factors, including:

• When your symptoms start
• How severe symptoms are
• Whether you've had clinical depression before
• How soon you get a diagnosis and treatment

Some women respond quickly to treatment for postpartum depression, while other women continue to struggle with symptoms for months or more than a year after giving birth. Women with untreated PPD may have chronic depression for even longer.

The best way to ensure you recover from postpartum depression quickly is to be evaluated by a mental health professional and start on a treatment plan as soon as possible.

What are the risk factors for postpartum depression?

Every new mom is at risk for PPD, but some women have a higher risk because of:

• A history of past depression. Women who have been depressed in the past are more than 20 times more likely to experience PPD.
• Depression or anxiety during pregnancy
• Stressful life events during pregnancy or soon after giving birth
• A traumatic childbirth experience
• Preterm labor and birth
• Having a baby in neonatal intensive care (NICU)
• Lack of support from family and friends
• Relationship problems
• Breastfeeding problems
• Unresolved childhood trauma

Other risk factors include:

• An unplanned or unwanted pregnancy
• A baby born with birth defects or other medical problems
• Multiple babies (such as twins or triplets)
• A family history of psychiatric problems
• Being a single parent
• Money problems or unemployment
• Domestic violence
• Unemployment
• Pregnancy complications
• Pregestational or gestational diabetes

Remember that these risk factors don't actually cause PPD. Many women with multiple risk factors will never experience clinical depression or anxiety, while others with just one risk factor (or even none) end up with a diagnosis of postpartum depression.

Is postpartum depression in men possible?

Yes. Dads and partners can experience PPD, too. Up to 10 percent of new dads have symptoms of depression, most often in the first three to six months after their baby's birth.

A father also goes through some hormonal changes during his partner's pregnancy. For one, testosterone levels drop to help dads bond with their newborn. Those hormones can lead to PPD symptoms occurring. Additionally, the lack of sleep new parents get in those first few months can make depression symptoms worse.

The partners at highest risk for depression are those with:

• A history of depression
• Financial or marriage difficulties
• Other children
• A female partner with depression
• An unplanned pregnancy

Postpartum depression in fathers looks a bit different than it does in mothers. In addition to the typical symptoms, fathers may experience irritability, indecisiveness, and a lack of emotion.

Because depression can affect any new parent's ability to bond with and care for their baby, it's not just moms who need help for postpartum depression. Dads and other partners can also benefit from being screened and potentially treated by a mental healthcare provider.

What is the treatment for postpartum depression?

Postpartum depression treatment is the same as treatment for depression that happens before or during pregnancy. The most common treatments are talk therapy, antidepressant medication, or both, depending on your symptoms. While you may feel embarrassed, remember that seeing a therapist or a psychiatrist or taking medication doesn't make you weak. It shows that you're willing to do what's necessary to keep you and your baby healthy.

Talk therapy

Also called counseling or psychotherapy, talk therapy can take place one-on-one with a mental health therapist or in a group setting with other women who are going through a similar experience. In couples or family therapy, a therapist works with you and your partner or relatives. Cognitive behavioral therapy (CBT) is a type of therapy that helps you recognize and change the unhealthy thoughts that are making you unhappy.

Antidepressant medication

Prescription medications can help balance the brain chemicals that regulate your mood. Different types of antidepressants work in different ways – sometimes they're combined to improve results.

While small amounts of antidepressant medication do pass through your breast milk, most selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are considered a safe option for breastfeeding women with depression. Monoamine oxidase inhibitors (MAOIs) and bupropion (Wellbutrin) are riskier.

A newer medication called brexanolone (Zulresso) is the first drug to be approved specifically for postpartum depression. Because this medicine comes as an IV that you receive over a period of two-and-a-half days, you'll need to visit a medical clinic or hospital. Though it starts to work quickly, within a couple of days, Zulresso may not be safe to take while you're breastfeeding. If you're breastfeeding, your provider can help you find an antidepressant that's safe for your baby.

Antidepressants take time to work: You may need to take one for six to eight weeks before you see improvement. The response to different antidepressants can vary from person to person, so don't be discouraged if there's some trial and error before finding the right medication and dose.

Antidepressants can cause side effects, but most resolve after a short time. If you experience side effects that interfere with your daily life, your depression gets worse, or you think your medication is affecting your baby, let your healthcare provider know right away. Stopping the medication on your own could cause your depression symptoms to return.

For more details on specific medications, learn more about medication while breastfeeding.

Practicing self-care

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

• Be kind 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 that you're a bad mom or that you don't love your child. After you begin treatment, these feelings should start to fade.
• Don't demand too much of yourself. If you have depression or anxiety, it can be hard enough just to get out of bed and face the day. Be gentle, and take things one step at a time.
• Ask for support. Part of being a good mom 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 they can help, whether it's taking care of the baby, handling chores, or going with you to medical 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.
• Dress the part. Getting cleaned up on the outside can sometimes help you feel better inside. Have your partner or a friend watch your baby so you can take a shower or bath. If you're able, buy some non-maternity clothes that make you feel good to boost your spirits.
• 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. Take breaks to rest, even if you just read or watch videos. Taking 10- to 20-minute naps is helpful too. If doable, consider hiring a postpartum doula or a babysitter experienced with newborns, or ask a relative or friend to watch your baby for an hour or so. Note: Always put your baby on a safe sleep surface (such as their crib or bassinet) before you settle down to rest. Nodding off with your baby in your arms while on a couch or adult bed is a risk factor for sudden infant death syndrome (SIDS) and other types of sleep-related risks.
• Go outside. Postpartum exercise, even in its most simple form, can help you feel better. Put your baby in a stroller and take a walk around the block, or meet a friend at a nearby cafe. If even a brief excursion is too much for you right now, then just go outside, close your eyes, and take some deep breaths. Or sit in the sunshine for a few minutes.
• Slow down. Don't feel like you have to do chores while your baby sleeps – housework can wait. Instead of checking social media, try listening to music or an audiobook, or use a meditation app. If you're on maternity leave, don't stress about the work waiting for you at the office – you'll get back on track soon enough.

Research indicates that transcranial magnetic stimulation (TMS), a noninvasive brain stimulation technique, may be effective for women with postpartum depression who haven't found help from medication. Magnetic fields (similar to those used in MRIs) are used to target areas of the brain that are related to depression. TMS does require daily treatments, so it may not be convenient for some new moms, but it seems to be safe.

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

How do I get help for postpartum depression?

If you're struggling with feelings of persistent sadness or other symptoms of postpartum depression, it's important to reach out to your healthcare provider right away so that you can get help. They'll do a postpartum mood screening and refer you to a mental health professional for further evaluation and treatment, if needed.

There's no shame in asking for what you need, and you are far from alone. Untreated depression can be lonely, confusing, and even scary. Getting help and starting to feel better can spark or rekindle the joy of motherhood. Treatment provides an opportunity to understand what's causing your depression, as well as give you the support you need to recover.

It's also important to get treated for your baby's sake. Having a mother who has untreated postpartum depression is linked to a variety of potential social, emotional, and behavioral problems for children, as well as possible language and learning delays.

Here are some other resources that can help:

• Coordinators at Postpartum Support InternationalOpens a new window provide free, confidential advice and support, facts about PPD, and help finding local resources, such as therapists and support groups. Their support line – 1-800-944-4773 – is available 24/7.
• Postpartum ProgressOpens a new window provides in-depth information and support for pregnant and new moms with mental health conditions.
• The Black Virtual Wellness DirectoryOpens a new window can connect you with mental health specialists who have specific experience working with Black women.
• Some hospitals have perinatal mood clinics for new moms staffed with trained mental health professionals familiar with postpartum depression.
   

  Important

  If you're ever thinking about harming yourself or your baby, call or text the National Suicide Prevention LifelineOpens a new window at 988 immediately for free, confidential support.

It's very rare that a baby will be taken away from a mother who's struggling with postpartum depression, but this fear prevents many moms with PPD from seeking help. There is the possibility that you might be hospitalized for treatment if your depression is severe or you're thinking of hurting yourself or your baby. This doesn't mean you're unfit to care for your child. It means that you care enough about your family to get help.