Could This Be Postpartum Depression?

Dr. LeeshaMD, MPH

What to Know

Childbirth brings an array of emotions. Moms and families expect positive emotions like excitement and joy as well as exhaustion and even some worry, but negative emotions are quite common. Almost 80% of moms experience the baby blues. Between demanding feeding schedules, frequent diaper changes, and erratic sleep, most moms will have mood swings, irritability, feelings of being overwhelmed, crying spells, fatigue, and insomnia within the first two to three days after delivery. However, the baby blues typically resolve on its own in one to two weeks.

 Sometimes, those symptoms linger and worsen which is what happens with Postpartum Depression or PPD. Postpartum Depression is a serious medical condition. According to the Centers for Disease Control and Prevention, PPD affects as many as 1 in 8 women after childbirth. Symptoms can begin as early as a few weeks following birth up to a year later. Symptoms of PPD are more severe than those seen with the baby blues and may include:

  • Severe mood swings
  • Feelings of sadness, worry, or irritability
  • Loss of interest in activities that are normally enjoyable
  • Crying for no reason
  • Difficulty concentrating and making decisions
  • Trouble sleeping or sleeping too much
  • Loss of appetite or eating too much
  • Finding it hard to bond with your baby
  • Feeling hopeless and worthless
  • Believing that you are a bad mom
  • Withdrawing from family and friends
  • Thoughts of harming yourself or wanting to die
  • Thoughts of harming your baby

Women who have experienced miscarriages or stillbirths can also experience Postpartum Depression. Per the CDC, about 10% of new dads can develop PPD as well.

There is an exceedingly rare subtype of Postpartum Depression known as Postpartum Psychosis that is considered a medical emergency. The meaning of psychosis is to be out of touch with reality. Symptoms of Postpartum Psychosis include confusion, paranoia, hearing voices, strange beliefs that are untrue called delusions, agitation, poor sleep, and obsessive thoughts about the health and safety of your baby. These symptoms usually appear early within the first few weeks after a baby’s birth. Moms with Postpartum Psychosis are more likely to be diagnosed with Bipolar Disorder rather than Major Depression. Because moms with Postpartum Psychosis may have thoughts of harming herself or her baby, this condition is a life-threatening illness that requires immediate treatment.

There is no one cause to explain why moms experience Postpartum Depression. What we do know is that PPD develops in the context of multiple factors, both emotional and physical. Hormone levels rapidly decrease after childbirth which can lead to mood swings. Also, new moms are often tired and sleep-deprived and benefit from support from significant others as well as family and friends though these social supports are not always readily available. We also know that, while PPD affects all kinds of moms irrespective of race, socioeconomic status, educational level, or number of births, there are some significant risk factors worth mentioning. Some common risk factors include: history of depression associated with a previous pregnancy; pregnancy complications such as premature birth or having a baby with medical problems; lack of social support; young maternal age; ambivalent feelings about the pregnancy; and psychosocial stressors during pregnancy such as job loss, financial limitations, involved in an abusive relationship, and if mom has her own health problems.

What to Do: 6 Steps to Help Moms and Families Understand and Address PPD

  1. Understand that Postpartum Depression is not your fault. This doesn’t mean that you did something wrong or that you caused this. You are not weak. You are not a failure. It is a common outcome associated with childbirth like C-sections and other pregnancy and childbirth complications.
  2. Talk to a trusted friend or your significant other. Don’t go through this motherhood journey alone. Use your support system (friend, family, significant other) or find a support system like a local support group for new moms. You don’t have to do this alone.
  3. Learn to recognize symptoms of PPD. Up to 50% of moms with postpartum depression do not get diagnosed. Sometimes moms do not recognize their symptoms. Other times they may worry about telling their family or health care provider about their symptoms out of fear of being labeled a bad mom or that such disclosure could cause them to lose custody of their children. But symptoms of PPD don’t get better on their own and often worsen without appropriate treatment.
  4. Get professional help. Talk to your health care provider. Sometimes, your Obstetrician may screen for postpartum depression during your follow up visits. If he or she doesn’t, tell them about it. Or you can contact your primary care provider or inform your children’s pediatrician. The point is to get help. You can’t take care of your baby if you don’t take care of your health and well-being, too. It’s okay to ask for help. You are worth it.
  5. Call 911 if you have thoughts of harming yourself, harming your baby, or are feeling out of touch with reality (psychosis). Moms and families can also call 1-800-273-8255 which is the National Suicide Prevention Lifeline.
  6. Treatment options include therapy and medications like antidepressants. It is best to talk to your doctor about what treatment measures are best for you which depends on the severity of your symptoms and whether you are breastfeeding. In 2019, the FDA approved Zulresso, also known as Brexanaolone, a medication designed specifically to treat moderate to severe postpartum depression. Because of the cost and can only be administered under medical supervision, Zulresso has limited use at this time.

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