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Women who have had depression are more likely to develop postpartum depression.
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Women feel extremely sad, cry, become irritable and moody, and may lose interest in daily activities and the baby.
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Women should see their doctor if they continue to feel sad and have difficulty doing their usual activities for more than 2 weeks after delivery or if they have thoughts about harming themselves or the baby.
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A combination of psychotherapy and antidepressants is recommended for women with postpartum depression.
The baby blues—feeling sad or miserable within 3 days of delivery—is common after delivery. Women should not be overly concerned about these feelings because they usually disappear within 2 weeks.
Postpartum depression is a more serious mood change. It lasts for weeks or months and interferes with daily activities. About 10 to 15% of women are affected. Very rarely, an even more severe disorder called postpartum psychosis develops.
Causes
The causes of sadness or depression after delivery are unclear, but the following may contribute or increase the risk:
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Baby blues
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Depression that was present before or developed during pregnancy
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Postpartum depression in a previous pregnancy
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Previous episodes of sadness or depression that occurred during certain times of the month (related to the menstrual cycle) or while taking oral contraceptives
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Close relatives who have depression (family history)
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Stresses such as having marital problems, having an unemployed partner, having financial difficulties, or having no partner)
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Lack of support from a partner or family members
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Problems related to the pregnancy (such as a preterm delivery or a baby with birth defects)
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Ambivalence about the current pregnancy (for example, because it was unplanned or the woman considered ending the pregnancy)
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Problems with breastfeeding
The sudden decrease in levels of hormones (such as estrogen, progesterone, and thyroid hormones) that occurs after delivery and lack of sleep may contribute to developing postpartum depression. Also, a gene that makes a woman more susceptible to postpartum depression may be involved.
If women have had depression before they became pregnant, they should tell their doctor or midwife. Such depression often evolves into postpartum depression. Depression during pregnancy is common and is an important risk factor for postpartum depression.
Symptoms
Typically, symptoms of postpartum depression develop gradually over 3 months, but they may begin more suddenly. Postpartum depression interferes with women’s ability to care for themselves and the baby.
Symptoms of postpartum depression may include
Less common symptoms include
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Extreme fatigue
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Sleep problems (too much or too little)
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Headaches and body aches
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Loss of interest in sex and other activities
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Anxiety or panic attacks
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Loss of appetite or overeating
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Difficulty functioning
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Lack of interest in or unreasonable worries about the baby
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A feeling of being incapable of caring for the baby or of being inadequate as a mother
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Guilt about having these feelings
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Fear of harming the baby
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Suicidal thoughts
Women may not bond with their baby. As a result, the child may have emotional, social, and cognitive problems later.
In postpartum psychosis, depression may be combined with suicidal or violent thoughts, hallucinations, or bizarre behavior. Sometimes postpartum psychosis includes a desire to harm the baby.
Fathers may also become depressed, and marital stress may increase.
Without treatment, postpartum depression can last for months or years. About one in three or four women who have had postpartum depression have it again.
Diagnosis
Early diagnosis and treatment of postpartum depression are important for women and their baby. Women should see their doctor if they continue to feel sad and have difficulty doing their usual activities for more than 2 weeks after delivery or if they have thoughts about harming themselves or the baby. If family members and friends notice symptoms, they should talk with the woman and encourage her to talk to a doctor.
When women go for their postdelivery visit, doctors may ask them to fill out a questionnaire designed to identify depression and anxiety. If women are depressed, doctors may also do blood tests to determine whether a disorder, such as a thyroid disorder, is causing the symptoms.
Treatment
If women feel sad, support from family members and friends is usually all that is needed. But if depression is diagnosed, professional help is also needed. Typically, a combination of psychotherapy and antidepressants is recommended.
Exercise, phototherapy (light therapy), massage, and omega-3 fatty acid supplements may also help. Phototherapy involves sitting a specific distance from a light box that provides light at the recommended intensity. People should remain in front of the light for at least 30 minutes, but they should not look directly at the light. Phototherapy can be done at home.
Women who have postpartum psychosis may need to be hospitalized, preferably in a supervised unit that allows the baby to remain with them. They may need antipsychotic drugs as well as antidepressants.
Women who are breastfeeding should consult with their doctor before taking any of these drugs to determine whether they can continue to breastfeed (see Taking Drugs While Breastfeeding). Many of these drugs (such as sertraline and paroxetine) allow women to continue breastfeeding.
