Depression - postpartum; Postnatal depression; Postpartum psychological reactions
Postpartum depression is moderate to severe
The exact causes of postpartum depression are unknown. Changes in hormone levels during and after pregnancy may affect a woman's mood. Many non-hormonal factors may also affect mood during this period:
- Changes in your body from pregnancy and delivery
- Changes in work and social relationships
- Having less time and freedom for yourself
- Lack of sleep
- Worries about your ability to be a good mother
You may have a higher chance of postpartum depression if you:
- Are under age 25 years
- Currently use alcohol, take illegal substances, or smoke (these also cause serious health risks for the baby)
- Did not plan the pregnancy, or had mixed feelings about the pregnancy
- Had depression, bipolar disorder, or an anxiety disorder before your pregnancy, or with a past pregnancy
- Had a stressful event during the pregnancy or delivery, including personal illness, death or illness of a loved one, a difficult or emergency delivery, premature delivery, or illness or birth defect in the baby
- Have a close family member who has had depression or anxiety
- Have a poor relationship with your significant other or are single
- Have money or housing problems
- Have little support from family, friends, or your spouse or partner
Feelings of anxiety, irritation, tearfulness, and restlessness are common in the week or two after pregnancy. These feelings are often called the postpartum or "baby blues." They almost always go away soon, without the need for treatment.
Postpartum depression may occur when the baby blues do not fade away or when signs of depression start 1 or more months after childbirth.
The symptoms of postpartum depression are the same as the symptoms of depression that occurs at other times in life. Along with a sad or depressed mood, you may have some of the following symptoms:
- Agitation or irritability
- Changes in appetite
- Feelings of worthlessness or guilt
- Feeling like you are withdrawn or unconnected
- Lack of pleasure or interest in most or all activities
- Loss of concentration
- Loss of energy
- Problems doing tasks at home or work
- Significant anxiety
- Thoughts of death or suicide
- Trouble sleeping
A mother with postpartum depression may also:
- Be unable to care for herself or her baby.
- Be afraid to be alone with her baby.
- Have negative feelings toward the baby or even think about harming the baby. (Although these feelings are scary, they are almost never acted on. Still you should tell your doctor about them right away.)
- Worry intensely about the baby or have little interest in the baby.
If you often feel sad, blue, unhappy, miserable, or down in the dumps, you may have depression. Let's talk about depression, and what you can do to get out of your funk. Depression often runs in families. This may be due to your genes, passed down by your parents and grandparents, the behaviors you learn at home, or both. Even if your genetic makeup makes you more likely to develop depression, a stressful or unhappy life event may triggers the depression. Depression can have many causes, including internal factors like genetics, or negative personality. External factors, substance misuse, or trauma and loss. Common triggers include alcohol or drug use, and medical problems long-term pain, cancer or even sleeping problems. Stressful life events, like getting laid off, abuse at home or on the job, neglect, family problems, death of a loved one, or divorce, can send someone spiraling into depression. There are three main types of depression; major depression, atypical depression and dysthymia. To be diagnosed with major depression, you must demonstrate 5 or more of the primary symptoms for at least two weeks. Atypical depression occurs in about a third of patients with depression, with symptoms including overeating, oversleeping, and feeling like you are weighed down. Dysthymia is a milder form of depression that can last for years if not treated. Other forms include the depression that is part of bipolar disorder, postpartum depression, occurring after a woman gives birth, premenstrual dysphoric disorder, occurring 1 week before a woman's menstrual period and seasonal affective disorder, occurring in both males and females during the fall and winter seasons. No matter what type of depression you have and how severe it is, some self-care steps can help. Get enough sleep if you can, exercise regularly, and follow a healthy, nutritious diet. Avoid alcohol and recreational drugs. Get involved in activities that make you happy and spend time with family and friends. If you are religious, talk to a clergy member. Consider meditation, tai chi, or other relaxation methods. If you are depressed for 2 weeks or longer, contact your doctor or other health professional before your symptoms get worse. Treatment will depend on your symptoms. For mild depression, counseling and self-care may be enough. Either psychotherapy or antidepressant medicines may help, but they are often more effective when combined. Vigorous exercise and light therapy could offer significant benefit alone or in combination. Healthy lifestyle habits can help prevent and treat depression, and reduce the chances of it coming back. Talk therapy and antidepressant medication can also make you less likely to become depressed again. In fact, talk therapy may help you through times of grief, stress, or low mood. In general, staying active, making a difference in the life of others, getting outside and keeping in close contact with other people is important for preventing depression.
Exams and Tests
There is no single test to diagnose postpartum depression. Diagnosis is based on the symptoms you describe to your health care provider.
Your provider may order blood tests to screen for medical causes of depression.
A new mother who has any symptoms of postpartum depression should contact her provider right away to get help.
Here are some other tips:
- Ask your partner, family, and friends for help with the baby's needs and in the home.
- Do not hide your feelings. Talk about them with your partner, family, and friends.
- Do not make any major life changes during pregnancy or right after giving birth.
- Do not try to do too much, or to be perfect.
- Make time to go out, visit friends, or spend time alone with your partner.
- Rest as much as you can. Sleep when the baby is sleeping.
- Talk with other mothers or join a support group.
The treatment for depression after birth often includes medicine, talk therapy, or both. Breastfeeding will play a role in what medicine your provider recommends. You may be referred to a mental health specialist. Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are types of talk therapy that often help postpartum depression.
Support groups may be helpful, but they should not replace medicine or talk therapy if you have postpartum depression.
Having good social support from family, friends, and coworkers may help reduce the seriousness of postpartum depression.
Medicine and talk therapy can often successfully reduce or eliminate symptoms.
Left untreated, postpartum depression can last for months or years.
The potential long-term complications are the same as in major depression. Untreated postpartum depression may put you at risk of harming yourself or your baby.
When to Contact a Medical Professional
Call your provider if you have any of the following:
- Your baby blues do not go away after 2 weeks
- Symptoms of depression get more intense
- Symptoms of depression begin at any time after delivery, even many months later
- It is hard for you to perform tasks at work or home
- You cannot care for yourself or your baby
- You have thoughts of harming yourself or your baby
- You develop thoughts that are not based in reality, or you start hearing or seeing things that other people don't
Do not be afraid to seek help right away if you feel overwhelmed and are afraid that you may hurt your baby.
Having good social support from family, friends, and coworkers may help reduce the seriousness of postpartum depression, but may not prevent it.
Women who had postpartum depression after past pregnancies may be less likely to develop postpartum depression again if they start taking antidepressant medicines after they deliver. Talk therapy may also be helpful in preventing depression.
American Psychiatric Association. Depressive disorders. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013:155-233.
Nonacs RM, Wang B, Viguera AC, Cohen LS. Psychiatric illness during pregnancy and the post-partum period. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 31.
Siu AL; US Preventive Services Task Force (USPSTF), Bibbins-Domingo K, et al. Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016;315(4):380-387. PMID: 26813211
Last reviewed on: 9/7/2020
Reviewed by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.