Depression After Pregnancy

What Is Depression After Pregnancy?

Depression after pregnancy refers to the negative thinking and feelings of despondency that many women experience after the birth of a child. In addition to the sad, lifeless feelings that accompany any depression, women who suffer from depression after pregnancy often fear that their baby will somehow be harmed and may worry that they are “bad” mothers.

Depression after pregnancy may be mild, moderate, or severe, and may be temporary or long lasting. But it is treatable, manageable, and in some cases, preventable. Depression after pregnancy is generally divided into three types:

  • The baby blues, also called maternity blues, natal blues, or postpartum blues, is a temporary “down” period common among new mothers. Tearfulness, fatigue, irritability, difficulty sleeping, mood swings, and other signs of the baby blues usually begin one to two days after birth and may last up to three weeks.
  • Postpartum depression is a mood disorder characterized by negative thinking patterns and feelings of hopelessness, sadness, and despondency. Unlike the temporary baby blues, postpartum depression deepens and lasts beyond the first month after birth. The new mother may feel like she has fallen into a dark hole, have obsessive thoughts, and find herself unable to shake troublesome worries.
  • Postpartum psychosis is a rare form of postpartum depression that affects one in every thousand women. It usually begins within three to ten days after a woman gives birth. These women experience a break with reality: they may lose weight quickly without dieting, go without sleep for more than 48 hours, or experience delusions and hallucinations. Postpartum psychosis is a crisis that requires immediate professional intervention.

Need To Know:

Although depression after pregnancy usually appears shortly after childbirth, it can begin at any time during the first year. If symptoms occur after the first months, they may be more subtle and difficult to detect. Spouses or family members may notice changes before the new mother does.

Nice To Know:

Q. Instead of feeling happy after my baby was born, I cried constantly and felt terribly anxious. What’s normal and what’s not?

A. Normal reactions include irritability, anger, crying, exhaustion, tension, restlessness, anxiety, and insomnia, all of which appear about three days after birth and may last for about two weeks. If these symptoms worsen and extend beyond a few weeks, you may be experiencing true postpartum depression and should consult a physician or other health care professional.

Q. I was fine for the first month after my baby was born. Then I began feeling terrible. Is this the baby blues?

A. At least half of new mothers get the baby blues, a mild form of depression that begins a few days or a week after delivery and usually lasts no more than two weeks. Since you started feeling low about six weeks after delivery, it may be true postpartum depression, which can last from two weeks to a year. It is less common, affecting 10 to 20 percent of new mothers. Best to consult your physician.

Facts about postpartum depression:

  • At least half of all new mothers experience some form of postpartum depression, usually temporary baby blues.
  • True postpartum depression affects from 10 to 15 percent of women who give birth.
  • One in one thousand women who have a child will suffer from postpartum psychosis.
  • Women who have several children can suffer postpartum depression after the birth of any child, whether it be their first or tenth.
  • Although postpartum depression has been discussed since ancient times, it has only been recognized as a treatable condition since the mid 1980s.
  • Steps can be taken to prevent postpartum depression before the baby arrives.

 

What Are The Signs And Symptoms Of Depression After Pregnancy?

The weeks after a woman gives birth can be exciting and joyful for her and her family. But for many women, the stresses of new motherhood, combined with the physiological changes that occur in their bodies after pregnancy, can lead to conflicting emotions and wide mood swings.

Although a woman may become depressed at any time in her life, she is especially vulnerable to depression after the birth of a baby. Depression is a mood disorder characterized by negative thinking and feelings of sadness, despair, and dejection. People who are depressed sometimes describe the experience as being in a “gray fog,” or feeling “numb.” They may have difficulty sleeping, feel extremely fatigued, and find it difficult to concentrate on complex tasks. Depression may affect a person’s appetite, immune system, physical movements, and general physical health.

The signs and symptoms of depression after pregnancy, or postpartum depression, are generally the same as for any kind of depression. However, women suffering from postpartum blues or depression are often overly fearful, without good cause, that their baby will be harmed. They may also fear that they are “bad” mothers and feel guilty that they are not “good enough.”

Generally, depression after pregnancy is divided into three major types, depending on the severity of the symptoms and how long they last:

Symptoms Of The Baby Blues

The baby blues usually occur one to two days after a woman gives birth and may last up to three weeks. The disorder is so common among new mothers that it is considered “normal,” although a woman suffering from the baby blues does not feel normal. She may feel fine one minute and then burst into tears the next. She may feel irritable and generally depressed or down. Other symptoms include:

  • Lack of energy
  • Inability to sleep
  • Loss of appetite
  • Feeling tired even after sleeping
  • Anxiety
  • Excessive worrying
  • Confusion
  • Excessive concern over physical changes
  • Lack of confidence
  • Sadness
  • Feeling overwhelmed

Although upsetting and unpleasant, the baby blues usually disappear with rest, good nutrition, and supportive help.

Symptoms Of Postpartum Depression

True postpartum depression affects 10 to 15 percent of women who give birth. Postpartum depression is best described as the baby blues that deepen and last beyond the first month. Women who suffer from postpartum depression may feel profound sadness, have obsessive thoughts, and be unable to shake troublesome worries.

The appearance of postpartum depression varies from woman to woman. It may appear as depression, anxiety, obsessive-compulsiveness, or any combination of these. Women may be suffering from postpartum depression if they feel depressed, lose interest in daily life and activities they used to find pleasurable, and suffer from at least four of the following symptoms almost continuously for at least two weeks:

  • Extreme fatigue/sluggishness/exhaustion
  • Hopelessness and helplessness
  • Sleeplessness despite exhaustion
  • Changes in appetite (i.e., loss of appetite, food cravings)
  • Anxiety, fear, guilt
  • Difficulty concentrating
  • Difficulty making decisions
  • Heart palpitations, tingling, numbness, or feelings of dread, all of which signal a panic attack
  • Impulses to harm baby or self
  • Disinterest in personal hygiene/appearance
  • Obsession with baby’s health
  • Inability to cope with everyday situations

Postpartum depression varies in severity and may last for several months. Major depression is the most common kind of depression that occurs after pregnancy. Other women suffer from dysthymia, a mild but long-lasting depression that may stem from childhood trauma or a current abusive relationship.

Women with mild to moderate postpartum depression, whose anxiety and troublesome thoughts come and go, may still be able to care for their babies and maintain daily activities. Others may be so overwhelmed by anxiety that they may not have the energy to care for themselves or their babies.

For more detailed information about depression go to, Depression: How To Overcome It.

Nice To Know:

Stress Triggers: A New Mother’s Report

If you’re a new mother and feeling blue, the first step toward overcoming the blues is to identify the things that are making you feel stressed and overwhelmed, called stress triggers. Here is one new mother’s list:

Sleep interrupted several times a night

  • Baby waking every two hours day and night
  • Increased workload, i.e. laundry, baby bottles
  • Being “on call” 24 hours a day, even when baby is sleeping

Loss of freedom

  • Baby’s unpredictable schedule
  • Physical pain such as sore breasts from nursing or an episiotomy during birth

Symptoms Of Postpartum Psychosis

Postpartum psychosis is a rare but severe illness that affects one in every thousand women who give birth. The woman with postpartum psychosis may experience delusions, such as thinking her baby is evil, or hallucinations, which involve seeing, hearing, smelling, or otherwise sensing things that aren’t really there.

Psychosis is often termed “a break from reality.” Its hallmark symptoms are delusions and hallucinations. Postpartum psychosis is thought to differ from other types of psychosis and is generally considered a severe form of depression called bipolar depression. It is not known whether postpartum psychosis is one illness or a combination of illnesses.

Postpartum psychosis usually occurs soon after a woman gives birth, within three to 10 days. Postpartum psychotic episodes are generally brief, lasting for at least one day and less than a month. The new mother may experience periods of relatively normal behavior. A psychotic episode that occurs more than a month after a woman gives birth is not considered postpartum, but may be caused by other factors.

Besides experiencing delusions and hallucinations, the woman suffering from postpartum psychosis may also:

  • Be extremely agitated
  • Lose weight quickly without dieting
  • Go without sleep for more than 48 hours

Need To Know:

An episode of postpartum psychosis is a crisis situation, and medical help should be sought immediately if a new mother is experiencing delusions, hallucinations, disorganized speech, or grossly disorganized behavior.

 

What Causes Depression After Pregnancy?

There is no single cause for the emotional difficulties many women experience after giving birth. However, experts suspect that rapid postpartum changes in levels of the female hormones estrogen and progesterone may have a powerful effect on women’s postpartum mental health.

  • Progesterone and estrogen are secreted by the ovaries and placenta, allowing the uterus to receive and maintain a fertilized egg. Levels of these hormones increase 10-fold during pregnancy. If levels of these hormones are too low, a miscarriage may occur.
  • After childbirth, progesterone levels drop dramatically, reaching pre-pregnant levels about 72 hours after delivery. Experts suspect that this dramatic shift in female hormones may play a major role in depression after childbirth.
  • During pregnancy, levels of endorphins, which are naturally secreted chemicals that make us feel good, also increase. Endorphin levels drop sharply after pregnancy, which also adds to the risk of depression.

In addition to these physiological changes, other factors that may contribute to postpartum depression include:

  • Difficult pregnancy and/or delivery
  • Problematic or troubled marriage or intimate relationship
  • Baby with a high level of needs
  • Sense of loss at not being pregnant anymore

Need To Know:

Women who are suffering from postpartum blues, depression, or psychosis are not at fault. They are not bad or incompetent mothers, and have done nothing wrong.

Need To Know:

The importance of getting enough sleep cannot be overstated. Many experts believe a disruption in a new mother’s sleep patterns can contribute significantly to depression. Napping during the day, while the baby naps, is a good way to catch up on sleep that may be interrupted repeatedly during the night.

 

Which Women Are At Greater Risk of Developing Depression After Pregnancy?

A woman’s risk for depression after pregnancy cannot be accurately predicted based on her hormone levels. But some women may be at higher risk for postpartum depression. These include women who:

  • Have had a previous postpartum episode. Women who have experienced postpartum depression after the birth of a child may have a greater chance of having the same problem again.
  • Had a traumatic birth experience. Women who have had a difficult labor and delivery may be more prone to depression after pregnancy.
  • Experienced prebirth (antepartum) depression. Women who have experienced depression, mood swings, and panic attacks while pregnant may be at greater risk for experiencing those feelings after delivery.
  • Have experienced depression unrelated to pregnancy. Women who have had a previous mood disorder may have a greater chance of experiencing postpartum depression.
  • Have a mother or sister who suffered from postpartum depression. The condition seems to run in families.
  • Have had a recent stressful life event or major life change. Losing a job or home, marital difficulties, the death of someone close to you, or other stressful life events may worsen the effects of a drop in hormone levels after delivery.
  • Have a history of extreme premenstrual syndrome (PMS). Women who suffer from severe PMS may be more susceptible to hormonal imbalances after birth.

How-To Information:

Having a Baby, and a Life, Too

You knew your life would change after you had a baby. You just didn’t realize the range of emotions you would feel. Having a baby challenges your sense of control, and this may leave you depleted and overwhelmed. Sometimes you may even feel resentful, wishing you could return to your pre-baby life. The following exercise will help you identify what is missing and may help you to identify some changes you can make to regain a sense of control:

  • Make a list of the old parts of your life that you miss, such as going shopping when you want or having a night out with girlfriends. Write down everything you can think of, no matter how small, without editing or passing judgment.
  • Review your list with your partner or other family members. Talk over each item on the list, discussing the advantages and disadvantages of the things you feel you can no longer do. For example, you may have more time with your new family if you don’t go out with your friends every Thursday night, but you may also miss spending time with your friends and feel sad and isolated without them. Be honest about the items you have listed.
  • Next, choose one or two items from the list that you may be able to add back into your life. For example, if you miss going out to dinner with your partner or friends, maybe other friends or family members could watch the baby for an hour or two while you go to your favorite restaurant.

Choosing a few specific activities to restore to your life can help you to regain a sense of balance in your life, and it may help you shake those baby blues.

What Should You Do If You’re At Risk?

To reduce your risk of depression after pregnancy, learn as much as you can about the responsibilities of parenthood before the baby arrives. Read parenting books and magazines and interact with other couples who are experienced parents. If you are at high risk for postpartum depression, it may be wise to identify a therapist during your pregnancy.

How-To Information:

Before you give birth, develop a good postpartum plan. A good postpartum plan can also help to reduce the emotional upheaval many women experience following childbirth. The plan should include specific ways to:

  • Take care of yourself. Nurture and pamper yourself. Take breaks when you can. Sleep when baby sleeps.
  • Accept help from others. Ask for help when you feel exhausted or overwhelmed.
  • Avoid major life changes. Ideally, make changes such as moving or changing jobs before you become pregnant. Next best is making such changes while pregnant.
  • Arrange for at-home help. Try to have a friend or family member stay with you for the first week to assume household chores and help with older children.
  • Limit visitors. Showing off baby is fun, but a constant stream of visitors can be taxing. However, visits from family members are inevitable, and if you have a large family, this could be stressful. Sometimes staying in your robe or pajamas for the first week will at least remind your family that you are still recovering from childbirth.
  • Make a “To Do” list. When friends and family call and ask how they can help, you can simply read from the list. Most people genuinely like to feel helpful.
  • Prepare meals ahead of time. During the last weeks of pregnancy, freeze several meals and mini-meals that can easily be heated up during those first weeks at home with baby.
  • Eat balanced meals through the day. Some new mothers have found eating small portions every three hours helpful. Limit alcohol, nicotine, and caffeine.
  • Avoid rigid schedules. Go with the flow. Try to be flexible, adjusting schedules to baby’s needs rather than trying to follow fixed schedules suggested in books or by friends.
  • Get enough rest. Avoid overexertion. Rest, meditate, and sleep when baby sleeps. Baby’s naps are not the time to catch up on household chores or phone calls.
  • Express bothersome feelings. Find people-spouse, friends, family, or a support group-with whom you can share.
  • Exercise every day. If weather permits, take your new family member outside. A brisk walk on a beautiful day can lift your spirits. Check with your doctor before starting any exercise program.

Need To Know:

What if it’s too late for a postpartum plan and you’re in the throes of depression? Find a quiet half-hour with a spouse, friend, or family member to identify stress factors and brainstorm solutions. You can’t solve everything all at once, but you can take positive steps toward feeling better if you simply slow down and work things through. Having someone do this exercise with you will help you remain more objective even though you are feeling overwhelmed and trapped.

How-To Information:

Tips to Relax

A few minutes of quiet time each day can help to reduce your risk of depression after pregnancy, or to restore equilibrium to your life if you are feeling blue. Here are some simple exercises you can do:

  • Sit in a comfortable chair, close your eyes, and breathe deeply. You can even practice childbirth breathing techniques. Breathe in and out slowly, concentrating on your breathing. (3 minutes)
  • Sit quietly and pay attention to noises, smells, and feelings. Think about the details of these stimuli. What do you hear? Smell? Feel? If your mind wanders, gently return to the smells and noises around you. (5 minutes)
  • Sit down where you are and notice the environment around you. Notice the dirty dishes, unfolded laundry, unopened pile of mail. Try to notice these things without passing judgment and without using the words, “should,” “ought,” or “must.” This form of “detachment” is a particularly helpful technique in keeping your expectations of yourself in perspective. (3 minutes)
  • Step outside. Notice nature-trees, clouds, sun, flowers, birds. Take a few moments to water the flowers or repot a favorite plant. (5 to 10 minutes)
  • Keep a journal. Write down the things you accomplished each day. It may be eating a healthy lunch, or spending a half-hour rocking baby or reading a story to an older child. Give yourself credit for the things you do, not criticism for the things that you don’t do. If you find yourself thinking about all the things that didn’t get done, gently bring your mind back to your accomplishment list. (5 to 10 minutes)
  • Indulge yourself. Use a rich hand lotion. Give yourself a quick manicure or pedicure. Apply a favorite perfume. (5 minutes)
  • Listen to soothing music or uplifting motivational tapes. (15 to 30 minutes)

When To Seek Professional Help

It can be difficult to determine when to seek professional help, especially if a woman is only experiencing a mild case of the blues. But it is important to know the difference between a case of the baby blues that will resolve itself and ongoing postpartum depression. Through treatment, many women have rediscovered the joy of being a new mother.

The following guidelines can help new mothers and their spouses decide whether it’s time to seek professional help:

  • A case of the baby blues is normal. But new mothers who are feeling down or sad should alert their doctors, in case symptoms of depression become extreme or last for more than three weeks.
  • Seek professional help if:
    • You are following your postpartum plan and your symptoms last for two or more weeks
    • Talking with friends, family, or your spouse does not help, or
    • The activities of daily living are totally overwhelming
  • Hospitalization is urgently needed if:
    • You are hearing voices
    • You have thoughts of hurting or killing yourself and/or your baby
    • You experience ideas or visions that seem unreal

What Treatments Are Available For Depression After Pregnancy?

Although a mild case of the baby blues may pass without the need for professional intervention, women who continue to feel depressed after three weeks should seek professional help from an obstetrician or other health professional.

The most appropriate treatment plans for depression after pregnancy usually consist of a combination of treatments including:

Types of Therapy

Even after the decision to enter therapy is made, it can be confusing to choose from among the many types of therapy. Remember that there is no one best type of therapy for everyone.

One general guideline: Experts recommend that women suffering from postpartum depression choose a therapeutic approach that helps them to focus on problem-solving in the present rather than trying to work through childhood issues.

Two therapeutic approaches are most often used to treat depression and anxiety:

Cognitive Therapy

Cognitive therapy is based on the theory that the way we think and perceive the world affects our mood and daily functioning. Cognitive therapists work on the premise that negative perceptions can quickly lower self-esteem, decrease energy and motivation, and increase stress levels.

In cognitive therapy, the client learns to respond in new ways to events or occurrences. For example, if you have a difficult time soothing your baby, you may believe you are not a good mother. A cognitive therapist will help you to see that the baby may simply be reacting to some physical discomfort, like gas, that no mother can do anything about.

Cognitive therapy is a collaborative process between the therapist and client. Expect interactive sessions, feedback from the therapist, and homework assignments

Interpersonal Psychotherapy

A therapist who specializes in interpersonal psychotherapy establishes a relationship with the patient. Interpersonal psychotherapy is based on the idea that there is a link between your mood disorder and interpersonal relationships, such as those with your spouse or new baby. This therapeutic approach may help you to balance the role of mother with that of partner, worker, or friend.

Need To Know:

Choosing A Therapist:

Family practitioners, psychologists, social workers, marriage and family counselors, and psychiatrists are all potentially qualified to help you overcome postpartum depression. Your obstetrician or family doctor may be able to recommend someone who specializes in depression after pregnancy.

There are several questions to ask when choosing a therapist.

  • What type of therapy does he practice? Are you comfortable with the approach? Ask the prospective therapist about his approach to treating depression and how long treatment is expected to last.
  • What are the therapist’s credentials, and is she familiar with postpartum depression?
  • Is it likely that medications will be needed? Only medical physicians, psychiatrists, and some psychiatric nurse clinicians are licensed to prescribe medications. However, many therapists provide medications to their patients through arrangements with a psychiatrist or other M.D.
  • Do you feel comfortable with the therapist?
  • How much does the therapist charge, and does your insurance cover the costs of therapy?
  • For how many weeks does the therapist expect treatment to last, and how often will sessions be scheduled? A good general expectation is for weekly sessions for 12 to 24 weeks.

AntiDepressant Medications

Antidepressant medications offer an additional option for women with postpartum depression. Antidepressants are not tranquilizers, pep pills, nerve pills, or drugs that cause addiction. Antidepressants help lift your mood and increase energy so that you can cope with life again. The combination of therapy and antidepressants appears to be the most effective treatment for many women who suffer depression after pregnancy, partly because it may make them more responsive to therapy.

Many effective antidepressants are available today, and no single drug is best for everyone. Older antidepressant drugs, referred to as “tricyclics,” are considered safe and effective, although they may cause side effects such as dry mouth or tremors. Newer antidepressants are called Serotonin Re-uptake Inhibitors (SRIs). The most famous and popular of these is fluoxetine, known by its brand name Prozac.

Nice To Know:

How Antidepressants Work

Each nerve cell in your brain is separated by microscopic gaps, called synapses. Naturally occurring messenger chemicals called neurotransmitters carry information across these synapses to a receptor on the other side. The neurotransmitter fits into the receptor like a key into a lock.

There are more than 50 known neurotransmitters, many of which work in concert with each other to regulate thinking, emotions, and behaviors. Mood-regulating neurotransmitters include serotonin, acetylcholine, dopamine, norepinephrine, and epinephrine (also called adrenaline).

People who are depressed or anxious usually have too little of one or more of the neurotransmitters. In some cases, the neurotransmitters can’t fit into the receptors. This means that message can’t be transferred between nerve cells, and communication in the brain slows down. Antidepressant medications alleviate symptoms of depression by helping the body maintain normal levels of neurotransmitters.

Antidepressant medications are not the best choice for all women suffering from depression after pregnancy. But if symptoms are severe enough, or have continued for long enough, your doctor may recommend that that you add medication to your treatment.

Here are some important facts about antidepressants:

  • Antidepressants are effective in about 60 – 80 percent of those who use them as directed.
  • The effects of antidepressant medications are often not apparent until a month to six weeks after treatment starts.
  • Antidepressant dosage has nothing to do with the severity of depression. Some antidepressants work at lower doses than other antidepressants.
  • Since some antidepressants work better for different combinations of symptoms than others, your physician needs an accurate description of your feelings.
  • Although many antidepressants are safe for mothers and babies and can even be taken while breastfeeding, the prescribing physician should always be informed if a woman is pregnant or breastfeeding.
  • Women with histories of depression who have been on medication should generally continue medication throughout pregnancy and after delivery.
  • Drugs such as lithium carbonate may be used for women with a history of bipolar disorder. Lithium is often discontinued during pregnancy because of possible harm to the developing fetus. Mothers who are breastfeeding should not take lithium.

Nice To Know:

Researchers have recently begun experimenting with hormonal replacement therapies for women with postpartum depression. By artificially increasing women’s levels of the female hormones estrogen and progesterone, researchers hope to alleviate the emotional difficulties that are associated with rapid changes in hormone levels. The work is preliminary and remains controversial.

Peer Support Groups

Peer support groups form the third leg of support for women suffering from depression after pregnancy. Women who are experiencing the baby blues can benefit from peer support groups, as well as those who are getting professional help. Peer support can be an important addition to therapy and medication, and should be an important part of your postpartum plan. Many of these groups are organized and led by women who have experienced various degrees of postpartum depression.

The benefits of peer support groups include:

  • Talking with other new mothers creates opportunities to share or trade ideas for handling problems.
  • Although talk therapy can’t change your hormones, it can help you ride out a hormonal imbalance without feelings of despair.
  • They offer a place to share your frustrations with other new mothers who may have similar feelings, and may have found other ways to cope.

How Can Partners Help Women Overcome Depression After Pregnancy?

Partners can be important lifelines for women suffering from depression after pregnancy. Partners should be on the alert for characteristic symptoms:

  • Feelings of sadness and worthlessness
  • Trouble sleeping
  • Changes in appetite
  • Excessive exhaustion
  • Withdrawal from friends and family
  • Irritability
  • Anxiety
  • Guilt
  • Anger

Need To Know:

Here are some tips for partners and friends of new mothers:

  • Remember that postpartum depression is a real illness. Your partner is not going crazy; she is simply coping with tremendous changes in her life and her body.
  • Your support is vital in the recovery process. She may think that she will never get through this. You can offer her understanding and reassurance.
  • Do not judge your partner’s feelings or reactions. Do not offer solutions that she is in no mood to hear. Instead, listen and sympathize.
  • Be consistent in offering your support and understanding, and encourage her to take some time for herself. Mothers who try to be “the best” or “perfect” are most likely to become burned out.
  • Offer help without being asked or needed. Take on more responsibility around the house. More than likely, laundry is piling up, dishes need washing, and floors need sweeping. If you do just a few chores, your partner may feel less overwhelmed.
  • Care for the baby for a few hours, so the new mother can take a long bath, a walk, or read for a while.
  • If your partner or friend is unwilling to care for baby or talking about suicide, seek immediate professional help.
  • Take time for yourself. After all, you are learning new responsibilities, too. You may start to feel drained if you are trying to manage everything at once. You may even feel negative about the situation for a while, which is a normal part of the adjustment process and will pass.

Need To Know:

Babies Get Depressed, Too

Left untreated, postpartum depression may have negative effects on babies, too. A study presented at the American Psychiatric Convention showed that some babies whose mothers are depressed might also become depressed. The babies in the study all had high blood levels of cortisol, a hormone present during stress. Months later, after the mothers had been treated for depression and their cortisol levels had returned to normal, the babies’ cortisol levels remained high. Researchers concluded that new mothers suffering from depression react by either smothering their babies with attention or ignoring them. Either reaction tends to stress baby. Other studies have shown that high levels of cortisol early in life can result in overreaction to stress later on. This is the best reason of all to keep yourself emotionally healthy.

 

Depression After Pregnancy: Frequently Asked Questions

Here are some frequently asked questions related to depression after pregnancy.

Q: Instead of feeling happy after my baby was born, I cried constantly and felt terribly anxious. What’s normal and what’s not?

A: Normal reactions include irritability, anger, crying, exhaustion, tension, restlessness, anxiety, and insomnia, all of which appear about three days after birth and may last for about two weeks. If these symptoms worsen and extend beyond a few weeks, you may be experiencing true postpartum depression and should consult a physician or other health care professional.

Q: I was fine for the first month after my baby was born. Then I began feeling terrible. Is this the baby blues?

A: At least half of new mothers get the baby blues, a mild form of depression that begins a few days or a week after delivery and usually lasts no more than two weeks. Since you started feeling low about six weeks after delivery, it may be true postpartum depression, which can last from two weeks to a year. It is less common, affecting 10 to 20 percent of new mothers. Best to consult your physician.

Q: Is a sudden drop in hormones the only cause of postpartum depression?

A: Cases of postpartum depression have been reported in adoptive mothers and new fathers, which tells us that the condition is not only hormonal. Psychological or relationship factors may also contribute to postpartum depression. For example, a new mother may have exceptionally low confidence as a parent or may have a problematic relationship with her partner.

Q: Are there steps I can take if I am at risk for postpartum depression?

A: You can develop a postpartum plan that includes taking care of yourself, avoiding exhaustion, asking for help from family and friends, and finding a therapist and support group before delivery.

Q: Could breastfeeding my baby contribute to depression?

A: Social isolation or lack of support while breastfeeding can certainly contribute to depression. However, breastfeeding is not a contributing factor to postpartum depression. In fact, the hormonal changes after birth occur more gradually when a mother breastfeeds, and breastfeeding increases levels of the hormone prolactin, which is known to help produce a calm feeling.

Q: Even though I am exhausted, I cannot sleep. Is this just part of the baby blues?

A: Chances are that if everything is quiet and baby is asleep, you should be able to sleep as well, thereby getting the rest you need as a new mother. One of the signs that the baby blues may be developing into true postpartum depression is the inability to sleep no matter how tired you are or how quiet the house is. If this is happening, it may be wise to seek professional help.

Depression after Pregnancy: Putting It All Together

  • Depression after pregnancy refers to the negative thinking and feelings of despondency that many women experience after the birth of a child.
  • In addition to the sad, lifeless feelings that accompany any depression, women who suffer from depression after pregnancy often fear that their baby will somehow be harmed and may worry that they are “bad” mothers.
  • There are three types of depression after pregnancy: the baby blues, true postpartum depression, and postpartum psychosis.
  • Several factors, including a history of depression, put some women at higher risk for depression after pregnancy.
  • A brief period of mild sadness after childbirth is normal and affects up to 75 percent of all new mothers.
  • Professional help is needed if symptoms continue for more than a few weeks.
  • New mothers who are unable to care for themselves or their babies, or who are experiencing delusions and hallucinations, need immediate professional help.
  • Although all the causes of depression after pregnancy are not known, rapid postpartum changes in levels of the female hormones progesterone and estrogen are thought to play a major role in the disorder.
  • A clear postpartum plan, with specific ideas about how to deal with the stresses of new motherhood, can help to reduce the risk of postpartum depression.
  • Treatment for postpartum depression includes therapy, antidepressant medications, and peer support groups.
  • A supportive partner can be a lifeline for a woman suffering from depression after pregnancy. But partners have to watch out for their own needs, too.
  • A happier mother means a happier baby.

Depression after Pregnancy: Glossary

Here are definitions of medical terms related to depression after pregnancy.

Antepartum: Before birth.

Bipolar depression (Bipolar disorder): A mood disorder characterized by the alternation of manic and depressive states.

Cortisol: A hormone produced by the adrenal cortex. High levels of cortisol have been associated with stress.

Delusion: A false belief.

Dysthymia: A mild but long lasting form of depression. Dysthymia is often associated with early childhood trauma or abuse, and is sometimes seen in adults who are in abusive situations.

Episiotomy: A surgical cut into the opening of the vulva during childbirth. It is performed to prevent ragged tearing of tissues.

Estrogen: The general term for the female sex hormone responsible for developing and maintaining female secondary sex characteristics. It is formed in the ovary, placenta, testes, and adrenal cortex. Estrogen is a key component of women’s monthly menstrual cycles.

Hallucination: The false perception of something that isn’t there as a visual image or sound, usually the result of a disorder of the nervous system.

Hormones: Chemicals produced by an organ or part of the body and carried in the bloodstream to another organ or part to stimulate or retard its function. Hormones have specific effects.

Lithium carbonate: A medication used in the treatment of bipolar disorder, a mood disorder characterized by alternate episodes of mania and depression.

Major depression: A common type of depression. Major depression is a serious disorder marked by sadness, fatigue, changes in sleep patterns, difficulty thinking and concentrating, changes in appetite, feelings of dejection and hopelessness, and sometimes suicidal thoughts.

Neurotransmitter: A substance that transmits nerve impulses across a tiny gap between nerve cells. Low levels of certain neurotransmitters are associated with depression.

Obsession: A recurring, unwanted idea that cannot be eliminated. Obsessive ideas are often unreasonable and disturbing. Preoccupation with an obsessive idea can interfere with normal daily activities.

Panic attack: A sudden experience of fear, often accompanied by the physiological “fight or flight” response. The panicky feelings are not attached to any obvious source. During a panic attack, a person may begin to sweat, have an increased heart rate, feel dizzy, have diarrhea, and show other signs of fear.

Premenstrual Syndrome (PMS): The occurrence of some or all of the following during the week before menstruation: low backache, abdominal pain, nervous irritability, headache, tender breasts, and abdominal bloating.

Progesterone: A hormone produced in the ovary. It stimulates changes in the wall of the uterus in preparation for implantation of the fertilized egg.

Prolactin (luteotropic): A protein hormone that is responsible for women’s production of breast milk after giving birth to a child. Prolactin is produced by the pituitary gland.

Receptor: A part of a cell that acts as a go-between linking a chemical agent and nervous tissue. Receptors act like keyholes forneurotransmitters.

Serotonin Reuptake Inhibitor (SRI): An antidepressant drug that enhances the activity of the “feel good” neurotransmitter serotonin.

Synapse: A microscopic gap between nerve cells where a nervous impulse passes from one nerve cell to another, allowing communication between nerve cells.

Uterus: The female organ that contains and nourishes an infant during the mother’s pregnancy.

Depression after Pregnancy: Additional Sources of Information

Here are some reliable sources that can provide more information on depression after pregnancy.

Organizations:

Depression After Delivery (D.A.D.) 
Phone: (800) 944-4773
http://www.depressionafterdelivery.com/

An organization dedicated to universal awareness of mood and anxiety disorders surrounding pregnancy and childbirth. Resources, support, and more for new mothers and professionals.

Postpartum Stress Center 
Phone: (610) 526-7527
http://www.postpartumstress.com

A support and counseling service offering help for postpartum depression, postpartum stress syndrome, pregnancy loss, postpartum obsessive-compulsive disorder, postpartum anxiety disorders, and prenatal depression. Established in 1988, the Center seeks to provide a better understanding and comprehensive clinical intervention foe any woman who suffers from the range of postpartum psychiatric disorders. Resources for both new mothers and mental health professionals including an online chat room.

Postpartum Support International 
Phone: (805) 967-7636
http://www.postpartum.net

A social support network, information center, and research guide concerning postpartum depression. Offers a rich variety of resources for new parents, members, and researchers, including written and online materials, online chat room, and more. Advocates for legislative support of healthcare issues surrounding postpartum psychiatric disorders.

Depression Awareness, Recognition, and Treatment Program National Institute of Mental Health 
Phone: (800) 421-4211
http://www.nimh.nih.gov (The home page for the National Institute of Mental Health).

Complete Depression Guide 
http://www.depression-guide.com/depression-and-women.htm

Clear, pratical advice on women and depression, bringing guidance to sufferers and their families. Knowing when to seek help, what help is available and where to find it.

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