Postpartum Depression

Baby Blues

Up to 80% of women experience something called the baby blues, feelings of sadness and emotional surges that begin in the first days after childbirth. With the baby blues, a woman might feel happy one minute and tearful or overwhelmed the next. She might feel sad, blue, irritable, discouraged, unhappy, tired, or moody. Baby blues usually last only a few days — but can linger as long as a week or two.

Why It Happens

These emotional surges are believed to be a natural effect of the hormone shifts that occur with pregnancy and childbirth. Levels of estrogen and progesterone that have increased during pregnancy drop suddenly after delivery, and this can affect mood. These female hormones return to their pre-pregnancy levels within a week or so. As hormone levels normalize again, baby blues usually resolve on their own without medical treatment.

What to Do

Getting proper rest, nutrition, and support are quite important — since being exhausted or sleep deprived or feeling stressed can reinforce and fuel feelings of sadness and depression.

To cope with baby blues, new moms should try to accept help in the first days and weeks after labor and delivery. Let family and friends help with errands, food shopping, household chores, or child care. Let someone prepare a meal or watch the baby while you relax with a shower, bath, or a nap.

Get plenty of rest and eat nutritious foods. Talking to people close to you, or to other new mothers, can help you feel supported and remind you that you're not alone. You don't have to stifle the tears if you feel the need to cry a bit — but try not to dwell on sad thoughts. Let the baby blues run their course and pass.

When to Call the Doctor

If baby blues linger longer than a week or two, talk to your doctor to discuss whether postpartum depression may be the cause of your emotional lows.

Postpartum Depression

For some women, the feelings of sadness or exhaustion run deeper and last longer than baby blues. About 10% of new mothers experience postpartum depression, which is a true clinical depression triggered by childbirth.

Postpartum depression usually begins 2 to 3 weeks after giving birth, but can start any time during the first few days, weeks, or months post-delivery.

A woman with postpartum depression may feel sad, tearful, despairing, discouraged, hopeless, worthless, or alone. She also may:

• have trouble concentrating or completing routine tasks
• lose her appetite or not feel interested in food
• feel indifferent to her baby or not feel attached or bonded
• feel overwhelmed by her situation and feel that there is no hope of things getting better
• feel like she is just going through the motions of her day without being able to feel happy, interested, pleased, or joyful about anything

Feelings and thoughts like these are painful for a woman to experience — especially during a time that is idealized as being full of happiness. Many women are reluctant to tell someone when they feel this way. But postpartum depression is a medical condition that requires attention and treatment.

Why It Happens

Postpartum depression can affect any woman — but some may be more at risk for developing it. Women who have battled depression at another time in their lives or have one or more relatives who have had depression might have a genetic tendency to develop postpartum depression.

Most postpartum depression is thought to be related to fluctuating hormone levels that affect mood and energy. Levels of estrogen and progesterone that have increased during pregnancy drop suddenly after delivery. In some cases a woman's thyroid hormone may decrease, too.

These rapid hormone shifts affect the brain's mood chemistry in a way that can lead to sadness, low mood, and depression that lingers. Stress hormones may have an added effect on mood. Some women may experience this more than others.

When to Call the Doctor

If feelings of sadness or depression are strong, if they linger throughout most of the day for days in a row, or if they last longer that a week or two, talk to your doctor. A new mother who feels like giving up, who feels that life is not worth living, or who has suicidal thoughts or feelings needs to tell her doctor right away.

Postpartum depression can last for several months or even longer if it goes untreated. With proper treatment, a woman can feel like herself again. Treatment may include talk therapy, medication, or both. In addition, proper diet, exercise, rest, and social support can be very helpful. Some women find yoga to be beneficial. Some research suggests that expressing thoughts and emotions through certain writing techniques can help relieve symptoms of depression.

It may take several weeks for a woman to begin to feel better once she is being treated for depression, though some women begin to feel better sooner. Ask your doctor about how soon to expect improvements and ways to take care of yourself in the meantime.

Postpartum Psychosis

A more serious and rare condition is postpartum psychosis. It affects about 1 in 1,000 women who give birth and occurs within the first month after labor and delivery. It may include hallucinations, such as hearing voices or seeing things, or feelings of paranoia.

With postpartum psychosis, a woman can have irrational ideas about her baby — such as that the baby is possessed or that she has to hurt herself or her child. This condition can be extremely serious and disabling, and new mothers who are experiencing these symptoms need medical attention right away.

Why It Happens

Women who have other psychiatric illnesses, such as bipolar disorder or schizoaffective disorder, may be at greater risk of developing postpartum psychosis.

When to Call the Doctor

Postpartum psychosis requires immediate medical attention and, often, a brief hospitalization. If you or someone you know is experiencing symptoms, don't delay getting medical attention.

Understanding the Changes After Childbirth

New mothers experience many layers of change in the days and weeks immediately following labor and delivery. In addition to the sudden drop in estrogen and progesterone — which can affect mood — there are other huge physical, emotional, and domestic changes that can affect how a new mom feels.

Physical Changes

Pregnancy brings many physical changes, and labor and delivery are physically intense and challenging. It takes time for the body to recover, and a new mother might feel exhausted, emotionally drained, or uncomfortable after delivery.

Personal and Emotional Changes

A woman's role and responsibilities may change quite a bit when she becomes a new mother. It can take time to adjust — even if she felt prepared for the change. Some women may feel isolated, worried, or scared.

Some new mothers face added stresses related to difficult circumstances or lack of support. Enduring a tough relationship, a precarious financial situation, or some other major life event at the same time — like a move or a job loss — can add stress.

Pregnancy-related stress — such as difficulty conceiving or complications during pregnancy or labor — can add to a new mom's feeling of being depleted. Sometimes (but not always) these stresses can pave the way for depression.

Changes in Routines and Responsibilities

A newborn brings special demands on a mother's time, attention, and energy. For first-time mothers, there can be lots to learn about meeting the baby's most basic needs, like sleeping, feeding, bathing, and soothing. There are lots of new routines to establish.

The baby's sleeping, waking, and feeding schedules can make it hard for a new mom to get the sleep and rest required to help handle all these new stresses and responsibilities. And without a good night's sleep, even small things can seem overwhelming.

Getting Help and Helping Yourself

Tell your doctor if you're having trouble with postpartum moods, thoughts, or feelings. Let someone else you trust know, too. This might be your partner, a friend, or a family member. This is a time to reach out and accept help and support from people close to you.

In addition to getting treatment for postpartum depression, small things you do can make it easier to get through a difficult time. You might find it helpful to:

• Take time for yourself. Schedule a babysitter for a regular time. This way you'll be sure to get time for yourself and know that it's coming.
• Focus on little things to look forward to during the day. This might be a hot shower, relaxing bath, walk around the block, or visit with a friend.
• Read something uplifting. Since depression may make it difficult to concentrate, choose something light and positive that can be read a bit at a time.
• Indulge in other simple pleasures. Page through a magazine, listen to music you enjoy, sip a cup of tea.
• Be with others. Create opportunities to spend time with other adults, like family and friends, who can provide some comfort and good company.
• Ask for help. Don't shy away from asking for emotional support or help with caring for the baby or tackling household chores.
• Accept help. Accepting help doesn't make you helpless — by reaching out you help yourself and your baby.
• Rest. Give your child a quiet place to sleep, and try to rest when the baby does.
• Get moving. A daily walk can help lift mood. (Check with your doctor before starting any new exercise program.)
• Be patient. Know that it may take time to feel better and take one day at a time.
• Be optimistic. Try to think of small things you're grateful for.
• Join a support group. Ask your doctor or women's center about resources in your community.

Helping Someone With Postpartum Depression

If you're concerned that your partner or someone else you know is experiencing postpartum depression, it's important to encourage her to talk to her doctor and to a mental health professional. Sometimes a woman is reluctant to seek help or may not recognize her own symptoms right away.

Consider giving the new mom some information on postpartum depression, and offer to read through it together. You might offer to make an appointment for her and go with her if she wants.

Once she's receiving the care she needs, support, love, and friendship are good medicine, too. Here are a few things that you can continue do for her:

• Check in with her regularly to see how she's doing.
• Listen when she wants to talk.
• Go for a walk with her (every day if possible!).
• Make her a nutritious meal (regularly!).
• Give her some breaks from housework and child care responsibilities.
• Let her take a nap or a relaxing bath while you care for her baby.
• Be patient, be kind.
• Believe in her — and remind her of her true qualities and strengths.

Brighter Days Ahead

Like all forms of depression, postpartum depression creates a cloud of negative feelings and thoughts over a woman's view of herself, those around her, her situation, and the future. Under the cloud of depression, a woman might see herself as helpless or worthless. She might view her situation as overwhelming or hopeless. Things might seem disappointing, uninteresting, or without meaning. Keep in mind that the bleak negative perspective is part of depression.

With the right treatment and support, the cloud can be lifted. This can free a woman to feel like herself again, to regain her perspective and sense of her own strength, her energy, her joy, and her hope. With those things in place, it's easier to work with changes, to see solutions to life's challenges, and to enjoy life's pleasures again.