Postpartum Depression

What is postpartum depression?

Postpartum depression, commonly known as postnatal depression or peripartum depression, occurs after giving birth. Antenatal depression, on the other hand, occurs during pregnancy. Postpartum depression affects mothers, fathers and partners. It occurs most commonly among mothers, with 10-15% of mothers being affected ^[1], and around 4% of fathers are also affected.

People with postpartum depression can exhibit the typical symptoms of depression, including low mood, loss of interest in usual activities, ruminating or worrying excessively, change in appetite (eating too much or too little), and disrupted sleeping patterns (a lack of sleep, or sleeping excessively). Many of these depressive symptoms are normal in the first two weeks after giving birth, especially disrupted sleeping patterns, so it’s important to know the difference between normal adjustment to having a newborn and warning signs of postpartum depression.

In fact, it is so common to feel moody, sad or anxious following childbirth that this challenging period is often called the ‘baby blues’, however if these symptoms continue after two weeks it is advised to seek treatment. Postpartum depression can build up gradually so it is better to seek support in the earlier stages, if you are exhibiting these symptoms, than to wait. Postpartum depression can vary in duration, from months to years, depending on the person and their circumstances.

Symptoms of postpartum depression

Postpartum depression has a very similar set of symptoms to major depression, however certain symptoms and the way in which other symptoms manifest, can be more specific to postpartum depression. The most recently updated symptoms and behaviours of postpartum depression according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) ^[2] are :

• Feeling sad or having a depressed mood
• Loss of interest or pleasure in activities once enjoyed
• Changes in appetite
• Trouble sleeping or sleeping too much
• Loss of energy or increased fatigue
• Restlessness (e.g., inability to still still, pacing, handwringing)
• Slowed movements or speech
• Feeling worthless or guilty
• Difficulty thinking, concentrating, or making decisions
• Thoughts of death or suicide
• Crying more than usual, and without a clear reason
• Lack of interest in the baby, not feeling bonded to the baby, or feeling very anxious about/around the baby
• Feelings of being a bad mother
• Fear of harming the baby or oneself

As is common with other types of depressive disorder, anxiety disorder may occur alongside postpartum depression, also known as postnatal anxiety. In a study published in 2013, this is estimated to occur in 17% of women following pregnancy and 16% during the pregnancy ^[3]. Symptoms can include increased heart rate and panic attacks, a sense of impending doom regarding the future, regret, rumination, panic attacks, extreme irrational fears as well as obsessive thinking.

This can usually be effectively treated using a combination of therapy and medication.

In very severe cases, postpartum depression can turn into postpartum psychosis. This is an extremely rare medical condition that usually happens within the first 2 weeks following pregnancy. It only occurs in 4 individuals out of every 1000. Those who are more at risk of postpartum psychosis are individuals who have bipolar or schizoaffective disorder.

You should seek medical attention from a health care professional such as your doctor, midwife, or a therapist/counselor if your symptoms continue past the two week mark, or if you experience the following symptoms:

• You have had a depressed mood and any other of the symptoms listed above for more than 2 weeks following pregnancy.
• Your symptoms are getting more intense.
• You are not able to take care of yourself or your baby (e.g., eating, sleeping, bathing).
• You are having recurrent thoughts of harming yourself or your baby.

Diagnosing postpartum depression

When diagnosing postpartum depression, doctors will usually ask about medical history, current environmental factors in the patient’s life, such as their support system, and general questions about the patient’s mental health. Official assessment should include a psychiatric test as well as a medical test to rule out whether symptoms are part of a wider physical health issue.

Who is at risk of experiencing postpartum depression?

People who are prone to depression or bipolar disorder are more likely to experience postpartum depression i.e. people who have a prior personal experience or family history of depression or bipolar.

Circumstantially, people who are most at risk of postpartum depression are those whose social needs are not being met sufficiently, such as people who lack a support network or are experiencing relationship problems, as well as those experiencing other big life stressors such as financial instability, moving home, people dealing with grief, or with psychological problems such as substance use disorder, low self-esteem and anxiety. Likewise, people under the age of 20 or those who had an unplanned or unwanted pregnancy are also more likely to experience postpartum depression.

Causes of postpartum depression

Postpartum depression is said to be caused by a variety of environmental and genetic factors that vary from person to person. It can often be attributed to the stressors and life-changing upheaval that come with having a baby. Furthermore, the exhaustion from consistent sleep deprivation alongside the various other physical and emotional demands of caring for a newborn all play a part in adding to the stress experienced after having a baby. This big life transition affects all aspects of one’s existence, be it socially, professionally, practically, or physically.

Hormonal changes can also contribute to the development of postpartum depression among some women; whilst women are pregnant, estrogen and progesterone levels are at their highest, and rapidly drop back down to pre-pregnancy levels once the baby is born ^[4]. Similarly to these shifts, thyroid hormone levels can increase and fall after pregnancy. Research shows that these extreme changes in hormones could be a part of the cause of postpartum depression in some women.

Prevention of postpartum depression

There are many things you can do to bolster your mental health during this life-changing period. Having a solid support network of people that you can trust to open up to honestly about life as a new parent can help enormously in maintaining good mental health. It can also be a source of great support to join a community of other new parents by attending antenatal or postnatal classes or other baby group meetings, where you can make friends with other parents, who are going through similar experiences.

There are a great deal of resources available, so if you are planning to have a baby and you or your family have a previous history of mental health concerns it can be a good idea to speak to your GP to get the appropriate support during this exciting time. Likewise, your midwife and other medical professionals and therapists can support you along the way, or refer you to a specialist.

If you are experiencing postpartum depression, it is important to know that you are not alone. Postpartum depression is very common; it is not your fault and there is a huge network of support out there for you to tap into to make your journey easier.

Treatment for postpartum depression

There are various options available for someone experiencing postpartum depression. These include:

• Talk therapy - speaking with a (psycho)therapist, counselor, or psychologist to gain the skills, perspective and tools to manage and overcome postpartum depression effectively. It is advisable to speak with a mental health professional who is experienced in working with postpartum depression. Effective therapeutic approaches can range from cognitive behavioral therapy (CBT) to humanistic therapy and more.
• Medication - the most common medications usedin the treatment of postpartum depression are antidepressants like selective serotonin reuptake inhibitors (SSRIs). These usually take a few weeks to work. Some medications are safe to take while breastfeeding - your doctor or healthcare provider will advise you on the most appropriate medication.

Other self-help treatments include:

• Connect with your support network and talk about what you are going through
• Rest as much as you can - sleep when the baby is sleeping and negotiate sleep scheduling with your partner or anyone else who is assisting. This might look like deciding to alternate the nights spent awake caring for the baby
• Do things that are enjoyable and relaxing whenever possible
• Exercise where possible including stretching and yoga
• Take the baby for walks in nature
• Eat a nutritious diet
• Connect with other new parents who are experiencing similar things to you / join a support group
• Spend some quality time with your partner and/or friends. Reach out to your family and friends for support regarding some hours of babycare

Helping someone with postpartum depression

If you think that someone you are close to is experiencing postpartum depression here are some ways in which you can support them:

• Listen to them without any judgement. Postpartum depression can cause people to have extreme and sometimes shocking thoughts such as wanting to hurt themselves or the baby. These are fairly common symptoms of postpartum depression and do not mean that someone will act on them. Some individuals might be too scared, embarrassed or ashamed to talk about how they feel. Postpartum depression can be an isolating and lonely experience so making an effort to show that you’re there for someone can make a huge difference.
• Encourage them to see a therapist, counselor, or a medical professional.
• Offer to look after the baby so they can spend some quality time with their partner, friends or family.
• Encourage them to join a support group or connect with other new parents.

Know and recognize the signs to look out for. These can include: low mood, loss of energy and motivation, feeling restless, irritable or moody, change in appetite (increase or decrease), being unable to sleep when the baby sleeps despite being exhausted, or sleeping too much (often accompanied by excessive dreaming), trouble focusing or making decisions, withdrawal from friends and family, loss in self-esteem - feeling like a bad mother, worthless or guilty, loss of pleasure in usual activities, having little or no interest or connection to the baby or feeling like it is someone else’s baby.

Myths about postpartum depression

Myth 1 - It is a less serious form of depression than other types of depression.

Postpartum depression is just as severe as other types of depression.

Myth 2 - Postpartum depression is predominantly caused by hormonal changes.

It is caused by many different factors and both female and male parents are at risk of postpartum depression.

Myth 3 - Postpartum depression always affects you right after you give birth.

Postpartum depression can develop gradually over many weeks.

Myth 4 - Postpartum depression can only be treated with medication.

Postpartum depression can be effectively treated with therapy alone as well as with medication and therapy.

Myth 5 - Postpartum depression is the parents’ fault.

Postpartum depression is actually caused by many risk factors that are outside of the parents control.

FAQs about postpartum depression

Postpartum depression vs. Baby blues – what is the difference?

‘Baby blues’ refers to the first 2 weeks after the baby is born, whilst postpartum depression is the depression experienced from the 3rd week up till a year after the baby is born.

How common is postpartum depression?

Postpartum depression is very common. In 2010 it was estimated to affect around 1 in 7 mothers and roughly 4% of fathers ^[5]. These numbers could be higher today, as awareness and understanding of mental health is on the increase, as well as mental health concerns being increasingly socially acceptable and understood.

How long does it take to go away?

Recovery varies very much from person to person and depending on the therapy. For a more rapid recovery, solution-focused approaches can work in as little as 1- 4 sessions. But, as with most chronic conditions, ongoing management is the key to success.