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What Causes Postpartum Depression?

What Causes Postpartum Depression?

Depression after childbirth can happen to anyone. You didn’t cause this.

For some people, it may be natural to feel exhausted or drained after welcoming a new baby. If this is your first child, you’ve entered a completely new world.

But if your mood starts to change and your low motivation lingers for two or more weeks, you may find it difficult to care for yourself and your baby. It could also mean you’ve developed postpartum depression.

Experts believe several factors play a part in causing the condition. There’s one thing to remember in every case, though: Postpartum depression doesn’t happen because of something you did or did not do.

It’s a mental health condition, and symptoms can improve with support from a mental health professional.

Postpartum (perinatal) depression refers to depression symptoms that appear during pregnancy or shortly after giving birth.

This condition is very common. Between 10% and 20% of people who have a child will experience postpartum depression.

Common symptoms include:

  • feelings of sadness or hopelessness
  • frequent shifts in mood
  • frequent crying
  • feelings of worthlessness or guilt
  • feeling disconnected from your baby, your partner, or both
  • fear of hurting yourself or your baby
  • wanting to avoid other people
  • loss of energy
  • trouble sleeping
  • trouble concentrating or remembering things

At first, you might believe you’re just overwhelmed by parenthood. You could also worry that you’re struggling to cope because you’re not a good parent and wonder how other people will react if you tell them how you feel.

When you find yourself fixating on negative thoughts or struggling to bond with your baby, it’s important to reach out for help.

These symptoms don’t make you a bad parent in the slightest. Depression isn’t your fault, and you deserve help and support.

Many different factors can increase your chances of developing postpartum depression, including:

  • personal or family history of depression, anxiety, or bipolar disorder
  • stress during pregnancy or after giving birth
  • previous pregnancies
  • pregnancy loss or stillbirth
  • asthma
  • lack of social or family support
  • history of trauma or adverse life events
  • complications during pregnancy or childbirth, including illness, preterm labor, or having a baby with health concerns or other special needs
  • giving birth between the ages of 13 and 19 years
  • alcohol or substance use

Here are a few more specific factors that could contribute to postpartum depression:

Lack of sleep

Research suggests a link between postpartum depression and fatigue or sleep deprivation.

You might find it difficult to “sleep when the baby sleeps,” as well-meaning loved ones often urge. Maybe you worry about the baby needing you or want to get things done around the house.

And what if your baby never seems to sleep?

Pregnancy and childbirth take a toll on your body, and sleep is a key part of recovery. Having a hard time getting the sleep you need can contribute to health consequences, including depression.

Lack of time to relax, recover, and heal

After you give birth, your body needs to recover. Beyond sleep, you also need time to relax, unwind, and take care of your physical health.

You might have a hard time relaxing, especially when you want to “do everything right” as a parent.

Yet trying to care for your baby while also doing chores, working, and taking care of other children might leave you with no time for other key aspects of well-being, such as:

  • self-care
  • seeing loved ones
  • doing things you enjoy

Lack of social support

Feelings of loneliness and emptiness can contribute to depression, so a strong support network can make a big difference when you have a new baby.

If available, your partner can provide support on a daily basis. Friends and family members can also help out by:

  • bringing meals
  • providing company
  • looking after your baby while you rest

Simply spending time with loved ones can remind you that you’re not alone, which can help protect you against postpartum depression symptoms.

Changes in your body

You might have trouble adjusting to pregnancy’s physical changes or feel some pain and discomfort as you heal. Social pressure to “get your body back” can also affect your mood.

It’s not uncommon to feel guilty for worrying about these things when you and your baby are both physically healthy.

Yes, your health is important, but you also deserve to feel good about yourself. Exhaustion, an aching body, and difficulty finding time for self-care can all affect your sense of self-worth and leave you feeling low.

Emotional distress

It’s natural and not uncommon to feel anxious, stressed, or overwhelmed after having a baby.

You might:

  • worry about your ability to take care of the baby
  • worry about your relationship with your partner
  • feel as if you’ve lost your sense of self
  • struggle to balance caring for your baby and returning to work
  • feel sad or guilty
  • feel overwhelmed by the desire to be a “perfect” parent
  • feel lonely or isolated

Difficult or painful life changes during pregnancy or shortly after childbirth can also affect your emotional well-being. These might include:

  • job loss
  • financial issues
  • breakup or divorce
  • loss of a loved one

Emotional turmoil and distress often get worse when you don’t know how to talk about these feelings.

Hormonal changes during pregnancy and childbirth

During pregnancy, your body produces much more estrogen and progesterone than it typically does.

As soon as you give birth, levels of these hormones immediately begin to decline. This rapid shift in your hormone levels may contribute to postpartum depression.

A decrease in thyroid hormones can also contribute to symptoms of depression after childbirth.

Genetics

Only a few scientific studies have explored the role of genetics in postpartum depression, but some evidence suggests genes may play a part.

One 2017 study compared RNA samples from six women who had recovered from postpartum depression with 10 women with no history of the condition.

Researchers found that nine altered genes seemed to predict postpartum depression in women diagnosed with the condition.

They also noted that lasting genetic changes may help explain why postpartum depression after one pregnancy increases your chances of depression after future pregnancies.

This study was very small, so future research may offer more insight into how genes contribute to postpartum depression.

Feeling overwhelmed by your baby’s needs

You might be more likely to feel overwhelmed, exhausted, or guilty if your baby:

  • has trouble eating or sleeping on a regular schedule
  • has health concerns
  • cries frequently or is difficult to soothe

This doesn’t mean that you’ve done anything wrong or that there’s anything wrong with your baby. Still, you could have a harder time adjusting — especially if you don’t have much support.

Any parent or primary caregiver can experience postpartum depression, regardless of gender. This includes:

  • fathers
  • transgender or nonbinary parents
  • adoptive parents

Research from 2019 suggests that around 8% to 10% of fathers may develop depression during the first year after the birth of a child.

Potential contributing factors to depression in other parents include:

  • low income
  • sleep deprivation
  • history of depression
  • relationship issues
  • unplanned pregnancy
  • changes in hormones believed to promote father-child bonding

Along with the hormonal changes that happen in pregnancy, transgender and nonbinary parents who give birth may also face cissexism (transphobia) from healthcare providers and society in general.

This stigma can contribute to isolation and depression symptoms.

Postpartum depression is a mental health condition, and it can’t be prevented completely.

You could still develop postpartum depression even if you follow all the recommendations, minimize stress during pregnancy, and have plenty of support.

Recognizing key signs is an important step toward getting help.

If you’ve had symptoms of depression or postpartum depression before, let your care team know early in pregnancy. They can help you identify options for treatment and prevention.

Here are some other helpful steps:

Talk about how you’re feeling

It may be difficult to share painful or unwanted feelings with other people, especially when they expect you to be happy.

But opening up might lead you to discover that your partner and other loved ones can listen, validate your distress, and offer emotional support.

Minimize stress

Life is sometimes unpredictable, and you can’t avoid all sources of stress.

Healthy coping strategies, like time with loved ones, meditation, or breathing exercises, can help you navigate stress and reduce its impact.

Be kind to yourself

You’ve just become a parent. That’s an incredible feat.

Practicing compassion for yourself as you grow accustomed to the changes and new responsibilities of parenthood might help you cope with the situation.

Prioritize rest and self-care

Your health is most important, so remind yourself that it’s just fine to let less-essential tasks slide.

Instead of forcing yourself to do some work or a few chores, take time to nap and relax.

Make time for physical activity

Exercise can help improve your mood and well-being. Walking, yoga, and stretching are all great ways to get moving, once your doctor clears you for exercise.

Open up to other new parents

Support groups for new parents or parents with postpartum depression can help you connect with others in a similar situation.

Talking to people who understand can help you feel less alone and remind you that depression is common and not your fault.

Explore local postpartum support groups at Postpartum Progress or talk to your healthcare professional or community mental health center to find support near you.

Experts haven’t found a root cause of postpartum depression. It’s most likely a combination of contributing factors that leads to the development of the condition.

Consider seeking the support of a health professional if you notice signs of postpartum depression in yourself or a loved one.

Without treatment, symptoms could linger for months, even years.

Needing a little extra support to care for yourself and a new baby is not uncommon. It doesn’t mean you’ve failed, and asking for help is a sign of strength.


Postpartum Depression

All translations of the English Postpartum Depression brochure were partially funded by a grant from the American Psychological Foundation.

It’s common for women to experience the “baby blues” — feeling stressed, sad, anxious, lonely, tired or weepy — following their baby’s birth. But some women, up to 1 in 7, experience a much more serious mood disorder — postpartum depression. (Postpartum psychosis, a condition that may involve psychotic symptoms like delusions or hallucinations, is a different disorder and is very rare.) Unlike the baby blues, PPD doesn’t go away on its own. It can appear days or even months after delivering a baby it can last for many weeks or months if left untreated. PPD can make it hard for you to get through the day, and it can affect your ability to take care of your baby, or yourself. PPD can affect any woman—women with easy pregnancies or problem pregnancies, first-time mothers and mothers with one or more children, women who are married and women who are not, and regardless of income, age, race or ethnicity, culture or education.

All translations of the English Postpartum Depression brochure were partially funded by a grant from the American Psychological Foundation.

The warning signs are different for everyone but may include:

A loss of pleasure or interest in things you used to enjoy, including sex

Eating much more, or much less, than you usually do

Anxiety—all or most of the time—or panic attacks

Feeling guilty or worthless—blaming yourself

Excessive irritability, anger or agitation—mood swings

Sadness, crying uncontrollably for very long periods of time

Fear of not being a good mother

Fear of being left alone with the baby

Inability to sleep, sleeping too much, difficulty falling or staying asleep

Disinterest in the baby, family, and friends

Difficulty concentrating, remembering details, or making decisions

Thoughts of hurting yourself or the baby (see below for numbers to call to get immediate help).

If these warning signs or symptoms last longer than 2 weeks, you may need to get help. Whether your symptoms are mild or severe, recovery is possible with proper treatment.

A change in hormone levels after childbirth

Previous experience of depression or anxiety

Family history of depression or mental illness

Stress involved in caring for a newborn and managing new life changes

Having a challenging baby who cries more than usual, is hard to comfort, or whose sleep and hunger needs are irregular and hard to predict

Having a baby with special needs (premature birth, medical complications, illness)

First-time motherhood, very young motherhood, or older motherhood

Other emotional stressors, such as the death of a loved one or family problems

Financial or employment problems

Isolation and lack of social support

Up to 1 in 7 women experience PPD

For half of women diagnosed with PPD, this is their first episode of depression

About half of women who are later diagnosed with PPD may have begun experiencing symptoms during pregnancy–so it’s important to seek help early! Getting the right help can make all the difference for you, your baby and your family.

Don’t face PPD alone—Seek help from a psychologist or other licensed mental health
provider contact your doctor or other primary health care provider.

Talk openly about your feelings with your partner, other mothers, friends, and relatives.

Join a support group for mothers—ask your health care provider for suggestions if you
can’t find one.

Find a relative or close friend who can help you take care of the baby.

Get as much sleep or rest as you can even if you have to ask for more help with the baby
—if you can’t rest even when you want to, tell your primary health care provider.

As soon as your doctor or other primary health care provider says it’s okay, take walks, get exercise.

Try not to worry about unimportant tasks—be realistic about what you can really do while
taking care of a new baby.

Cut down on less important responsibilities

Postpartum depression is not your fault–it is a real, but treatable, psychological disorder .

If you are having thoughts of hurting yourself or your baby, take action now:

Put the baby in a safe place, like a crib. Call a friend or family member for help if you need to.

Call a suicide hotline (free & staffed all day, every day):

Call your psychologist’s or other licensed mental health provider’s emergency number.

Call your doctor’s or other primary health care provider’s emergency number.

Go to your local hospital emergency room. Tell someone you trust about what you are feeling
ask him or her to help you take these steps.

Adapted from MedEdPPD
Copyright 2007 by MediSpin, Inc. Adapted by permission.

The Good news: There Is Hope

PPD Can Be Treated! You Can Feel Better!

Early detection and treatment make all the difference.

If you or someone you know shows symptoms of depression and anxiety like the ones discussed here–either during pregnancy or after childbirth—a psychologist or other licensed mental health provider can help.

Effective treatments for PPD include various forms of psychotherapy, often combined with antidepressant medication. You will learn how to develop skills to manage feelings and cope with problems.

Don’t wait! Take action and seek treatment as soon as you notice any of these physical or emotional symptoms. PPD can get worse without treatment.

To find a psychologist or other licensed mental health provider near you, ask your ob/gyn, pediatrician, midwife, internist or other primary health care provider for a referral.

The American Psychological Association’s Consumer Help Center can also help you find a local psychologist: Call 1-800-964-2000, or visit the APA Help Center.

Postpartum Health Alliance
(If you need immediate support please call the San Diego Access and Crisis Line at (888) 724-7240. The toll-free call is available 24 hours a day, seven days a week.
Talk to mothers who have recovered from PPD.


Postpartum Depression

In the case of suicidal thoughts or thoughts of harming the baby, postpartum depression is a medical emergency, and medical care should be accessed immediately.

What are postpartum depression and peripartum depression? Are there different types of peripartum depression?

Postpartum depression, now included in the describer of depression with peripartum onset (during pregnancy or within a month after giving birth), may be the most common problem associated with childbirth. It has been described as afflicting prominent historical figures like author/suffragist Charlotte Perkins Gilman in the 19th century. This illness is characterized by depression that a woman experiences either during pregnancy or within four weeks of giving birth, affecting about 3%-6% of women who give birth, up to 20% when only women with postpartum depression, rather than including those who are depressed during the pregnancy are counted. Peripartum depression, as well as postpartum anxiety, occurs after one out of every eight deliveries in the United States, affecting about half a million women every year. Peripartum depression is also called major depression with peripartum onset. Delusional thinking after childbirth, called postpartum psychosis, affects about one in every 500 to 1,000 women.

Notably, postpartum depression is not an illness that is exclusive to mothers. Fathers can experience it, as well. As with women, symptoms in men can result in fathers having difficulty caring for themselves and for their children when suffering from postpartum depression.

Unfortunately, up to 50% of individuals with postpartum depression or postpartum psychosis are never detected. That can result in devastating outcomes for the patient and family. For example, postpartum psychosis is thought to have been a potential factor in Andrea Yates drowning her five children in 2001 and was explored as a factor in Susan Smith drowning her two sons in 1994.

QUESTION

What are causes and risk factors for postpartum depression?

Similar to many other mental health conditions, there is thought to be a genetic vulnerability to developing postpartum depression, in that people who have family members who have had this or any other mental illness have a higher risk of developing postpartum depression compared with people who have no such family history.

Rapid changes in reproductive hormone levels (like estrogen and progesterone) that occur during pregnancy and after delivery are thought to be biological factors in the development of this condition. People with any history of depression, anxiety, alcohol or another substance use disorder prior to the pregnancy are at risk for developing depression during the pregnancy or within a few weeks after delivery. Examples of specific illnesses that have been associated with being associated with the potential to develop postpartum depression include any form of major depression, such as premenstrual dysphoric disorder, bipolar disorder and generalized anxiety disorder.

Interestingly, men are also known to experience changes in a number of hormonal changes during the peripartum period that can contribute to the development of PPD. Also, the stress of any medical complications as a result of the pregnancy or delivery, as well as the stress that is inherent in caring for a newborn are considerable factors.

Further risk factors for developing postpartum depression include age younger than 20 years, low self-esteem or life stressors like low socioeconomic status, a lack of having social support before and after the birth of the baby, and marital problems, including any history of intimate partner violence.

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What are postpartum depression symptoms and signs?

Symptoms of postpartum depression begin either during pregnancy or within four weeks after having a baby and include the following:

  • Feelings of profound sadness, emptiness, emotional numbness, irritability, or anger.
  • A tendency to withdraw from relationships with family, friends, or from activities that are usually pleasurable for the PPD sufferer
  • Constant fatigue or tiredness, difficulty sleeping, overeating, or loss of appetite
  • A strong sense of failure or inadequacy
  • Intense concern and anxiety about the baby or a lack of interest in the baby
  • Thoughts about suicide or fears of harming the baby

Postpartum psychosis occurs much more rarely and is thought to be a severe form of postpartum depression. Symptoms of that disorder include the following:

    (false beliefs) (for example, hearing voices or seeing things that are not real)
  • Thoughts of harming the baby
  • Severe depressive symptoms

SLIDESHOW

What tests to doctors use to diagnose postpartum depression?

There is no one test that definitively indicates that someone has PPD. Therefore, health care providers diagnose this disorder by gathering comprehensive medical, family, and mental health history. Patients tend to benefit when the health care provider takes into account their client's entire life and background. This includes, but is not limited to, the person's gender, sexual orientation, cultural, religious, ethnic background, and socioeconomic status. The health care professional will also either perform a physical examination or request that the individual's primary care doctor perform one. The medical examination will usually include lab tests to evaluate the person's general health and as part of screening the individual for medical conditions that might contribute to mental health symptoms.

Postpartum depression must be distinguished from what is commonly called the postpartum blues or "baby blues," which tend to occur in most new mothers. In the brief mood problem of baby blues, symptoms like crying, sadness, irritability, anxiety, and confusion can occur. In contrast to the symptoms of PPD, the symptoms of the baby blues tend to occur within a few days postpartum, peaking around the fourth day after delivery, resolve by the tenth day and do not tend to affect the individual's ability to function.

Postpartum psychosis is a psychiatric emergency that requires immediate intervention because of the danger that the sufferer might kill their baby or themselves. Postpartum psychosis usually begins within the first two weeks after delivery. Symptoms of this disorder tend to involve extremely disorganized thinking, bizarre behavior, unusual hallucinations, and delusions. Postpartum psychosis is often a symptom of bipolar disorder, previously called manic depression.

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What are the treatments for postpartum depression?

Educational programs and support groups

Treatment of postpartum depression in men and women is similar. Both mothers and fathers with this condition have been found to greatly benefit from being educated about the illness, as well as from the support of other parents who have been in this position.

Psychotherapy ("talk therapy") involves working with a trained therapist to determine methods to solve problems and cope with all forms of depression, including postpartum depression. It can be a powerful intervention and may produce, positive biochemical changes in the brain. This is a particularly important alternative to treatment with medication in women who are breastfeeding. In general, these therapies take weeks to months to complete. More intense counseling may be needed for longer when treating very severe depression or other psychiatric symptoms.

Interpersonal therapy (IPT): This helps to alleviate depressive symptoms and helps the person with PPD develop more effective skills for coping with social and interpersonal relationships. IPT employs two strategies to achieve these goals.

  • The first is education about the nature of depression. The therapist will emphasize that depression is a common illness and that most people can expect to get better with treatment.
  • The second is defining specific problems (such as child care pressures or interpersonal conflicts). After the problems are defined, the therapist is able to help set realistic goals for solving these problems. Together, the individual with PPD and his or her therapist will use various treatment techniques to reach these goals.

Cognitive behavioral therapy (CBT): This helps to alleviate depression and reduce the likelihood it will return by helping the PPD sufferer change his or her way of thinking. In CBT, the therapist uses three techniques to accomplish these goals.

  • Didactic component: This phase helps to set up positive expectations for therapy and promote cooperation.
  • Cognitive component: This helps to identify the thoughts and assumptions that influence behaviors, particularly those that may predispose the person with PPD to being depressed.
  • Behavioral component: This employs behavior-modification techniques to teach the individual with PPD more effective strategies for dealing with problems.

Medications

Medication therapy for postpartum depression usually involves the use of an antidepressant medication. The major types of antidepressant medication are the selective serotonin reuptake inhibitors (SSRIs), serotonin/norepinephrine/dopamine reuptake inhibitors (NSRIs), the tricyclic antidepressants (TCAs), and the monoamine oxidase inhibitors (MAOIs). SSRI medications affect levels of serotonin in the brain. For many prescribing doctors, these medications are the first choice because of the high level of effectiveness and general safety of this group. People with depression or anxiety during pregnancy or postpartum (the two together being known as the perinatal period) should consult with their doctor about safety issues for the developing fetus then the new baby. That issue should also be addressed with the baby's pediatrician for babies who receive breast milk. Examples of antidepressants are listed here. The generic name is first, with the brand name in parentheses.

TCAs are sometimes prescribed in severe cases of depression or when SSRIs or SNRIs are ineffective. These medications affect a number of brain chemicals (neurotransmitters), especially epinephrine and norepinephrine (also called adrenaline and noradrenaline, respectively). Examples include

About two-thirds of people who take antidepressant medications improve. It may take anywhere from one to six weeks of taking medication at its effective dose to notice mood improvement. It is, therefore, important not to stop taking the medication because benefits may not be seen immediately. The MAOIs are not often used since the introduction of the SSRIs. Because of the possibility of interactions, the MAOIs may not be taken with many other types of medication, and some types of foods that are high in tyramine (like aged cheeses, wines, and cured meats) must be avoided as well. Examples of MAOIs include phenelzine (Nardil) and tranylcypromine (Parnate). Atypical neuroleptic medications are often prescribed in addition to a mood-stabilizer medication in people with severe postpartum depression or who have postpartum psychosis. Examples of atypical neuroleptics include

    (Abilify), (Zyprexa),
  • paliperidone (Invega), (Seroquel), (Risperdal), (Geodon),
  • asenapine (Saphris),
  • iloperidone (Fanapt),
  • paliperidone (Invega),
  • lurasidone (Latuda), and
  • brexpiprazole (Rexulti).

Non-neuroleptic mood-stabilizer medications are also sometimes used with a neuroleptic medication to treat people with postpartum psychosis because bipolar disorder may also be present in some patients. Examples of non-neuroleptic mood stabilizers include

Electroconvulsive therapy (ECT), previously called electroshock therapy or shock treatment, is a therapy that addresses severe psychiatric symptoms. It involves inducing seizures in people by placing electrodes on the person's head, usually on what corresponds to one side of the brain. The treatment occurs while the person is fully sedated to avoid any distress associated with having seizures. Health care professionals administer treatments up to three times per week for at least one week, continuing until symptoms have significantly improved. Side effects usually include confusion and memory loss immediately after the procedure, the latter of which may take weeks to resolve.

Also effective in treating many people with severe depression, psychosis, and the mood swings associated with manic depressive (bipolar disorder) episodes in general, ECT is effective in treating postpartum psychosis and severe forms of postpartum depression. In fact, there is research that indicates higher response of people with depression or psychosis during the postpartum period compared with those symptoms outside of the postpartum period


Psychosocial and psychological interventions for preventing postpartum depression

Background: The cause of postpartum depression remains unclear, with extensive research suggesting a multi-factorial aetiology. However, epidemiological studies and meta-analyses of predictive studies have consistently demonstrated the importance of psychosocial and psychological variables. While interventions based on these variables may be effective treatment strategies, theoretically they may also be used in pregnancy and the early postpartum period to prevent postpartum depression.

Objectives: Primary: to assess the effect of diverse psychosocial and psychological interventions compared with usual antepartum, intrapartum, or postpartum care to reduce the risk of developing postpartum depression. Secondary: to examine (1) the effectiveness of specific types of psychosocial and psychological interventions, (2) the effectiveness of individual versus group-based interventions, (3) the effects of intervention onset and duration, and (4) whether interventions are more effective in women selected with specific risk factors.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register (January 27 2004), the Cochrane Depression, Anxiety and Neurosis Group trials register (October 2003), the Cochrane Central Register of Controlled Trials (October 2003), MEDLINE (1966 to 2004), EMBASE (1980 to 2004) and CINAHL (1982 to 2004). We scanned secondary references and contacted experts in the field.

Selection criteria: All published and unpublished randomised controlled trials of acceptable quality comparing a psychosocial or psychological intervention with usual antenatal, intrapartum, or postpartum care.

Data collection and analysis: Both reviewers participated in the evaluation of methodological quality and data extraction. Additional information was sought from several trial researchers. Results are presented using relative risk for categorical data and weighted mean difference for continuous data.

Main results: Fifteen trials, involving over 7600 women, were included. Overall, women who received a psychosocial intervention were equally likely to develop postpartum depression as those receiving standard care (relative risk (RR) 0.81, 95% confidence interval (CI) 0.65 to 1.02). One promising intervention appears to be the provision of intensive postpartum support provided by public health nurses or midwives (RR 0.68, 95% CI 0.55 to 0.84). Identifying mothers 'at-risk' assisted the prevention of postpartum depression (RR 0.67, 95% CI 0.51 to 0.89). Interventions with only a postnatal component appeared to be more beneficial (RR 0.76, 95% CI 0.58 to 0.98) than interventions that also incorporated an antenatal component. While individually-based interventions may be more effective (RR 0.76, 95% CI 0.59 to 1.00) than those that are group-based, women who received multiple-contact intervention were just as likely to experience postpartum depression as those who received a single-contact intervention.

Reviewers' conclusions: Overall psychosocial interventions do not reduce the numbers of women who develop postpartum depression. However, a promising intervention is the provision of intensive, professionally-based postpartum support.


Postpartum Depression Treatment

Postpartum depression is treated differently, depending on the type of symptoms and how severe they are. Treatment options include anti-anxiety or antidepressant medications, psychotherapy, and participation in a support group for emotional support and education. For severe cases, an IV of a new medication called brexanolone (Zulresso) may be prescribed.

In the case of postpartum psychosis, drugs used to treat psychosis are usually added. Hospital admission is also often necessary.

If you are breastfeeding, don't assume that you can't take medication for depression, anxiety, or even psychosis. Talk to your doctor. Under a doctor's supervision, many women take medication while breastfeeding. This is a decision to be made between you and your doctor.


Final thoughts: postpartum depression affects millions of women, but a healthy lifestyle may help

Postpartum depression affects around 1 in 8 women each year. Symptoms are similar to normal depression but may also include doubts about one’s ability to care for a baby. It can also present as worrying about the baby or feeling disconnected from him or her. This type of depression can feel isolating, scary, and confusing.

However, Keerti shows that you can beat depression with a healthy lifestyle, incorporating exercise and proper nutrition. Of course, don’t hesitate to see a licensed therapist or consider medication if this feels right for you. Above all, listen to your intuition, and know that the painful feelings will not last forever.


Psychosocial Theory

Specific neurophysiological and neurochemical changes in the brain are triggered by psychosocial stressors and interpersonal events that significantly change the neurotransmitter balance. It is considered that depression is related with psychosocial stressors, as described below.[30]

Psychodynamic theory

The psychodynamic point of view supports the idea that some unfinished business in women's childhood or family may cause more psychological troubles after birth.[31] Women have a tendency to imitate their own mother's role as soon as they become mother after birth, however, if there is a rejection in accepting their own mother's role, they have trouble coping or adapting to their new role of motherhood.[30] The outcome of the mother's role conflict can lead to rejecting the female identity as well as threaten her feminism.[30] Some experts have also noted that childbirth results in loss of their identity and leads to withdrawal of love, affection, and loss of independence.[31,32] Moreover, family's negative attitude affects women's well-being and results in the maladjustment of coping mechanisms.[31]

Cognitive psychology theory

The cognitive approach instead of postulating internal conflicts in psychodynamic theory emphasizes certain characteristics of personality which predispose new mothers to PPD. It is the unrealistic expectation of childbirth and motherhood which may cause mothers to be anxious, controlling, perfectionist, and exhibit compulsive tendencies.[33] Beck (1967) postulated that depressed mood is the result of thought disturbances.[34] Pessimism toward oneself, the world, and the future contributes to a depressive mood.[31,33,35] In addition, in the absence of suitable role models, the woman feels loss of control and anxiety resulting in a lack of a capability to cope with infant's demands and care.[31]

Social and interpersonal theory

Egeline (2008) contends that environment plays a significant role in an individual's life.[36] Attachment theory says that interpersonal struggles in an individual's life have significant influences on mental health. It is obvious that an individual requires affection which needs to be fulfilled in the initial stage of a relationship. Uncertainties concerning a relationship may result to disappointment and bring about depression and anxiety.[37] A number of interpersonal factors play a role in women's distress and sensitivity makes them prone to develop postpartum disorders. These include insufficient social support and marital conflicts.[38] Childbirth is a significant transitional event in life and support at this stage can potentially affect women's mental status after delivery.[39] Sudden psychosocial fluctuations within motherhood and its challenges coupled with stresses could be other factors that may trigger PPD.[20]

Behavioral theory

According to the behavioral theory, depressive episode can result from major life events that disrupt an individual's normal support pattern.[40] Life stressors and psychological problems such as parent's divorce, low parental emotional support, mother-daughter conflict, and self-esteem are predictors of PPD.[38]

The theory of operant condition paradigm claims that depression is a consequence of a decrease in the positive efficient reinforced behavior and could be a sign of obvious punishment for nonconformant behavior. It is also the result of a decrease in the accessibility of reinforcement events, personal ability to maneuver the environment, the impact of variety of events, or a combination of the above. Moreover, a negative feedback of social reinforcement behaviors may result from unavailability of support from family and other social networks such as social withdrawal. However, a low rate of positive reinforcement for mood-enhancing behavior and high rate of positive reinforcement for depressive behavior may be experienced by people who experience major stress originating from unexpected events.[40]

Evolutionary theory

Scholars have suggested relevant adaptive functions for PPD which are consistent with ideas of evolutionary theorists. Usually the women experiences negative effects such as gloomy and depressed mood due to problems concerning the infant, marital problems, and lack of social support associated with the social and family environment. Some women, who suffer from major PPD and with symptoms such as psychomotor retardation, weight loss, loss of interest in activities, lack of concentration, and constant suicidal thoughts may sometimes not seek social support. Moreover, actions that women take to reduce these psychological problems predispose her to PPD.[41]

From an evolutionary perspective, there are situations when it would be in the women's best interest to decrease her investment for a baby, for instance when there is a lack of sufficient social support to raise the newborn or when the child has a problem.[31,41]

According to evolutionary theorists, PPD results from an adaptive function that signals a potential fitness cost to the mother. Thus, PPD is not a dysfunction but rather an adaptive mechanism. It signals a mother who has suffered a social cost motivating her to evaluate whether to continue to or cease to provide care to her offspring. From this viewpoint, PPD is a universal phenomenon that appears in women around the world. As a result, in societies that give rise to the circumstances, its prevalence is reduced.[42]


Postpartum Depression Causes And Symptoms

Postpartum depression is a severe form of depression occurring after childbirth and pregnancy. One study found that out of ten thousand participants, one out of every seven mothers with newborns experienced postpartum depression. Although postpartum depression may begin any time in the first year of birth, it typically occurs within the first three weeks. Postpartum depression is unique to every pregnancy and may affect both experienced and first-time moms alike.

Symptoms

Symptoms of postpartum depression may include severe mood swings, excessive crying, sad feelings, change in appetite, intense anger and irritability, insomnia or fatigue, and apathy. Women suffering from postpartum depression may have difficulty bonding with their new baby or fear they are not a good mother. They may feel shame, guilt, and worthlessness, or have problems concentrating or thinking clearly. Severe cases may include panic attacks or thoughts of suicide or harming the new baby.

Postpartum Psychosis

Postpartum psychosis is a rare condition characterized by a more severe form of postpartum depression. It usually occurs during the first week of childbirth. Symptoms may include sleep disturbances, obsessive thoughts over the new baby, disorientation and confusion, paranoia, delusional thinking, hallucinations, and suicide attempts or efforts to harm the new baby. It is a serious condition that requires immediate treatment to prevent life-threatening thoughts or actions to both mom and baby.

Anxiety

Postpartum depression may present itself in forms other than depression. Some women may experience no depression at all but have extreme anxiety over the new baby. This may include crying spells when someone else holds the baby or anytime the mother has to put the baby down. Some women refuse help from friends or family because they feel the need to be the sole caretaker of the child, which results in extreme exhaustion and eventually may lead to depression.

Pitocin

Pitocin is a brand name of oxytocin used to induce childbirth by causing or strengthening contractions. It can also be used to control bleeding after childbirth and induce abortion. A study published in February of 2017 found that women who were exposed to oxytocin during childbirth had an increased risk of being diagnosed with postpartum depression or anxiety within the first year after birth compared to women who were not exposed to oxytocin.

Sleep Deprivation

New babies typically need to be fed every two to four hours. This can be draining and exhausting for the new mother, especially if she does not have the help of a partner, friends or family. Some babies also need to be held regularly, or they cry. Children often seek the comfort of their mothers over other family members, which can make it hard for the new mother to rest more than a few hours at a time.

Hormones

A woman experiences a significant increase of the hormones estrogen and progesterone while she is pregnant. When the baby is born, hormone levels suddenly drop, which may trigger psychological problems such as depression or anxiety. Other hormones produced by the thyroid gland may also rapidly fall, which can lead a woman feeling depressed, tired, and sluggish. The drop in hormones coupled with the demands of a newborn baby may contribute to depression or feelings of being overwhelmed.

Body Image

A woman&rsquos body changes dramatically after giving birth. Some women may experience postpartum depression after the baby is born due to the image of their new body. It may take some time before a woman returns to a healthy weight. Some women may also experience depression over C-section scars and other issues with their new postpartum body. The demands of a newborn may also prevent a new mom from having the energy or time to work on her appearance, which may also contribute to depression.

High Maintenance Babies

Although most women are well aware a new baby will change their life, they might experience a shock when the new baby comes. There is less time to spend on themselves and simple tasks such as showering, eating, and using the bathroom become challenging. This can be frustrating, depressing, and irritating. New babies may also become colicky, which makes them fussier than normal. This may affect how much a new mom can sleep.

Risk Factors

A woman&rsquos risk of postpartum depression increases if the pregnancy was unwanted or unplanned or if she is having problems in her relationship with her significant other. Job stress, health, and financial problems may also increase the risk of postpartum depression. Having a history of depression, anxiety or bipolar disorder also increases the risk. Babies with special needs or having difficulty breastfeeding may cause postpartum depression. Having a weak support system or lack of help with the new baby may cause sad feelings.

When To Seek Treatment

Women who experience depressive symptoms for longer than a few days or weeks should seek treatment to help cope with the daily stress of a new baby. Seek immediate treatment if feelings of suicide or thoughts of harming the baby are present. For many women, postpartum depression may get better over time however, seeking treatment can help make the day to day responsibilities easier. Speaking to a therapist a few times a week or taking an anti-depressant may help provide relief.


Causes of Postpartum Depression

Depression is a state of depression, despair, longing. Postpartum depression occurs in many young mothers. This affects the fear for the health and life of the baby. Often the fear that she will not cope with the duties of her mother, and her own tiredness after childbirth makes itself felt.

Postpartum depression most often affects mothers who have conflicted with their own mothers, and those who have not received maternal love at all.

Symptoms

Any disease has its own signs, and postpartum depression is no exception.

Symptoms that occur most often are:

  • anxiety
  • intrusive actions
  • palpitations
  • headache
  • lack of strength
  • feeling of sadness and panic
  • tearfulness
  • impaired appetite
  • sadness
  • insomnia
  • depression
  • feeling of complete loneliness.

Very often, a young mother is tormented by remorse caused by a sense of shame if she begins to consider herself not a good enough mother.

There are signs of postpartum depression when a woman is unable to perform maternal duties because lethargy and difficulties appear. Mothers during this period may not even respond to infants, since activity during this period decreases sharply.

One of the common symptoms is the refusal of a young mother to see a doctor. They often experience a deep sense of guilt when they do not quite cope with the difficulties of caring for the baby. Often an error occurs when they believe that with the help of maternal love, almost all problems can be solved, and they don’t imagine what the first days and months of caring for a child are.

A young mother is embraced by deep disappointment in her abilities, and she simply “gives up”. Daily constant worries take away not only physical, but also mental strength. And this often causes a feeling of helplessness.

After three months, a gloomy mood for the future may come, irritability and anxiety, inability to do daily necessary tasks.

Causes of Postpartum Depression

A depressed state, an inability to do anything, a fading interest in the environment is often a manifestation of postpartum depression in women after the birth of a baby. And it begins because often people just don’t notice how difficult it is for her, they don’t try to help, they don’t support in the very first weeks after the birth of the baby.

There are many factors that affect her condition and increase depression more and more. Among them are social, biological, interpersonal and psychological aspects.

The most common causes of postpartum depression are the following:

  • past depression
  • low standard of living
  • lack of family support
  • insufficient or completely absent husband’s help
  • alcoholism
  • there are no normal living conditions
  • difficult pregnancy
  • late pregnancy
  • termination of work and early departure on maternity leave
  • lack of emotional communication.

How to identify?

Many symptoms of depression are very similar to a little stress that can occur after childbirth. Therefore, the diagnosis must certainly be made by a doctor who has a woman after the birth of a child. Signs of postpartum depression may appear in the first days after the birth of the baby.

But still, some signs can be recognized on their own, as they are common symptoms of postpartum depression. For example, if a woman fails to fall asleep, even if she is very tired, and the child is sleeping calmly at this time.

Anxiety and constant tearfulness, irritability and changeable mood. Very often the appetite disappears, some are prone to sudden panic. Sometimes young mothers admit to doctors about suicidal thoughts that begin to visit them, or even negative emotions about their baby.

If you have any thoughts about causing harm to yourself or your baby, or if symptoms appear for more than 2 weeks, you should already consult a doctor so that the disease does not drag on.

How is depression treated?

Psychologists and treating doctors will be able to tell how to deal with postpartum depression, since treatment depends on its complexity and type. Common options are medications prescribed by your doctor.

Helps with postpartum depression treatment with sedatives and antidepressants. But when breastfeeding without a doctor’s prescription, medications should not be used, since they will affect the baby.

Psychotherapy helps with which a woman is restored to peace of mind and the disease recedes.
In addition, you can get rid of postpartum depression using other means, such as physical activity, trips to a beauty salon, aromatherapy, and much more.

Exercise helps, so daily exercise will not be superfluous. In addition, constant communication is necessary, a young mother needs to be periodically in public places, a movie or a cafe. Diets are excluded unless they are prescribed by a doctor. A young mother should eat well.

Beauty salons can work miracles with a woman’s mood. Especially after childbirth, when it seems to them that their body will no longer be the same. You can sign up for a massage, which can not only give the necessary rest, but also tighten the skin after childbirth.

Many doctors recommend not cognitive, but interpersonal therapy, the course of which includes many sessions focused on the role of the parent and the resolution of conflicts between spouses.

Essential oils also positively affect the normalization of the psychological and emotional state of a young mother and help cope with postpartum depression. They help reduce anxiety, get rid of despair, relieve irritability, insecurity and suicidal thoughts.

If possible, a young mother should take a warm bath with one of the following oils:

  • clary
  • bergamot
  • geranium
  • jasmine
  • incense
  • Melissa
  • grapefruit
  • rose flower
  • neroli oil
  • tangerine.

But when using oils, you need to remember that more than 6 drops per bath should not be used so as not to cause the opposite effect. In general, a warm bath alone will help relieve fatigue and irritation.

Help of relatives, relatives and friends is also important. Especially the husband. If possible, then at night the spouse can get up to the child, giving his wife a good night’s sleep before a hard day. It should be remembered that she really needs strength and relaxation.

In addition, visiting relatives or friends can very much help: sit with the child, prepare the necessary mixes, wash, walk, etc. That is, to give the young mother a little necessary “fresh sip” of freedom. In this case, the woman has time to sleep a little during the day, if she did not sleep well because of the baby at night, and the negative because of this disappears. Like irritability, that he is crying, and she “at least burst.” She becomes calmer and gradually the depression recedes.

Prevention

It is better not to bring to the treatment of postpartum depression. For this, prevention is preferable, which directly depends on the causes that led to the breakdown of a young mother.

Childbirth is a global hormonal restructuring of the whole organism, and often this causes a depression. Thanks to studies, it turned out that most often disorders occur in women whose motherhood did not live up to their expectations.

In order not to cause depression after childbirth, a woman still needs to discuss situations with her husband during pregnancy, prioritize responsibilities, be prepared for the difficulties that may arise when caring for a child.

Psychologically prepare for the fact that at first it will be difficult, even despite the support of the spouse.

An ideal option when you can agree with friends or relatives so that they help the first time. Since you may not have time to do the necessary things with the habit, and as a result, a panic may develop, developing into irritability and postpartum depression.

It is necessary to solve in advance all issues related to the first weeks of a young mother’s stay at home. It is best to pre-prepare the necessary (even with a margin): diapers, vests, toys, bottles, etc. In this case, you can delay the washing for a short time if the baby is capricious. And having laid it, calmly overtake everything.

When the question arises about postpartum depression, how long this condition lasts – it is impossible to answer it, as it is individual, and a lot depends on the environment of the woman and those who help her to cope with this condition.