Postpartum depression: A manual for new parents with big feelings

What Is Postpartum Depression?

Postpartum depression (PPD) is a serious but common complication of childbirth that can affect both moms and dads. Most doctors diagnose any depressive episode that occurs within the first year after childbirth as postpartum depression. A depressive disorder that begins during pregnancy or within four weeks after delivery is technically known as perinatal depression (PND). But for the purposes of this guide, we’ll refer to all depressive episodes with onset in the year after delivery as PPD. 

What Are the Symptoms of Postpartum Depression?

It can be hard to distinguish between PPD and normal, postnatal life because both can involve drastic changes in daily functioning. Postpartum depression shares all the symptoms of major depression, but with a teeny tiny baby involved. These symptoms include:

• Severe, lingering sadness
• Anhedonia (loss of pleasure and interest)
• Extreme feelings of guilt or worthlessness

In PPD, the loss of interest that can characterize major depression might now apply to a parent’s feelings toward her newborn. That’s normal. A new mom or dad could have trouble with acute caregiving demands due to feelings of sadness, emptiness, or extreme fatigue. These overwhelming emotions might prevent parents from bonding with their infant, leading to negative consequences for parents and children alike. 

What Are the Diagnostic Criteria for Postpartum Depression?

Major depression disorder (MDD) and postpartum depression both have the same diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which psychiatrists use to diagnose and treat mental health conditions. There are nine PPD criteria in all, but a person only has to meet five of them, for at least two weeks, to qualify as clinically depressed:   

• Depressed mood for most of the day, nearly every day. You might burst into tears for no reason. You might feel incredibly sad, empty, or hopeless. Other people will probably notice your change in mood.
• Markedly diminished interest or pleasure in activities you used to enjoy. In the case of PPD, a new mom might not feel interested in bonding with her baby.
• Significant, unintentional weight loss or weight gain, or change in appetite. But keep in mind that a woman who just gave birth is experiencing hormonal changes that can naturally affect weight and appetite.
• Insomnia (inability to sleep) or hypersomnia (sleeping too much). Again, new parents also experience upsets in sleeping patterns due to round-the-clock caregiving.
• Psychomotor agitation (sped-up thoughts and actions) or psychomotor hindrance (slowed-down thoughts and actions).
• Fatigue or loss of energy.
• Feelings of worthlessness or excessive or inappropriate guilt. Someone with PPD might feel like a terrible mother, for example. 
• Diminished ability to think or concentrate, or indecisiveness.
• Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for suicide. 

A rare variation of PPD is postpartum psychosis, in which a person might hallucinate or imagine harming their child.

What Is the Difference Between Postpartum Depression and the "baby blues"?

The “baby blues” and the “maternity blues” are synonymous names for the wild mood swings that might occur in the days after childbirth. These moods can involve sadness, anxiety, irritability, fear, difficulty concentrating, and other forms of emotional distress. 

The majority of new moms experience these episodes. But the baby blues fade or go away in fewer than two weeks. Usually, the feelings are related to fluctuating hormones and the radical transition of having a newborn in the house. If the mood swings are severe and last longer than two weeks, then they may call for a PPD screening. 

How Common Is Postpartum Depression?

Postpartum depression is incredibly common, affecting about 13% of mothers and 10% of fathers in the first year after childbirth. It’s so common that health providers routinely screen for it during and after pregnancy. It’s important to seek medical intervention for PDD to prevent adverse outcomes for parents and baby. 

How Long Does Postpartum Depression Last?

If your postpartum depression symptoms endure past your child’s first birthday, mental health experts may begin to call it major depressive disorder. But the timeline for PDD can vary from person to person. For 38% of mothers, PDD can develop into chronic depression. But these mothers may have already been depressed or dysthymic before pregnancy.  

Can Postpartum Depression Start Before Birth?

If a woman is depressed while pregnant, the condition is referred to as perinatal depression (PND) or antenatal depression (AND). If someone is diagnosed with depression after birth, then it’s called PND or postpartum depression (PPD). Women who experience depression during pregnancy might feel ashamed if they feel a social expectation to be happy, glowing, and perpetually rubbing their baby bump with a smile on their face. But that’s not always the case. Unfortunately, doctors sometimes overlook a pregnant woman’s mental health because they’re focused on her and the baby’s physical health.

What Causes Postpartum Depression?

There is no single cause for postpartum depression. Certainly, new parents who have experienced depressive episodes in the past are more at risk (more on risk in the section below). The following biological and environmental factors may also contribute to PPD:

• Sudden change in hormones immediately following childbirth
• Changes in your blood volume, blood pressure, immune system, and metabolism, which can contribute to fatigue and mood swings
• Sleep deprivation
• Anxiety about your role as a new caregiver, perhaps feeling as if you’re not up to the task of handling the new role
• Difficulty breastfeeding
• Lack of support from a partner or other loved ones
• Financial difficulties

Who Is at Risk of Developing Postpartum Depression?

Being high-risk for postpartum depression doesn’t mean that you’ll develop PPD, but you should take more care with health screening and self-monitoring. The following factors may dispose you more to developing PPD:

• Depression during pregnancy (aka antenatal or prenatal depression) 
• Domestic abuse
• History of depression
• Low self-esteem
• Maternity blues
• Stressful life events
• Poor marital quality
• Poor social support
• Low socioeconomic status
• Unintended pregnancy
• Difficult childbirth/obstetrical stressors
• Infant with a challenging temperament
• More sensitivity to a sudden drop in estradiol (a female hormone) levels 
• Genetic variations on specific chromosomes

Can Men Develop Postpartum Depression?

Fathers develop postpartum depression at slightly lower rates than moms, but yes, they do experience PPD. Interestingly, paternal depression is correlated with maternal PPD, suggesting that dads may get depressed in response to their partner’s moods.

How Can I Prevent Postpartum Depression?

• Counseling. A therapist can give you tools to cope with stress, manage your expectations, and combat negative self-talk. 
• Medication. Reproductive psychiatrists specialize in working safely with women who experience mental health conditions during pregnancy and breastfeeding. Many women are reluctant to take medication that might cross the placental barrier, but sometimes it’s worse for the baby’s health to have a mother with depression. Antidepressants can take 6-8 weeks to start working, so if you have a history of depression and you’re worried about PPD, it might be wise to talk to your doctor about safe drug treatments before your due date.
• Support system. Establish your support system before giving birth. Delegate future tasks like meal preparation and decide who you’re comfortable being vulnerable with from day to day. That person may not be your mother-in-law, but it could be your best friend or neighbor. Be prepared to ask for help. 
• Learn your triggers. Not to fixate on this hypothetical mother-in-law, but if you already know that she pushes your buttons, have boundaries in place during the sensitive postpartum period. 

How Is Postpartum Depression Treated?

Postpartum depression is treated effectively in most of the same ways that major depressive episodes are treated, with psychotherapy and psychiatric medications. The following supports have proved extremely beneficial for parents experiencing this difficult, but highly treatable mental health condition:

• Interpersonal psychotherapy (IPT), a short-term talk therapy that aims to alleviate the symptoms of depression and address interpersonal problem areas.
• Cognitive behavioral therapy (CBT), an evidence-based method of modifying maladaptive thoughts and beliefs to relieve the symptoms of depression.
• Medications like SSRIs or hormonal treatments, which can target underlying physiological issues that might contribute to depressive disorders.
• Psychosocial interventions, which might include support groups, tangible assistance, or care coordination

And remember, getting the help you need isn’t selfish. When parents are treated for their postpartum depression, their children benefit as well.

How Do I Cope with My Postpartum Depression?

If you’re experiencing postpartum depression, try not to despair. It’s a very common, treatable condition. Don’t waste energy beating yourself up for not meeting some unreasonable standard of Mom or Dad perfection. You can only be the parent that you are. Your priority should be getting the mental health support you need. Be gentle with yourself. Don’t try to do it all by yourself. And trust that your child will be okay. Kids are super resilient, and the best thing you can do for them in the long-term is to make sure you’re happy and healthy.