Postpartum depression (PPD) is a serious depression * occurring within the first year after giving birth and lasting more than a few weeks.
Many new mothers experience the “baby blues,” also called maternal or postpartum blues. This is hardly surprising considering that the female hormones * estrogen * and progesterone * , which are maintained at very high levels during pregnancy, drop precipitously during the first 24 hours after giving birth. Giving birth is also a life-changing experience for all mothers, and having a new baby is both stressful and exhausting. However, women who suffer from postpartum depression have feelings of anxiety * , sadness, or emptiness that interfere with their daily routines and possibly with their ability to care for the baby. Women who are predisposed to stress and depression may have a particularly hard time coping with the fatigue that accompanies caring for a newborn.
Characteristics associated with PPD may include the following:
Although the precise cause of PPD is unknown, physical, emotional, and lifestyle factors can all contribute. Women suffering from PPD are thought to have an increased genetic * susceptibility to depression resulting from hormonal changes, including those that occur during their monthly menstrual cycle * .
However, an abrupt drop in female hormones is only one of the physiological changes that accompanies giving birth. During pregnancy the endocrine * system's stress response is damped down. In most cases the stress response returns to its normal pre-pregnancy level following delivery. In women with PPD, however, the endocrine system can overreact to stress, producing too much of the stress hormone cortisol. A woman's inability to filter out irrelevant or stressful stimuli * also has been associated with PPD.
The levels of thyroid gland * hormones may drop sharply after giving birth, leading to low energy, fatigue, and depression. Postpartum levels of neurotransmitters * * can further contribute to fatigue and mood swings.
Other factors that can contribute to PPD include the following:
Symptoms of PPD can vary greatly, but they include symptoms of clinical depression lasting more than two weeks:
Women with PPD may be overprotective of their babies or behave in a hypervigilant manner. They may also have difficulty bonding with their babies. Symptoms of severe PPD include the following:
No one diagnostic tool is used to identify postpartum depression. Detection of PPD can be complicated, in part because the symptoms are similar to that of major depression. Also, a period of adjustment is to be expected after the birth of a child and first time mothers may not recognize the symptoms. Cultural differences may make it difficult to ask for help. Social pressures to be a good mother may lead women with PPD to attempt to hide it. They may feel embarrassed, ashamed, or guilty about their feelings. Physicians sometimes administer a questionnaire to distinguish between PPD and the postpartum blues. A simple blood test can determine whether thyroid hormone levels are low.
PPD usually can be treated effectively with antidepressant medications * . There are antidepressants available that are unlikely to cause side effects * in breastfeeding infants. Medication is often combined with other treatments, especially supportive talk therapy with a psychologist * , psychiatrist * , therapist, or social worker. Talk therapy can help women work through problems and learn to change the ways that depression causes them to think, feel, and act. Sometimes psychotherapy * alone is used to treat PPD. Support groups or marriage or family counseling can also help. Exercise and good nutrition can improve mood and aid in recovery. Caffeine should be avoided, since it can trigger anxiety and mood swings.
Hormone replacement therapy is sometimes used to treat PPD. Estrogen replacement therapy can restore estrogen levels and may ease PPD symptoms. Thyroid medicine is effective against depression stemming from low levels of thyroid hormones.
Alternative therapies that may help relieve PPD include the following:
With treatment PPD usually eases within a few months. Halting treatment early can lead to relapse. Even with treatment women with PPD are more likely to have subsequent major depressive episodes.
Women with untreated PPD may have difficulty caring for their babies and accomplishing other tasks. This situation, in turn, can intensify feelings of low self-esteem * , guilt, and depression. Untreated PPD may last for a year or longer and progress into a chronic depressive disorder.
Researchers believe that untreated PPD can adversely affect babies, possibly resulting in the following:
Women with a history of depression should be monitored for a recurrence as soon as they become pregnant. Early recognition of PPD can lead to early treatment, minimizing its impact. Women with a history of PPD are sometimes started on antidepressants as soon as they give birth.
Some scientists believe that breastfeeding can help prevent PPD in some women. Lactating women have diminished neuroendocrine and behavioral responses to at least some types of stressors, other than those that present a threat to the infant.
Techniques for preventing or managing PPD include the following:
See also Depressive Orders: Overview • Pregnancy
Belluck, Pam. “Thinking of Ways to Harm Her.” The New York Times. June 15, 2014. http://www.nytimes.com/2014/06/16/health/thinking-of-ways-to-harm-her.html (accessed November 12, 2015).
Kleiman, Karen R., and Valerie Davis Raskin. This Isn't What I Expected: Overcoming Postpartum Depression, 2nd ed. Boston, MA: Da Capo, 2013.
Paul, Maria. “Surprising Rate of Women Have Depression after Childbirth.” Northwestern University. March 13, 2013. http://www.northwestern.edu/newscenter/stories/2013/03/surprising-rate-of-women-have-depression-after-childbirth.html (accessed November 12, 2015).
MedlinePlus. “Postpartum Depression.” U.S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/postpartumdepression.html (accessed August 12, 2015).
National Institute of Mental Health. “Postpartum Depression Facts.” National Institutes of Health. http://www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml (accessed November 12, 2015).
National Institute of Mental Health. Science Writing, Press, and Dissemination Branch, 6001 Executive Blvd., Room 6200, MSC 9663, Bethesda, MD 20892. Toll-free: 866-615-6464. Website: http://www.nimh.nih.gov (accessed November 11, 2015).
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* depression (de-PRESH-un) is a mental state characterized by feelings of sadness, despair, and discouragement.
* hormones are chemical substances that are produced by various glands and sent into the bloodstream carrying messages that have certain effects on other parts of the body.
* estrogen (ES-tro-jen) is a steroid hormone that stimulates the development of female sexual characteristics and maintenance of the female reproductive system.
* progesterone (pro-JES-teh-ron) is a female steroid sex hormone that prepares for and supports pregnancy.
* anxiety (ang-ZY-e-tee) can be experienced as a troubled feeling, a sense of dread, fear of the future, or distress over a possible threat to a person's physical or mental well-being.
* bipolar disorder is a group of mood disorders that are characterized by alternating episodes of depression and mania.
* genetic (juh-NEH-tik) refers to heredity and the ways in which genes control the development and maintenance of organisms.
* menstrual cycle (MEN stroo-al SY-kul) culminates in menstruation (men-stroo-AY-shun), the discharging through the vagina of blood, secretions, and tissue debris from the uterus that recurs at approximately monthly intervals in females of reproductive age.
* endocrine (EN-do-krin) refers to a group of glands, such as the thyroid, adrenal, and pituitary glands, and the hormones they produce. The endocrine glands secrete their hormones into the bloodstream, and the hormones travel to the cells that have receptors for them.
* stimuli (STIM-yoo-lie) are agents in the environment that excite a response or reaction. Stimuli might cause a person to function, become active, or respond. The singular form is stimulus.
* thyroid gland (THY-roid GLAND) is located in the lower part of the front of the neck. The thyroid produces hormones that regulate the body's metabolism (me-TABo-LIZ-um), the processes the body uses to produce energy, to grow, and to maintain body tissues.
* neurotransmitters (NUR-o-tranzmit-erz) are chemical substances that transmit nerve impulses, or messages, throughout the brain and nervous system and are involved in the control of thought, movement, and other body functions.
* immune system (im-YOON SIStem) is the system of the body composed of specialized cells and the substances they produce that help protect the body against disease-causing germs.
* paranoia (pair-a-NOY-a) refers to either an unreasonable fear of harm by others (delusions of persecution) or an unrealistic sense of self-importance (delusions of grandeur).
* antidepressant medications are used for the treatment and prevention of depression.
* side effects are unwanted symptoms that may be caused by vaccines or medications.
* psychologist (sy-KOL-uh-jist) is a mental health professional who treats mental and behavioral disorders by support and insight to encourage healthy behavior patterns and personality growth. Psychologists also study the brain, behavior, emotions, and learning.
* psychiatrist (sy-KY-uh-trist) is a medical doctor who has completed specialized training in the diagnosis and treatment of mental illness. Psychiatrists can diagnose mental illnesses, provide mental health counseling, and prescribe medications.
* psychotherapy (sy-ko-THER-apea) is the treatment of mental and behavioral disorders by support and insight to encourage healthy behavior patterns and personality growth.
* self-esteem is the value that people put on the mental image that they have of themselves.