Topic Overview
Is this topic for you?
This topic is about major depression triggered by childbirth. It is different from the "baby blues," which many women have in the first couple of weeks after childbirth. For more information, see Baby Blues.
What is postpartum depression?
Postpartum
depression is a serious illness that can occur in the first few months after
childbirth. It also can happen after
miscarriage and stillbirth.
Postpartum
depression can make you feel very sad, hopeless, and worthless. You may have
trouble caring for and bonding with your baby.
Postpartum
depression is not the "baby blues," which usually go away within a
couple of weeks. The symptoms of postpartum depression can last for
months.
In rare cases, a woman may have a severe form of
depression called
postpartum psychosis. This is
an emergency, because it can quickly get worse and put her or others in
danger.
It's very important to get treatment for depression. The
sooner you get treated, the sooner you'll feel better and enjoy your
baby.
What causes postpartum depression?
Postpartum
depression seems to be brought on by the changes in
hormone levels that occur after pregnancy. Any woman
can get postpartum depression in the months after childbirth, miscarriage, or
stillbirth.
You have a greater chance of getting postpartum
depression if:
- You've had
depression or postpartum depression
before.
- You have poor support from your partner, friends, or
family.
- You have a sick or
colicky baby.
- You have a lot of other
stress in your life.
You are more likely to get postpartum psychosis if you or
someone in your family has
bipolar disorder (also known as
manic-depression).
What are the symptoms?
A woman who has postpartum
depression may:
- Feel very sad, hopeless, and empty. Some
women also may feel
anxious.
- Lose pleasure in everyday
things.
- Not feel hungry and may lose weight. (But some women feel
more hungry and gain weight).
- Have trouble
sleeping.
- Not be able to concentrate.
These symptoms can occur in the first day or two after
the birth. Or they can follow the symptoms of the baby blues after a couple of
weeks.
If you think
you may have postpartum depression, take a short quiz to check your symptoms:
- Interactive Tool: Are You Depressed?
A woman who has
postpartum psychosis may feel cut off from her baby. She may see and hear
things that aren't there. Any woman who has postpartum depression can have
fleeting thoughts of suicide or of harming her baby. But a woman with
postpartum psychosis may feel like she has to act on these thoughts.
If you think you can't keep from hurting yourself, your baby, or someone
else, see your doctor right away or call 911 for emergency medical care. For
other resources, call:
- The
national suicide hotline at 1-800-273-TALK (1-800-273-8255).
- The National Child Abuse Hotline at 1-800-4-A-CHILD (1-800-422-4453).
How is postpartum depression diagnosed?
Your
doctor will do a physical exam and ask about your symptoms.
Be
sure to tell your doctor about any feelings of baby blues at your first checkup
after the baby is born. Your doctor will want to follow up with you to see how
you are feeling.
How is it treated?
Postpartum depression is
treated with counseling and antidepressant medicines. Women with milder
depression may be able to get better with counseling alone. But many women need
both. Moms can still breastfeed their babies while taking certain antidepressants.
To help yourself get better, make sure you eat well,
get some exercise every day, and get as much sleep as possible. Get support
from family and friends if you can.
Try not to feel bad about
yourself for having this illness. It doesn't mean you're a bad mother. Many
women have postpartum depression. It may take time, but you can get better with
treatment.
Frequently Asked Questions
Learning about postpartum depression: | |
Being diagnosed: | |
Getting treatment: | |
Ongoing concerns: | |
Cause
Postpartum depression seems to be
triggered by the sudden
hormone changes that happen after childbirth, miscarriage, or stillbirth. This is more likely in women who have certain risk factors, including previous depression. For more information, see What Increases Your Risk.
Symptoms
The two most common symptoms of depression are:
- Feeling sad or hopeless nearly every
day.
- Losing interest in or not getting pleasure from most daily
activities, and feeling this way nearly every day.
An especially serious symptom of depression is thinking about death and
suicide. Some women with postpartum depression have fleeting, frightening thoughts of harming their babies.
Nearly every day, you may also:
- Lose or gain weight. You may also feel like eating more or less
than usual.
- Sleep too much or not enough. You may also have trouble sleeping, even when your baby is sleeping.
- Feel restless and not be able to sit still, or you may sit
quietly and feel that moving takes great effort. Others can easily see this
behavior.
- Feel unusually tired or as if you have no energy.
- Feel unworthy or guilty. You may have low
self-esteem and worry that people don't like you.
- Find it hard to focus, remember things, or make decisions. You may feel anxious or worried about things.
Are you depressed?
If you have
at least five of the above symptoms for 2 weeks or longer, and one of the
symptoms is either sadness or loss of interest, you may have depression and may
need treatment.
Even if you have fewer symptoms, you may still
be depressed and may benefit from treatment. No matter how many symptoms you
have, it's important to see your doctor. The sooner you get treatment, the
better your chance for a quick and full recovery.
If you think you may
have depression, take a short quiz to check your symptoms:
- Interactive Tool: Are You Depressed?
Postpartum psychosis
This severe condition is most likely to affect women who have
bipolar disorder or a history of
postpartum psychosis. Symptoms, which usually start
during the first 3 weeks (as soon as 1 to 2 days) after childbirth,
include:
- Feeling removed from your baby, other people,
and your surroundings (depersonalization).
- Disturbed sleep, even
when your baby is sleeping.
- Extremely confused and disorganized
thinking, increasing your risk of harming yourself, your baby, or another
person.
- Drastically changing moods and
bizarre behavior.
- Extreme agitation or restlessness.
- Hallucinations. These often involve sight, smell, hearing,
or touch.
- Delusional thinking that isn't based in
reality.
Postpartum psychosis is considered an emergency requiring
immediate medical treatment. If you have any psychotic symptoms,
seek emergency help right away. Until you tell your
doctor and get treatment, you are at high risk of suddenly harming yourself or
your baby.
What Happens
Symptoms of postpartum depression start in the weeks to months after childbirth, miscarriage, or stillbirth.
In some
cases, symptoms peak after slowly building for 3 or 4 months.
Fathers of new babies or partners of new moms can also experience postpartum depression.
Postpartum depression makes it
hard for you to function well. This includes caring for and bonding with your baby.
In rare cases, dangerous
postpartum psychosis symptoms can
occur within the first few postpartum weeks, as soon as a few days
after childbirth.
Early treatment counts
Early treatment is important for you, your
baby, and the rest of your family. The sooner you start, the more quickly you
will recover. And there's less chance that your depression will affect your baby. Babies of
depressed mothers might be less attached to their mothers and might lag behind
developmentally in behavior and mental ability.
For more information about who is more likely to have postpartum depression, see What Increases Your Risk.
What Increases Your Risk
A risk factor is anything that increases your chances of having a certain problem. Risk factors for postpartum depression include:
- A history of postpartum depression. This puts you at high risk of having it again.
- Poor support from family, partner, and
friends.
- High life stress, such as a sick or
colicky newborn, financial troubles, or family
problems.
- Physical limitations or
problems after childbirth.
- Depression during a current pregnancy.
- Previous depression.
- Bipolar disorder, also known as
manic-depression. It also increases the risk of dangerous
psychotic behavior after childbirth.
- A family history of depression or bipolar
disorder.
- Previous
premenstrual dysphoric disorder (PMDD), which is the
severe type of
premenstrual syndrome (PMS).
Risk factors for postpartum
psychosis include:
- A personal or family history of
bipolar disorder.
- Previous postpartum
psychosis.
When To Call a Doctor
Call 911, the national suicide hotline at 1-800-273-TALK (1-800-273-8255), the National Child Abuse Hotline at 1-800-4-A-CHILD (1-800-422-4453), or other emergency services right away if:
- You or someone you know is thinking seriously of suicide or has recently tried suicide. Serious signs include these thoughts:
- You have decided on how to kill yourself, such as with a weapon or medicines.
- You have set a time and place to do it.
- You think there is no other way to solve the problem or end the pain.
- You feel you cannot stop from hurting yourself, your baby, or someone else.
Call a doctor right away if:
- You hear voices.
- You have been thinking about death or suicide a lot, but you do not have a suicide plan.
- You are worried that your feelings of depression or thoughts of suicide are not going away.
Seek care soon if:
- You have symptoms of depression, such as:
- Feeling sad or hopeless.
- Not enjoying anything.
- Having trouble with sleep.
- Feeling guilty.
- Feeling anxious or worried.
- You have been treated for depression for more than 3 weeks, but you are not getting better.
Who to see
Your
pregnancy health professional may be the first person to note and
diagnose postpartum depression. This is one of many reasons why it's important to have a medical
check 3 to 6 weeks after childbirth.
Diagnosis and treatment of postpartum
depression can be provided by a:
Counseling can be provided by a:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
For part of your postpartum checkup, your doctor typically asks you about your moods and emotions.
Your
doctor may check your
thyroid-stimulating hormone (TSH) levels to make sure
a
thyroid problem isn't causing any depression symptoms.
Early detection
If you have had
depression,
postpartum depression, or
postpartum psychosis before, are now pregnant and have
depression, or have
bipolar disorder, ask your doctor and family members
to watch you closely. Some experts suggest that high-risk women have their
first postnatal checkup 3 or 4 weeks after childbirth, rather than the usual 6
weeks.
Treatment Overview
Talk to your doctor about your symptoms, and together you can decide what
type of treatment is right for you.
Treatment choices include:
- Counseling for both you and your
partner. Counseling can give you emotional support and help with problem solving and goal setting. For more information, see Other Treatment.
- Antidepressant medicine. It
relieves symptoms of postpartum depression for most women. For more information, see Medications.
Women with moderate to severe postpartum depression are advised to
combine counseling with antidepressant medicine. Women with mild depression are likely to
benefit from counseling alone.
You may also benefit from:
- A part-time or full-time mother's helper.
- Parent coaching or infant massage classes, for
strengthening mother-baby attachment.
How long do you need to take antidepressant medicine?
Antidepressants are typically used for 6
months or longer, first to treat postpartum depression and then to prevent a
relapse of symptoms.
To prevent a relapse, your doctor may recommend that you
take medicine for up to a year before considering tapering off of it. Women who have had several bouts of depression may need to take medicine for a long time.
Prevention
Keeping your body and mind strong and healthy will help reduce the effects of hormone changes and stress that come with childbirth.
- Ask for help from others so you can get as
much sleep, healthy food, exercise, and overall support as possible.
- Stay away from alcohol, caffeine, and other drugs or medicines
unless recommended by your doctor.
- If you are worried about postpartum depression, have your
first postnatal checkup 3 or 4 weeks after childbirth rather than the usual 6
weeks.
High-risk women
Women whose risk is higher for the reasons listed below may want to take extra steps to prevent postpartum depression.
- A history of depression. If you have no depression symptoms late in a first
pregnancy,
watchful waiting is recommended. But if you have a
history of severe depression, some experts recommend counseling and support
before childbirth. You and your doctor may choose to start antidepressant
medicine after the birth, particularly if you have had postpartum depression before.
- Depression: Should I Take Antidepressants While I'm Pregnant?
- A history of postpartum depression. After
childbirth, don't wait for symptoms to appear. Start with counseling and support
(some women start counseling a couple of months before childbirth). You and
your doctor may choose a combination of counseling and an
antidepressant.
- Depression during your pregnancy. If you took an
antidepressant medicine during pregnancy, continue taking it after the birth to reduce your high risk of postpartum depression.
- Domestic violence. The potential for domestic violence increases during a
woman's pregnancy and when a couple is adjusting to a new baby. If your partner
is violent or emotionally abusive, you and your baby are physically at risk,
and you have a higher risk of postpartum depression. Now more than ever, it's
crucial that you protect yourself and your baby. Seek support and help. For more
information, see the topic
Domestic Violence.
Home Treatment
Postpartum depression is a medical condition. It's not a sign of weakness. Be honest
with yourself and those who care about you. Tell them about your struggle. You,
your doctor, and your friends and family can team up to treat your
symptoms.
There's a lot you can do for yourself at home to cope with postpartum depression, from getting regular exercise to joining a support group.
- Depression: Managing Postpartum Depression
Medications
Antidepressants are commonly used, usually in combination
with counseling and support.
You may start to feel
better within 1 to 3 weeks of taking antidepressant medicine. But it can take
as many as 6 to 8 weeks to see more improvement. If you have questions or
concerns about your medicines, or if you don't notice any improvement by 3
weeks, talk to your doctor.
- Depression: Taking Antidepressants Safely
- Depression: Dealing With Medicine Side Effects
Antidepressants are typically
used for at least 6 months, first to treat postpartum depression and then to
prevent a relapse of symptoms. To prevent a relapse, your doctor may recommend
that you take medicine for up to a year before you think about stopping it.
Women who have had several bouts of depression may need to take medicine for a long time.
Can you take antidepressant medicine and breastfeed your baby?
Treating your depression is very important for your baby.
Breastfeeding is good for your baby's health. And it's good for your
baby's bond with you. At best, you will be able to treat your depression
and breastfeed your baby. But if you decide to choose
between taking medicine and breastfeeding, take the medicine.
Medicine choices
- Antidepressants, such as fluoxetine (Prozac), sertraline (Zoloft) and amitriptyline, are generally thought to be safe for use while breastfeeding. Check with your doctor to be sure.
- Selective serotonin reuptake inhibitors (SSRIs) are
usually the first-choice medicines. Most
SSRIs are thought to be safe for use while a woman is breastfeeding. That's because SSRIs generally pass into the breast milk at low levels.
- Tricyclics are generally thought to be safe for use while a woman is breastfeeding.
Other Treatment
Poor family and social support
and high stress raise the risk of
postpartum depression. For this reason, every
woman with a new baby needs plenty of support from family and friends. Any
special care you get will help you get through the challenges of the postpartum
period.
Counseling
Counseling helps
prevent and treat depression during pregnancy and after childbirth. To improve treatment success, both parents should try to take part.
Your doctor may recommend a licensed counselor who
specializes in treating postpartum depression. To effectively treat
depression, it's important that you and your counselor have a comfortable
relationship.
Alternative treatment
- Light therapy hasn't
been widely studied for postpartum depression. But it helps depression during pregnancy, winter-related depression (seasonal affective disorder), and general
depression.
- Parent coaching
offers both education and support for handling baby care and problems as well
as for the personal and couple transition into parenthood.
- Infant
massage classes teach you skills for physically and emotionally bonding with
your baby. And they give you a chance to spend time with other mothers.
In rare cases,
electroconvulsive therapy is used to treat
severe forms of depression. It works well as short-term treatment.
Other Places To Get Help
Organizations
American Congress of Obstetricians and Gynecologists
(ACOG)
www.acog.org
Postpartum Support International (U.S.)
www.postpartum.net
References
Other Works Consulted
- Abajo FJ, Garcia-Rodriguez LA (2008). Risk of upper gastrointestinal tract bleeding associated with selective serotonin reuptake inhibitors and venlafaxine therapy. Archives of General Psychiatry, 65(7): 795-803.
- American College of Obstetricians and Gynecologists (2008, reaffirmed 2009). Use of psychiatric medications during pregnancy and lactation. ACOG Practice Bulletin No. 92. Obstetrics and Gynecology, 111(4): 1001-1020.
- American College of Obstetricians and Gynecologists (2010). Screening for depression during and after pregnancy. ACOG Committee Opinion No. 453. Washington, DC: American College of Obstetricians and Gynecologists.
- Craig MC (2016). Postnatal depression: Drug treatments. BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/1407/overview.html. Accessed April 15, 2016.
- O'Hara MW, Segre LS (2008). Psychologic disorders of pregnancy and the postpartum period. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 504-514. Philadelphia: Lippincott Williams and Wilkins.
- Spinelli MG (2009). Postpartum psychosis: Detection of risk and management. American Journal of Psychiatry, 166(4): 405-408.
- Yonkers KA (2014). Management of depression and psychoses in pregnancy and in the puerperium. In RK Creasy et al., eds., Creasy and Resnik's Maternal-Fetal Medicine, 7th ed., pp. 1122-1131. Philadelphia: Saunders.
Credits
ByHealthwise Staff
Primary Medical ReviewerPatrice Burgess, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Specialist Medical ReviewerLisa S. Weinstock, MD - Psychiatry