Depression: Managing postpartum depression

Introduction

If you have the "baby blues" after childbirth, you're not alone—about half of women have a few days of mild depression after having a baby.1 However unsettling, a certain amount of insomnia, irritability, tears, overwhelmed feelings, and mood swings are normal. Baby blues usually peak around the fourth postpartum day and subside in less than 2 weeks, when hormonal changes have settled down. But you can have bouts of baby blues throughout your baby's first year.

If your depressed feelings have lasted more than 2 weeks, your body isn't recovering from childbirth as expected. Postpartum depression:

  • Is very common, affecting 1 in 8 women during the first months of their babies' lives.2
  • Is a serious medical condition that can be prolonged and disabling without treatment and can affect a baby's development.
  • Is best treated with counseling and an antidepressant medicine.3
  • Can further improve when you take some home treatment measures.

To prevent serious problems for you and your baby, now is the time to work with your doctor to treat your symptoms.

If you are having thoughts of hurting yourself, your baby, or anyone else, see your doctor immediately or call 911 for emergency medical care.

 

Postpartum depression is more than a temporary feeling of sadness or lack of energy—it is a medical condition that develops some time in the first several months after childbirth. It seems to be triggered by the normal hormonal changes that occur after pregnancy. These hormonal changes are especially likely to lead to postpartum depression if you've had depression before, are under a lot of additional stress, or have poor support from your partner, friends, or family.2

You probably have postpartum depression if you've had five or more of the following symptoms (including at least one of the first two symptoms) for most of each day over the past 2 weeks:2

  1. Depressed mood—tearfulness, hopelessness, and feeling empty inside, possibly with severe anxiety
  2. A significant loss of pleasure in either all or almost all of your daily activities
  3. Appetite and weight change—usually a drop in your appetite and weight, but sometimes the opposite
  4. Sleep problems—usually insomnia, even when your baby is sleeping
  5. Noticeable changes in how you walk and talk—usually restlessness, but sometimes sluggishness
  6. Extreme fatigue or loss of energy
  7. Feeling worthless or having inappropriate guilt
  8. Difficulty concentrating and making decisions
  9. Thinking a lot about death or suicide

If you think you have postpartum depression after reviewing this list, click here to fill out and print a postpartum depression checklist(What is a PDF document?) to take to your doctor. Early treatment is important for both you and your baby.

Test Your Knowledge

I know I'm supposed to be happy about having a baby, but I feel hopeless and unhappy. But I don't have all of the symptoms on the list. Should I see my doctor?

  • Yes
    This answer is correct.

    You don't necessarily have all possible depression symptoms when you have depression. Regardless of how many symptoms you have, talk to your doctor sooner rather than later, before it gets worse.

  • No
    This answer is incorrect.

    You don't necessarily have all possible depression symptoms when you have depression. Regardless of how many symptoms you have, talk to your doctor sooner rather than later, before it gets worse.

  •  

I've never had a problem with depression before. Do I have any risk of postpartum depression?

  • Yes
    This answer is correct.

    Every woman has a risk of postpartum depression during the first 3 months after childbirth. Women with a history of depression have an even greater risk.

  • No
    This answer is incorrect.

    Every woman has a risk of postpartum depression during the first 3 months after childbirth. Women with a history of depression have an even greater risk.

  •  

Continue to Why?

 

Postpartum depression affects both you and your baby. It interferes with your ability to function normally, including caring for and bonding with your baby. Babies of depressed mothers tend to lag behind developmentally in behavior and mental ability.2

On average, untreated postpartum depression lasts 7 months and can continue for at least a year.2 With treatment, symptoms improve much more quickly.3 Antidepressant medicine and counseling have proved to be equally effective, and some medicines are judged to be safe for use during breast-feeding.

Test Your Knowledge

I'll get along just fine if I wait out postpartum depression.

  • True
    This answer is incorrect.

    Depression can get much worse before it starts to get better on its own. The longer you wait, the harder it might become to seek treatment, and the harder your depression may be to treat.

  • False
    This answer is correct.

    Depression can get much worse before it starts to get better on its own. The longer you wait, the harder it might become to seek treatment, and the harder your depression may be to treat.

  •  

Continue to How?

 

Depression is a medical condition that requires treatment. 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 postpartum depression symptoms.

Talk to your doctor about your postpartum depression (PPD) symptoms, and decide on what type of treatment is right for you. (You may also have your thyroid function checked, to make sure a thyroid problem isn't causing your symptoms.) Treatment options include:

  • Cognitive-behavioral therapy with a supportive counselor. This is recommended for all women with postpartum depression. It can also help prevent postpartum depression. In one study, PPD symptoms improved after one session and showed much greater improvement after six sessions.3 A cognitive-behavioral counselor can also teach you skills for managing anxiety, such as deep breathing and relaxation techniques.
  • Interpersonal counseling , focusing on your relationships and the personal changes that come with having a new baby. This gives you emotional support and help with problem solving and goal setting. In one study, more women recovered from PPD after 12 interpersonal counseling sessions than did those who had no counseling.4
  • Antidepressant medicine, ideally with counseling. Because breast-feeding offers many emotional and physical benefits for both baby and mother, experts are studying which antidepressants are most safe for breast-feeding babies. So, you can breast-feed while taking an antidepressant for postpartum depression.2 Whether or not you are breast-feeding, your doctor is likely to recommend a selective serotonin reuptake inhibitor (SSRI). This class of medication has proved to work very well for women, with minimal to no side effects.5 Tricyclic antidepressants, excluding doxepin (Sinequan, Zonalon), are also used by breast-feeding women.

Breast-feeding babies whose mothers take an antidepressant do not often have side effects. But they can. If you take an antidepressant while breast-feeding, talk to your doctor and your baby's doctor about what types of side effects to look for.

Home treatment measures may also be helpful.

  • Schedule outings and visits with friends and family, and ask them to call you regularly. Isolation can make depression worse, especially when it's combined with the stress of caring for a newborn.
  • Get as much sunlight as possible—keep your shades and curtains open, and get outside as much as you can.
  • Eat a balanced diet. Avoid alcohol and caffeine. If you have little appetite, eat small snacks throughout the day. Nutritional supplement shakes are also useful for keeping up your energy.
  • Get regular daily exercise, such as outdoor stroller walks. Exercise helps improve mood.
  • Ask for help with food preparation and other daily tasks. Family and friends are often happy to help a mother with newborn demands.
  • Don't overdo it, and get as much rest and sleep as possible. Fatigue can increase depression.
  • Join a support group of moms with new babies. An infant massage class is another great way of getting out and spending time with others whose daily lives are like yours, while learning new ways to bond with your baby. To find a support group in your area, talk to your doctor or see the Web site of Postpartum Support International at www.postpartum.net.
  • Play stimulating music throughout your day and soothing music at night.

Test Your Knowledge

If I'm not willing to take an antidepressant medicine, there's really no point in talking to my doctor.

  • True
    This answer is incorrect.

    Your doctor needs to know how you're doing to best help you and your baby thrive, and he or she may want to rule out another medical condition that could be contributing to your symptoms. If you decide on counseling instead of medicine, ask your doctor to recommend a good licensed counselor whom you can work with.

  • False
    This answer is correct.

    Your doctor needs to know how you're doing to best help you and your baby thrive, and he or she may want to rule out another medical condition that could be contributing to your symptoms. If you decide on counseling instead of medicine, ask your doctor to recommend a good licensed counselor whom you can work with.

  •  

I have an antidepressant that I took before pregnancy, but I should check with my doctor before taking it again for postpartum depression.

  • True
    This answer is correct.

    Talk to your doctor before taking any medicine after having your baby, especially if you are breast-feeding. You may be more sensitive to medication side effects during your postpartum period and may need a lower dose than before. Some medicines are considered relatively safe for your baby during breast-feeding, but others are not. Your doctor will know the best type of medicine for you.

  • False
    This answer is incorrect.

    Talk to your doctor before taking any medicine after having your baby, especially if you are breast-feeding. You may be more sensitive to medication side effects during your postpartum period and may need a lower dose than before. Some medicines are considered relatively safe for your baby during breast-feeding, but others are not. Your doctor will know the best type of medicine for you.

  •  

Continue to Where?

 

Now that you have read this information about postpartum depression, you can take action, work with your doctor, and ask family and friends to support you along the way.

Return to topic:

References

Citations

  1. Cunningham FG, et al. (2005). Neurological and psychiatric disorders. In Williams Obstetrics, 22nd ed., pp. 1229–1248. New York: McGraw-Hill.
  2. Wisner KL, et al. (2002). Postpartum depression. New England Journal of Medicine, 347(3): 194–199.
  3. Appleby L, et al. (1997). A controlled study of fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression. BMJ, 314(7085): 932–936.
  4. O'Hara MW, et al. (2000). Efficacy of interpersonal psychotherapy for postpartum depression. Archives of General Psychiatry, 57: 1039–1045.
  5. Miller L (2002). Postpartum depression. JAMA, 287(6): 762–765.

Last Updated: June 24, 2008

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