What is prenatal or postpartum depression?

Depression is a mood disorder that can affect women during pregnancy, within a year after childbirth, miscarriage, or infant loss. Depression in pregnancy is called prenatal depression, while depression after giving birth is called postpartum depression or PPD. Women with depression experience feelings of extreme sadness, anxiety, and exhaustion that may make it difficult for them to take care of themselves or others.

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What causes depression in perinatal women?

Prenatal or postpartum depression does not have a single cause, but likely results from a combination of physical and emotional factors. Depression does not occur because of something a mother does or does not do.

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After childbirth, the levels of hormones (estrogen and progesterone) in a woman’s body quickly drop. This leads to chemical changes in her brain that may trigger mood swings. In addition, many mothers are unable to get the rest they need to fully recover from giving birth. Constant sleep deprivation can lead to physical discomfort and exhaustion, which can contribute to the symptoms of postpartum depression.
 

What are the symptoms of postpartum depression?

PPD is a mood disorder characterized by a cluster of symptoms (which are present most of the time during a period of at least two weeks) which can include:

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• Feeling sad, hopeless, empty, or overwhelmed

• Crying more often than usual or for no apparent reason

• Worrying or feeling overly anxious

• Feeling moody, irritable, or restless

• Oversleeping, or being unable to sleep even when her baby is asleep

• Having trouble concentrating, remembering details, and making decisions

• Experiencing anger or rage

• Losing interest in activities that are usually enjoyable

• Suffering from physical aches and pains, including frequent headaches, stomach problems, and muscle pain

• Eating too little or too much

• Withdrawing from or avoiding friends and family

• Having trouble bonding or forming an emotional attachment with her baby

• Persistently doubting her ability to care for her baby

• Thinking about harming herself or her baby.

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What does postpartum depression feel like?

•  “It feels scary.”

•  “It feels out of control.”

•  “It feels like I’m never going to feel like myself again.”

•  “It feels like a day will never end.”

•  “It feels like no one understands.”

•  “It feels like my marriage cannot survive this.”

•  “It feels like I’m a bad mother.”

•  “It feels like I’m a failure.”

•  “It feels like I can't get anything done.”

•  “It feels like I should never have had this baby.”

•  “It feels like if I could only get a good night's sleep, everything would be better.”

•  “It feels like I have no patience for anything anymore.”

•  “It feels like I can't stop yelling.”

•  “It feels like I’m going crazy.”

•  “It feels like I will always feel like this.”

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How is postpartum depression different from the “baby blues”?

The “baby blues” is a term used to describe the feelings of worry, unhappiness, and fatigue that many women experience after having a baby. Babies require a lot of care, so it’s normal for mothers to be worried about, or tired from, providing that care. Baby blues, which affect up to 80 percent of mothers, includes feelings that are somewhat mild, last a week or two, and go away on their own.

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With postpartum depression, feelings of sadness and anxiety can be extreme and might interfere with a woman’s ability to care for herself or her family. Because of the severity of the symptoms, postpartum depression usually requires treatment. The condition, which occurs in nearly 25 percent of expectant and new mothers, may begin before or any time after childbirth, but commonly begins between a week and a month after delivery.

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Are some women more likely to experience perinatal depression?

PPD is a condition that results from a combination of biological, hormonal, environmental, and psychological factors. It is most often influenced by a number of risk factors, some of which may include:

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• Symptoms of depression during or after a previous pregnancy

• Previous experience with depression or bipolar disorder at another time in her life

• A family member who has been diagnosed with depression or other mental illness

• A stressful life event during pregnancy or shortly after giving birth, such as job loss, death of a loved one, domestic violence, or personal illness

• Medical complications during pregnancy or childbirth, including miscarriage or premature delivery or having a baby with medical problems

• Mixed feelings about the pregnancy, whether it was planned or unplanned

• A lack of strong emotional support from her spouse, partner, family, or friends

• Alcohol or other drug abuse problems.

• Chronic sleep deprivation

• Lack of social support, environmental stressors

• Perceived loss of control

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It’s important to note that PPD can strike women with no risk factors, too. It is not fully understood why it happens to some women and not to others, but we do know exactly what to do to treat it. For each woman with PPD, the combination of factors that cause it is unique. In addition,  depression can affect any woman regardless of age, race, ethnicity, or economic status.

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How can I tell if I have depression?

Trust your instincts. If you think something is wrong, it probably is. That doesn’t mean anything terrible is happening. It may mean you are overwhelmed and overloaded and need some time to get things back on track. If you notice that you are feeling worse as time goes on, it’s important for you to let someone know how you are feeling. Do not let feelings of guilt or shame or embarrassment get in the way of you doing what you need to do to feel better.

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Only a health care provider can diagnose a woman with postpartum depression. Because symptoms of this condition are broad and may vary between women, a health care provider can help a woman figure out whether the symptoms she is feeling are due to postpartum depression or something else. 

 

Will this ever go away?

Yes. Postpartum illness is more common than one might think. It is a real medical condition that affects nearly 25% of pregnant and new mothers. It is not your fault. It did not happen because you are weak, or thinking about the wrong things, or because you are not a good mother.

 

These feelings and thoughts — which can make you feel like you are doing something wrong or simply not handling motherhood very well — are symptoms that respond well to treatment.

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What can I do about it?

First, focus on self-help measures, such as eating nutritiously, even if you’re not hungry; resting as much as you can, even if you can’t sleep; getting out of the house for a walk, even if you don’t feel like moving. Avoid caffeine, alcohol, high fat, and sugar foods. Talk to someone you trust about the way you are feeling. Let your healthcare provider know. Let your partner know. Find supportive people who can help you and accept their help. Do not delay getting proper treatment. The longer you wait, the harder it is to treat.

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What can happen if postpartum depression is left untreated?

Without treatment, postpartum depression can last for months or years. In addition to affecting the mother’s health, it can interfere with her ability to connect with and care for her baby and may cause the baby to have problems with sleeping, eating, and behavior as he or she grows.

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How can family and friends help?

Family members and friends may be the first to recognize symptoms of postpartum depression in a new mother. They can encourage her to talk with a health care provider, offer emotional support, and assist with daily tasks such as caring for the baby or the home.

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Where To Get Help

Don’t be afraid to reach out if you or someone you know needs help. Learning all you can about mental health is an important first step.

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Reach out to your health insurance, primary care doctor, or state/country mental health authority for more resources.

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Contact the PPSC SupportLine to find out what services and supports are available in your community. 

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If you or someone you know needs help now, you should immediately call the National Suicide Prevention Lifeline at 1-800-273-8255 or call 911.

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