Many women find they feel a bit down and gloomy after a child's birth - they may experience mood swings, anxiety, and crying spells and may have difficulty sleeping.
These symptoms - which generally appear two or three days into the postpartum period and begin to lessen within a few weeks - are completely normal and commonly known as baby blues. However, postpartum depression is a different condition that usually requires treatment.
Postpartum depression, or PPD, as it is known for short, can begin at any time during the first year after giving birth. Postpartum depression is a relatively common mental health condition, with as many as one in seven women affected by it, according to the National Institutes of Health.
In contrast, symptoms of postpartum depression may not even begin to appear until two weeks after the baby's birth. These depressive symptoms are indicative of a more serious and long-lasting form of depression. Postpartum depression can appear gradually and initially seem like a mild mood disorder, although it is serious and requires treatment just like other mental health conditions.
Although it is less common for a depressed mood to set in during pregnancy, it does happen. When this is the case, it generally continues into the postpartum period and can morph into postpartum depression. This is known as perinatal depression - depression 'around' or on 'both sides' of giving birth.
In rare cases, a condition called postpartum psychosis can occur when violent mood disorders appear. While it only affects one in five hundred women, it is a potentially dangerous mental illness that can cause hallucinations, delusions, manic behavior, and more and requires immediate medical attention.
Contrary to a common misconception, postpartum depression is just as severe as any other form of clinical depression. If left untreated, postpartum depression risks becoming a long-term mental health condition. While it often passes after six months or so, particularly with appropriate treatment, for some women experiencing postpartum depression, symptoms may not even appear until months, even a year or so after their child's birth.
When this happens, the condition suddenly starts making life more complicated for them, even if things had been going smoothly before. Managing their energy levels, coping with household chores, and caring for their baby can make life overwhelming. In all cases, prompt treatment and the right medical care can help prevent postpartum depression from continuing and becoming chronic.
One of the most widely used tools for assessing postpartum depression is the Edinburgh Postnatal Depression Scale (EPDS). Originally developed in the 1980s by mental health professionals in Scotland, it is a 10-item questionnaire designed to help identify symptoms of depression. Each question is answered with a number from one to three, and the total score is what indicates a woman's state of mental health.
While baby blues are due largely to hormone fluctuations, with progesterone and estrogen levels plummeting after childbirth, postpartum depression cannot be attributed to hormone levels. Indeed, it is unknown to what extent hormonal changes play in postpartum depression symptoms since fathers can be affected too.
Although postpartum depression in men is less well-documented and understood, fathers can begin to experience postpartum depression within a year. They can be affected by their partner's pregnancy and how it may change the mood in the household. Risk factors include a history of depression or anxiety disorders - in either parent.
While some symptoms of postpartum depression are easily confused with the baby blues, any symptoms that last longer may be a sign of depression. Common symptoms include:
Some postpartum depression symptoms are intense and severe. Untreated depression can become entrenched, and the longer it continues, the more difficult it gets to manage symptoms, let alone treat them.
At their most severe, the above symptoms can resemble those of postpartum psychosis. However, this condition, mentioned above, usually appears within the first week after giving birth. It is a dangerous mental health disorder and often a medical emergency. This is because a mother can experience delusional states in which she risks acting on irrational thoughts and could harm herself or her baby.
Fathers who experience postpartum depression display similar symptoms, particularly mood changes, anxiety, sadness, and tiredness, and may find their normal eating habits and sleeping patterns disrupted too.
Postpartum depression, just like any other kind of depression, is a genuine mental health condition that needs to be addressed. It generally lasts less than a year - several months at most - but, in some cases, particularly if left untreated, it can persist.
But, however long it lasts, postpartum depression is a difficult experience and can be hard to manage for the more than one in ten women (10% -15%) who get the condition or the smaller number of men also affected by it.
However, the good news is that for most women who develop postpartum depression, the condition lessens and dissipates after some months and can be treated successfully.
While PPD can sometimes resolve itself without medical intervention, anyone feeling down for longer than two weeks after their baby is born should seek the advice of a mental health provider or doctor specializing in women's health.
Early diagnosis and quickly beginning treatment with a healthcare provider can help reduce the duration of postpartum depression. Sadly, in the absence of diagnosis and treatment, some women develop long-term postpartum depression, which can last for years.
Research by the National Institutes of Health (NIH) revealed that about 5% of women reported: "...persistently high levels of postpartum depression symptoms for three years after giving birth."
Although most women make a complete recovery from postpartum depression, in case of doubt, it is always worth consulting a healthcare professional if symptoms of feeling sad and down persist.
PPD can affect anyone, regardless of age or ethnicity. It is a common and very real medical condition, and when it strikes, it is in no way the mother's fault, a failing, or a character flaw. It is difficult to predict if someone will end up experiencing postpartum depression or to what degree they do. Also, as we have seen, symptoms can affect fathers and partners.
That said, there are a number of factors that increase the risk of developing postpartum depression. Many are well-known, but a 2022 survey using a phone app, aimed at 1 million people across 38 countries, has provided further data.
A woman's risk of postpartum depression depends on both general and specific factors, such as:
Other risk factors revolve around more personal issues and circumstances and include:
Similarly, there are risk factors for fathers. Men who experience symptoms of PPD - sometimes referred to as paternal postpartum depression - are more likely to be affected if:
The risk also increases if a previous pregnancy and birth have been difficult, causing more anxiety about the current one.
Thankfully, there are various evidence-based treatments for PPD. Most of these treatments are identical to those used for other types of depression. The good news is that success rates tend to be high and depression symptoms in new mothers respond well to appropriate medication, therapy, or a combination of both.
Certain antidepressant medications can be prescribed, particularly selective serotonin reuptake inhibitors (SSRIs), which studies in the US and the UK have determined are safe for nursing mothers in the absence of contraindications. However, it takes six to eight weeks for SSRIs to take effect, so they cannot provide instant relief.
Many doctors prefer to suggest other therapies first before prescribing medication. There are a number of mothers too, who prefer to avoid medication unless other modalities fail to help. Often doctors recommend a treatment plan that includes both medication and therapy for a full approach to managing symptoms.
A classic but very effective form of therapy for postpartum depression is talk therapy. Many women suffering from depression have been too busy coping with pregnancy, and the transition to life as a mother, to have many opportunities to voice their feelings or discuss the emotional changes going on within them. Talk therapy allows them to talk through their experience to better understand what is happening to them. It also gives them a safe space to unburden themselves.
Talk therapy can be particularly effective for mothers who have lacked support and people to confide in or talk to, during their pregnancy and early days of motherhood.
Taking action to help oneself feels empowering, and certain activities and habits can help ride out postpartum depression. Resting as much as possible, eating a healthy diet, and resuming moderate but regular exercise all have beneficial effects. Making sure to have regular contact with family and friends and not end up alone too often also helps to feel supported.
Talking with friends who have already been through pregnancy and childbirth can be helpful too, and when there are none nearby, reaching out to support groups that bring together others with experience of postpartum depression is a helpful option.
There are other forms of treatment available. Depression, in general, responds well to Transcranial Magnetic Stimulation Therapy (TMS). This, evidence based, treatment has been used effectively for decades and utilizes cutting-edge technology that generates gentle magnetic pulses to stimulate certain areas of the brain softly. The method is FDA-approved for clinical depression in any form and is, therefore, a possible treatment for those suffering from PPD. In fact TMS is safe for women who are pregnant and experiencing depression, anxiety or other mental health conditions.
At GIA Miami, we don't want you to suffer unnecessarily. Our caring and compassionate team members are all highly credentialed in mental wellness. We will develop a treatment plan suited to your needs, and we are experts in the use of TMS to treat depression.
If you or a loved one are struggling to cope with PPD, reach out to us, and find out how we can help.
