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.
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.
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 are more likely to get postpartum psychosis if you or someone in your family has bipolar disorder (also known as manic-depression).
A woman who has postpartum depression may:
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:
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:
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.
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.
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The two most common symptoms of depression are:
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:
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:
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:
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.
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 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.
A risk factor is anything that increases your chances of having a certain problem. Risk factors for postpartum depression include:
Risk factors for postpartum psychosis include:
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 immediately if:
Call a doctor now if:
Seek care soon if:
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.
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.
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.
Talk to your doctor about your symptoms, and together you can decide what type of treatment is right for you.
Treatment choices include:
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:
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.
Keeping your body and mind strong and healthy will help reduce the effects of hormone changes and stress that come with childbirth.
Women whose risk is higher for the reasons listed below may want to take extra steps to prevent postpartum depression.
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.
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.
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.
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.
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 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.
In rare cases, electroconvulsive therapy is used to treat severe forms of depression. It works well as short-term treatment.
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.
- 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.
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