Having a baby can be one of the most significant events in a person’s life. For the person who gives birth, the period following delivery is a whirlwind of new emotions and physical sensations, as well as chemical and hormonal changes in the body. Trying to cope with these changes — all while caring for an infant — can be intense. Together, these factors can create an increased risk of depression.
After giving birth, many people experience a period of sadness that is commonly called the “baby blues”; this period typically lasts a couple of weeks. Approximately one out of every eight people who give birth will develop a more severe and longer-lasting depression after delivery, termed postpartum depression. This diagnosis is based not only on the length of time between delivery and onset, but also on the severity of symptoms. (And the non-birthing parent may also experience this condition.)
It can be difficult to manage postpartum depression on top of all the other changes that come with a new baby — in this post, we’ll talk more about postpartum depression, how it develops, and treatment options.
Postpartum depression goes by a variety of names. In recent years, it has been called perinatal depression, a change that reflects the inclusion of depression or mental health struggles that happen during pregnancy (singularly referred to as prenatal depression), as well as those that occur after birth.
Doctors differentiate between postpartum depression and a more common short-term feeling of worry, anxiety, and sadness following birth (commonly called “the baby blues”).
Most experts define postpartum depression as feelings of intense anxiety, depression, withdrawal, insomnia, and irritability or even anger that last for longer than two weeks after a baby’s birth. In very rare cases (about one in 1,000 births), postpartum depression can develop into postpartum psychosis, a severe condition characterized by symptoms such as confusion, hallucinations, paranoia, and even attempts at violence or self-harm.
There are many physical and mental symptoms of postpartum depression. Some of the most common include:
• Uncontrollable or excessive crying
• Fatigue and loss of energy
• Persistently feeling numb, sad, or hopeless
• Difficulty making decisions
• Extreme mood swings
• Feeling overwhelmed
• Trouble sleeping
• Muscle aches
In many cases, these symptoms will lead parents to withdraw from their partner or other loved ones, and they may even experience difficulties bonding with their baby.
Since postpartum depression manifests differently in every parent, it’s essential to be aware of the symptoms. While some fear, worry, uncertainty, and trouble sleeping are expected right after birth, families should actively look out for any sign that a new parent is feeling extreme versions of these symptoms for longer than two weeks. (Learn more at PostpartumDepression.org.)
Most doctors agree that abrupt hormonal changes resulting from pregnancy and birth are the most prevalent cause of postpartum depression. During pregnancy, levels of estrogen and progesterone are extremely high, but in the first 24 hours following birth, these levels return to normal, pre-pregnancy levels. The hormones in the thyroid often drop immediately post-birth, contributing to these symptoms.
Giving birth also marks a period of significant change in parent’s lives (including a disruption of regular activities and sleep deprivation), and this transition can cause emotional strain.
Certain risk factors put some people at greater risk of postpartum depression. These include:
• A lack of support from friends and family
• Depression during pregnancy
• A personal history of depression or bipolar disorder
• Relationship or financial issues
• Substance use disorder
• An unplanned or unwanted pregnancy
• Breastfeeding difficulties
If you’ve been feeling intense emotions and feel unable to cope following the birth of your baby, you talk to a healthcare provider immediately. Typically, a doctor can diagnose postpartum depression after listening to your symptoms and evaluating your situation. They may also ask about your mental health prior to getting pregnant and during pregnancy.
In most situations, the doctor will conduct a blood test to help evaluate whether an underactive thyroid is contributing to your symptoms. They may also perform other tests and evaluations to rule out additional contributing factors.
There are a few treatment options available for parents who are diagnosed with postpartum depression. The two most popular and effective are therapy and medication. These are frequently used together to offer the best possible outcomes.
If your doctor recommends therapy to treat postpartum depression, they can help you find a therapist, a psychologist, or another mental health clinician who can help you work through some of these feelings. Depending on your therapist’s methodology, they may use talk therapy or other evidence-based treatment options like cognitive behavioral therapy or interpersonal therapy to help you build better coping strategies.
There are a variety of medications that can help alleviate symptoms related to depression and anxiety. Some of the most commonly used medications for postpartum depression include:
• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Brexanolone (given through an IV)
• Bupropion (known commercially as Wellbutrin)
• Tricyclic antidepressants (TCAs)
Your healthcare provider will review your history and discuss any medication’s safety for people who are breastfeeding. Most of these medications take time to show results, so continuing to work with a therapist and incorporating positive lifestyle changes like reaching out for family or community support, getting as much sleep as possible, and eating a healthy, well-balanced diet will help in the interim.
If you have questions about postpartum depression, you can make a virtual appointment to talk to a healthcare provider via carbonhealth.com or through the Carbon Health app (virtual mental health appointments are available to California residents). If you or a loved one is experiencing thoughts of self-harm, seek emergency medical care or call the National Suicide Prevention Lifeline at any time, day or night, for free and confidential support, at 1-800-273-8255.
Carbon Health’s medical content is reviewed and approved by healthcare professionals before it is published, but it is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Talk to your healthcare provider about questions you may have regarding your health or a medical condition, and before making changes to your healthcare routine.