Postpartum Depression

What Increases Your Risk

A risk factor is anything that increases your chances of having a certain problem. Risk factors for postpartum depression include:

• A history of postpartum depression. This puts you at high risk of having it again.
• Poor support from your family, partner, and friends.
• High life stress, such as a sick or colicky newborn, financial troubles, or family problems.
• Physical limitations or problems after childbirth.
• Previous depression.
• Bipolar disorder, also known as manic depression.
• A family history of depression or bipolar disorder.
• Previous premenstrual dysphoric disorder (PMDD), which is the severe type of premenstrual syndrome (PMS).

Lowering Your Risk

If you have a history of depression or postpartum depression or if you're having symptoms of depression, be sure to tell your doctor or midwife. Counseling may help lower your risk for postpartum depression. In some cases, your doctor or midwife may recommend that you start taking an antidepressant.

It's common to feel down, anxious, or grumpy in the weeks after giving birth. For some, these feelings last longer and are more intense. If you or your loved ones are worried about how you're feeling, talk to your doctor or midwife right away.

Symptoms

The two main symptoms of depression are:

• Feeling sad or hopeless nearly every day.
• Losing interest in or not getting pleasure from most daily activities, and feeling this way nearly every day.

Nearly every day, you may also:

• Feel like eating more or less than usual. This can cause weight changes that are different from the weight changes that normally happen during pregnancy or after childbirth.
• Sleep too much or not enough. You may also have trouble sleeping, even when your baby is sleeping.
• Feel restless and not be able to sit still, or you may sit quietly and feel that moving takes great effort. Others can easily see this behavior.
• Feel unusually tired or as if you have no energy.
• Feel unworthy or guilty. You may have low self-esteem and worry that people don't like you.
• Find it hard to focus, remember things, or make decisions. You may feel anxious or worried about things.

An especially serious symptom of depression is thinking about death and suicide. Some people with postpartum depression have fleeting, frightening thoughts of harming their babies.

Are you depressed?

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 benefit from treatment. No matter how many symptoms you have, it's important to see your doctor or midwife. The sooner you get treatment, the better your chance for a quick and full recovery.

Postpartum psychosis

In rare cases, a person can get postpartum psychosis, a serious mental health condition that can cause symptoms such as hallucinations and delusions. This is an emergency because it can quickly get worse and put the person or others in danger.

Symptoms can include:

• Seeing, smelling, hearing, or touching things that aren't there (hallucinations).
• Believing things that aren't true (delusional thinking).
• Feeling removed from your baby, other people, and your surroundings (depersonalization).
• Disturbed sleep, even when your baby is sleeping.
• Extremely confused and disorganized thinking, increasing your risk of harming yourself, your baby, or another person.
• Extreme mood changes and strange behavior.
• Extreme agitation or restlessness.

If you have any psychotic symptoms, seek emergency help right away. Until you tell your doctor or midwife and get treatment, you are at high risk of suddenly harming yourself or your baby.

What Happens

Symptoms of postpartum depression can begin during pregnancy or after childbirth. Postpartum depression makes it hard to function well. This includes caring for and bonding with your baby. Early diagnosis and treatment are important.

When to Call for Help

Call 911 anytime you think you may need emergency care. For example, call if:

• You or someone you know is thinking seriously of suicide or has recently tried suicide. Serious signs include these thoughts:
  • You have decided on how to kill yourself, such as with a weapon or medicines.
  • You have set a time and place to do it.
  • You think there is no other way to solve the problem or end the pain.
• You feel you can't stop from hurting yourself, your baby, or someone else.

Where to get help 24 hours a day, 7 days a week

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away. You can:

• Call or text the Suicide and Crisis Lifeline at 988.
• Go online to chat.988lifeline.org to start a chat.
• Text HOME to 741741 to access the Crisis Text Line.

Consider saving these numbers or having this website in your phone.

Go to 988lifeline.org for more information.

Contact your doctor or midwife now if:

• You hear voices.
• You have been thinking about death or suicide a lot, but you don't have a suicide plan.
• You are worried that your feelings of depression or thoughts of suicide aren't going away.

Seek care soon if:

• You have symptoms of depression, such as:
  • Feeling sad or hopeless.
  • Not enjoying anything.
  • Having trouble with sleep.
  • Feeling guilty.
  • Feeling anxious or worried.
• You have been treated for depression for more than 3 weeks, but you are not getting better.

Your doctor or midwife 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.

Exams and Tests

As part of your postpartum checkup, your doctor or midwife will do a physical exam and ask about your moods and emotions. Be sure to tell them about any feelings of "baby blues" at your first checkup after the baby is born. Your doctor or midwife will want to follow up with you to see how you are feeling.

Your doctor or midwife may check your thyroid-stimulating hormone (TSH) levels. This helps make sure a thyroid problem isn't causing any depression symptoms.

Ask your doctor or midwife and family members to watch you closely if you're at higher risk for postpartum depression. For example, you may be at higher risk if:

• You've had depression, depression during pregnancy, or postpartum depression before.
• You've had postpartum depression with symptoms of psychosis, such as hallucinations and delusions, before.
• You have bipolar disorder.

If you have an increased risk for postpartum depression, follow up with your doctor or midwife 1 to 3 weeks after you give birth.

Treatment Overview

Treatment choices include:

• Counseling. It can give you emotional support and help with problem solving and goal setting. Others in your family may also benefit from counseling.
  • Cognitive-behavioral therapy helps you take charge of the way you think and feel.
  • Interpersonal counseling provides emotional support and help with problem solving and goal setting.
• Antidepressant medicine. It relieves symptoms for some people. Antidepressants are typically used for 6 months or longer. They're taken first to treat postpartum depression and then to prevent symptoms from coming back. Your doctor or midwife may recommend that you take medicine for up to a year before you think about stopping it. If you've had several bouts of depression, you may need to take medicine for a long time.

Doctors recommend that people with moderate to severe postpartum depression combine counseling with medicine. Your doctor or midwife may recommend a licensed counselor with special training in treating postpartum depression. To best treat depression, it's important that you and your counselor have a good relationship.

Getting regular exercise, eating well, and getting enough sleep may also help you feel better. Support from family or other parents may also help.

Some people with postpartum depression may try complementary and alternative medicine (CAM), like vitamins or supplements, to help with symptoms. Talk to your doctor or midwife if you are thinking about trying a CAM treatment.

Antidepressants and breastfeeding

You can still breastfeed while taking certain antidepressants.

Treating depression is very important for you and your baby. And breastfeeding is good for your baby's health. It's also good for your baby's bond with you.

If you are worried about taking an antidepressant while breastfeeding, talk to your doctor or midwife about the risks and benefits. Antidepressants can be helpful and generally have little risk for your baby while breastfeeding.

Self-Care

Here are some tips for taking good care of yourself when you have postpartum depression.

• If your doctor or midwife prescribed medicine, take it exactly as prescribed.
• Connect with people. Reach out to a friend or loved one. Let someone know how you're doing. Connecting with others can help when you have depression.
• Get as much sunlight as you can. Keep your shades and curtains open. And get outside when you can.
• Eat a variety of healthy foods so you can keep up your energy. And avoid alcohol.
• Try to be active every day. Activity can help improve your mood. For many people, walking is a good choice.
• Ask for help with preparing food and other daily tasks.
• Get as much rest and sleep as you can. Being too tired can make depression worse.
• Join a support group for new parents. To find one in your area, talk to your doctor or midwife. You can also call the Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262) for support.