What Is Postpartum Depression, and What Helps?

Medically reviewed by Michael MacIntyre, MD

Postpartum depression (PPD) is a subtype of major depressive disorder (MDD) (also called clinical depression) that affects nearly 1 in 9 pregnant people during the postpartum period. Experiencing sadness, loss of pleasure, fatigue, and brain fog while caring for a newborn can be an emotional roller coaster, causing exhaustion and affecting your well-being.

Many people avoid asking for help because they feel guilty about being sad during a time that is "supposed to" be joyful. Experiencing these feelings or having PPD does not mean you did anything wrong or are a bad parent. Reaching out for help and leaning on your medical team or support system is essential. To care for your baby, you must first care for yourself.

This article reviews the stages of postpartum depression, its causes, symptoms, treatment, risk factors, and support options.

Postpartum Depression: Is There a Set Beginning and End?

Perinatal depression occurs during pregnancy or just after birth. Postpartum depression is a specific type of perinatal depression that occurs after childbirth and lasts over two weeks.

PPD does not have a specific starting or ending point. It can occur at any time within the first year after delivery. PPD may occur immediately after childbirth (typically within the first 24 to 48 hours). However, it most commonly occurs within the first four weeks after delivery, known as immediate onset PPD.

Postpartum Depression vs. Baby Blues

Baby blues are mood swings or excessive worry in the days following childbirth. These mood swings affect 85% to 90% of postpartum birthing parents. While still impactful, baby blues are more mild and temporary than PPD, typically resolving within a week or two, and are manageable with support and self-care.

PPD symptoms are similar to baby blues but are more severe, last longer than two weeks, affect daily functioning, and typically require treatment.

What About Pregnancy Causes Depression?

Postpartum depression does not result from something a parent does or does not do. It is a medical condition that's due to a combination of the following:

• Hormonal shifts

• Physical demands of childbirth

• Sleep deprivation that comes with caring for a newborn

• Transition to parenthood

Postpartum Hormonal Shifts

Shifts in hormones affect the transmitters or chemicals in the brain. This can cause emotional, mental, and behavioral changes. The female reproductive hormones (estrogen and progesterone) spike to their highest level during pregnancy. Within the first 24 hours of childbirth, these levels quickly drop to prepregnancy levels. Additionally, thyroid hormone levels can drop, and cortisol (stress hormone levels) can increase, contributing to fatigue, overwhelm, and stress.

The following are factors that put some people at greater risk for PPD:

• History of depression or bipolar disorder

• Stressful life events (e.g., relationship or financial problems or the loss of a loved one)

• Lack of support

• Pregnancy complications (preterm birth, birth trauma)

• Giving birth to multiples

• Unplanned or unwanted pregnancies

• Abuse

• Post-traumatic stress disorder (PTSD)

• Adverse childhood events (abuse, neglect, trauma)

• Adolescence

• Substance abuse

• Smoking cigarettes

• An infant with special needs

• Breastfeeding difficulties

It's important to note that anybody, regardless of risk, can develop postpartum depression. Also, not everyone with these risk factors develops PPD, and not everyone who experiences PPD has these risks.

Disparities (Inequalities) Surrounding Postpartum Depression

Black, Indigenous, and other people facing racial and socioeconomic disparities are more likely to experience postpartum depression than White individuals. They are also less likely to receive screening and treatment. There is hope among healthcare providers that increasing awareness and representation among this community in research studies will help address underlying causes and decrease healthcare disparities.

Characteristics of Postpartum Depression Symptoms

Some common characteristic PPD symptoms include:

• Feelings of sadness, emptiness, guilt, worthlessness, or inadequacy

• Crying for extended periods

• Extreme fatigue

• Restlessness

• Loss of interest or pleasure in doing things

• Inability to care for yourself and the baby

• Changes in appetite or weight

• Sleep disturbances

• Difficulty bonding with the baby

• Intense anger, irritability, or frustration

• Withdrawal from loved ones

• Difficulty thinking, concentrating, or making decisions

• Breastfeeding problems (inadequate milk supply, reluctance to breastfeed, or feelings of guilt due to lack of breastfeeding)
  

In addition, new parents can experience anxiety disorders or excessive worrying during and after pregnancy.

How to Treat Postpartum Depression

Early identification and treatment of PPD can help you feel better sooner. This is important for you, your baby, your other children, and the rest of your family.

To diagnose PPD, providers use the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Diagnosis can occur if you are experiencing five (or more) depression symptoms that occur frequently over two weeks.

Medical treatment typically involves a combination of the following:

• Mental health therapy: Therapy and cognitive behavioral therapy (CBT) may help you learn strategies to cope or manage thoughts and actions.

• Antidepressants: Selective serotonin-reuptake inhibitors (SSRI) such as Zoloft (sertraline), Prozac (fluoxetine), or Lexapro (escitalopram) are typically the first line of treatment for PPD.

• Zulresso (brexanolone): Zulresso was the first medication the Food and Drug Administration (FDA) approved for the treatment of postpartum depression (PPD) in adult females. It is given through an intravenous line (IV) over 60 hours under healthcare supervision.

• Zurzuvae (zuranolone): Zurzuvae is the first FDA-approved oral medication for PPD. It’s taken once a day, in the evening, for 14 days.

• Electroconvulsive therapy (ECT): In extreme cases, providers may suggest ECT. This treatment passes an electrical current through the brain while a person is under general anesthesia.

Risks of Severe Postpartum Depression

Left untreated, PPD may persist for weeks, months, or years (rare). When it extends more than six months after delivery, the stage or characterization is chronic or persistent PPD. Those with severe PPD may experience thoughts of harming themselves or their baby. PPD can also interfere with the maternal-infant bond, breastfeeding, and the ability to care for yourself and the baby.

Suicide Prevention

If you have thoughts of harming yourself or your baby, immediately ask your partner or a loved one to care for the baby. Contact the 988 Suicide & Crisis Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one is in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Depression Medications Postpartum: What’s Safe?

There’s a slight chance of antidepressants transferring to breast milk, but they have a proven history of minimal side effects on breastfeeding infants. Tell your healthcare provider if you're breastfeeding to determine the best medication for you.

Your provider may recommend stopping breastfeeding while getting a Zulresso infusion. Some low-quality evidence suggests it’s safe for breastfeeding. But it is a relatively new medication, so studies are minimal.

Also, Zulresso can cause sedation, so it’s essential to have a second caregiver present during the infusion and the days following.

Zurzuvae can cause drowsiness, so you should not drive or operate heavy machinery for at least 12 hours after taking it. Your provider will likely ask you to stop breastfeeding while taking it, as initial animal studies show that it can harm the baby.

Related: How Perinatal Depression Is Treated

Self-Care in Postpartum Depression

Prioritizing self-care can be difficult for a new parent, but it is not selfish behavior. In fact, it’s necessary so you are better able to care for the baby and your family. Self-care strategies include:

• Prioritizing rest when the baby sleeps

• Doing gentle exercises such as walking or Pilates (increases feel-good chemicals in the brain)

• Spending time with your partner and other loved ones

• Finding time for activities you enjoy

• Practicing deep breathing exercises

• Eating a nutrient-dense diet (fresh vegetables, fruit, lean protein, and plenty of water)

• Setting realistic expectations for yourself

• Avoiding additional significant life changes when possible

Complementary Therapies for Postpartum Depression

In addition to therapy and medications, the following are complementary therapies that may help provide relaxation and help with symptoms of postpartum depression:

• Foot reflexology: Applying pressure to certain areas of the foot to relieve symptoms

• Music therapy: Listening to calming music, engaging in music-making activities, dancing, or singing

• Acupressure and massage: Using therapeutic forms of physical touch helps increase oxytocin, the "love hormone," to support parent-child bonding and breast milk production

• Stress reduction techniques: Participating in guided imagery, progressive muscle relaxation, tai chi, yoga, deep breathing, and mindfulness

• Art therapy: Leveraging creative activities to express and process emotions.

• Aromatherapy: Smelling lavender or bitter orange (Citrus aurantium) essential oils

• Supplements: Replenishing low levels of vitamin B6 or folic acid, both of which may contribute to PPD

Research on alternative approaches is limited. Always talk to a healthcare provider before beginning new supplements or herbal remedies to ensure they are safe options.

Support and Help During Postpartum Depression

Seeking support and asking for help is crucial for recovery and well-being. In addition to your loved ones and healthcare provider, the following are some sources of support:

• Doulas: Doulas are trained professionals who provide support during pregnancy, childbirth, and after birth. Studies have shown that doulas help improve maternal health outcomes and decrease the risk of PPD, especially among marginalized populations.

• Support groups: Postpartum Support International (PSI) is a website that can help you find local PPD support groups.

• Online communities: Postpartum Progress can help you make online connections.

• Mental health therapy or counseling: If in-person support is limited, consider virtual therapy sessions.

Related: 10 Best Online Therapy Services for Postpartum Depression and Anxiety

Summary

Postpartum depression (PPD) is a subtype of major depressive disorder (MDD) that occurs after childbirth and lasts more than two weeks. Symptoms include sadness, fatigue, sleep problems, difficulty bonding with the baby, and more. While it’s common to experience “baby blues,” PPD symptoms are more severe and persistent and typically require treatment.

Hormonal shifts, physical demands of childbirth, sleep deprivation, and the transition to parenthood are some causes of PPD. Treatment for PPD typically involves a combination of self-care, practical support, medications, mental health counseling, and complementary therapies.

Read the original article on Verywell Health.