Mood swings and fatigue can be a result of changes in hormone levels and the demands of having a new baby. In most cases, the “baby blues” will subside after a few weeks, but some women develop a more serious mood disorder known as postpartum depression.
What is postpartum depression?
Postpartum depression affects 10-20% of all women who give birth. It is a mood disorder which is more severe and lasts longer than the “baby blues”, a normal period of mood swings and fatigue that is experienced by most new mothers. Postpartum depression can cause feelings of sadness, anxiety, and tiredness which limit a new mother’s ability to care for their child or themselves.
In the postpartum period, sudden changes in hormone levels, sleep deprivation and the demands of caring for a new infant all contribute to Normally, the baby blues will go away after a few weeks, but postpartum depression can last much longer and may require treatment.
What are the symptoms of postpartum depression?
The signs of postpartum depression are similar to other types of depression and include:
- Feelings of sadness and hopelessness
- Feelings of guilt
- Loss of energy
- Anxiety and irritability
- Lack of interest in a pleasurable activity
- Fatigue and tiredness
- Inability to sleep or sleeping too much
- Lack of appetite or overeating
- Lack of interest in social activity
- Excessive crying
- Feelings of anger
In addition to symptoms of depression experienced at other times, postpartum depression may also include symptoms specific to being a mother such as:
- Excessive worry about infant
- Feeling distant from infant
- Worry about the inability to parent
- Fear of hurting the infant
Emergency help should be obtained for postpartum depression if the mother has suicidal thoughts or thoughts of harming the infant or anyone else. New mothers should be encouraged to ask for help from loved ones and to discuss their concerns. In the event of an emergency, mothers or family members should call 911.
How is postpartum depression diagnosed?
Many women who develop postpartum depression are unaware of the severity of their symptoms. They may have been told to expect mood swings and fatigue that accompanies baby blues and will not seek help right away. The first postpartum checkup should include a discussion of mood symptoms.
Diagnosing postpartum depression usually involves a combination of physical and psychiatric evaluations including:
- Laboratory testing to rule out medical conditions such as low thyroid, anemia or infections
- Physical exam conducted as part of the postpartum or other routine checkups will help to eliminate other causes for symptoms of depression.
- Questionnaires such as the Hamilton Depression Scale (Ham-D), the PHQ-9 or other inventories may be used to help identify women with depression.
- Interview and discussion of symptoms of depression, anxiety and fears will help determine a plan of action
- Comparison with requirements of Diagnostic and Statistical Manual of Mental Disorders edition 5 (DSM-V) which lists criteria for an official psychiatric diagnosis of “postpartum depression”.
How is postpartum depression treated?
Postpartum depression is more severe than baby blues and may require behavioral or medical intervention. If left untreated, it can persist for months or even years and may impact the physical health of the mother and the ability to bond with the new baby. It is important that women who are experiencing symptoms of postpartum depression seek help from a physician or mental health professional.
With appropriate treatment, women with postpartum depression may begin to improve within a few weeks. In most cases, treatment will include a combination of self-management, individual or group “talk” therapy, and medication.
Psychotherapy is also called “talk therapy”. A trained therapist can help new mothers with postpartum depression to understand their illness and develop coping strategies to reduce symptoms. Many therapists practice cognitive behavioral therapy (CBT) which is designed to change negative thinking patterns that may affect the way a person feels. Most therapy for postpartum depression will be done on an “individual” basis with the patient and a therapist but some women also benefit from group therapy with other new mothers.
While therapy may help with thought patterns and strategies, self-management is also necessary for most women. The therapist or doctor may make recommendations for self-care such as establishing a routine, eating a healthy diet, participating in physical activity, avoiding isolation and connecting with friends or family. Women with postpartum depression should be encouraged to ask for help and to set reasonable expectations.
Some women with postpartum depression will benefit from antidepressant medication. Antidepressants work by increasing the activity of certain brain chemicals, called neurotransmitters. Over time, this may help to improve mood levels. In other cases, short-term use of anti-anxiety medications may be recommended.
Some medications are excreted into breast milk and while many medications are considered safe, women who are breastfeeding should discuss the potential risks and benefits for both mother and baby.
Suicide hotline for postpartum depression
The National Suicide Prevention Lifeline hotline was established to help people who are considering suicide. It is staffed 24 hours a day, 7 days a week and available to take calls from those struggling with suicidal ideation or from those who are concerned about a loved one. The National Suicide Prevention Lifeline can be reached at 1-800-273-TALK or 1-800-273-8255.
The National Suicide Prevention Lifeline also maintains a Twitter account at @8002738255, a Facebook page “800273talk” and has an online chat service available on their website at https://suicidepreventionlifeline.org/chat/.