Postpartum Depression and Mental Health

A quick look at postpartum depression and mental health

After giving birth, some new mothers may develop a mood disorder known as postpartum depression due to a combination of factors such as hormone imbalance, stress and exhaustion.

Our doctors and staff discuss the issue of postpartum depression with every mother, emphasizing that it is a treatable condition and fairly common, experienced by about 15 percent of new mothers.

Symptoms can occur any time in the first year after delivery and include insomnia, hopelessness, difficulty bonding with the newborn and more.

There are many resources available for women with postpartum depression mental health issues. Treatment options are individualized for each woman and include talk therapy and medication.

What is postpartum depression?

About 85 percent of new mothers experience some emotional turmoil after childbirth. This is often referred to as “baby blues” and includes crying spells, anxiety, mood swings and trouble sleeping. These symptoms begin the first few days after giving birth and typically last up to two weeks. Postpartum depression is not the same as the baby blues. Postpartum depression is a more severe mood disorder affecting the mother’s mental health and may be experienced any time after birth and through the first year of motherhood.

Though difficult for the mother and her family to adjust to, these feelings are not unusual. Pregnancy and giving birth bring a number of powerful emotions including joy and excitement, as well as anxiety and depression. When these negative feelings occur during pregnancy, it is known as prenatal depression. After childbirth, depression and negative feelings can be categorized as postpartum depression. Collectively, depression during and after pregnancy is known as perinatal depression.

According to the Postpartum Support International group, 10 percent of women experience depression during pregnancy and 15 percent experience significant depression after giving birth. Depression during pregnancy and postpartum differs for each woman and are temporary, treatable conditions.

While the term “postpartum depression” is the most common, there are several forms of this condition that women may experience, including:

• Anxiety during pregnancy and postpartum.
• Pregnancy or postpartum obsessive-compulsive disorder (OCD).
• Postpartum post-traumatic stress disorder.
• Bipolar mood disorders.
• Postpartum psychosis.

New fathers can also experience the same symptoms mothers with postpartum depression experience. Men may feel sad, fatigued, overwhelmed, have anxiety or changes in their normal patterns. This is sometimes referred to as paternal postpartum depression.

What are the causes of postpartum depression?

Doctors haven’t found a clear, single cause of postpartum depression or prenatal depression. But these are not caused by anything the mother does or does not do. She is not at fault, though many women feel guilty that they are not being good mothers.

Postpartum depression is likely the result of the psychological and biological strain of pregnancy in combination with the hormonal changes a woman undergoes during pregnancy. According to the National Institutes of Mental Health, a mother’s levels of hormones quickly decrease after giving birth, which could cause mood swings. Additionally, mothers with newborns struggle to get the amount of sleep necessary to fully recover. This can cause exhaustion and contributes to the symptoms of postpartum depression.

Any woman can experience postpartum depression although some women are at a greater risk. Some causes are situational aspects of a mother’s relationship and pregnancy, some are related to the mother’s psychological or physical condition. Some causes include:

• A personal or family history of depression.
• Financial stress.
• Marital stress.
• Fatigue and loss of energy.
• Lack of support in caring for the baby.
• Difficulty in pregnancy, during birth or with breastfeeding.
• Multiple births (twins, triplets, etc.).
• The pregnancy was unplanned.
• Stressful life changes, such as job loss, death of a loved one or illness.

It’s important for new mothers who have any of these factors to discuss them with their OB-GYN. We can work together to create a care plan to treat or avoid depression during pregnancy and possibly after giving birth.

Can you prevent postpartum depression?

We help new moms take steps to prevent or lessen the severity of postpartum emotional distress and depression. CU Medicine OB-GYN East Denver (Rocky Mountain) follows the American College of Obstetricians and Gynecologists recommendations of providing detailed information and developing a postpartum care plan that addresses a woman’s transition to parenthood. This includes discussing some of the common causes of stress for new mothers including feeding the baby, postpartum emotional health, the “baby blues” and the challenges of parenting and recovery from birth.

Our physicians will also stress the importance of postpartum appointments. During these appointments, in addition to a physical checkup, women can discuss their emotional well-being with their physicians, address any issues or identify resources for more individualized care.

For mothers-to-be with a history of depression, emotional health will be closely monitored by a physician, who may also recommend that the woman attend a support group to help prevent escalation. If a woman is taking antidepressants (more information below) before pregnancy, we will assess the situation and help her decide on continuing or discontinuing medication during pregnancy.

What are postpartum depression symptoms?

We tell new moms that postpartum depression is very different than the baby blues but, they may feel the same at the onset of these symptoms. Postpartum depression symptoms last longer and are far more intense than those with the baby blues. These feelings may prevent some women from properly caring for their babies.

Some symptoms of postpartum depression include:

• Overwhelming fatigue or loss of energy.
• Panic attacks and severe anxiety.
• Intense irritability and anger.
• Difficulty bonding with your baby.
• Severe mood swings.
• Insomnia or sleeping too much.
• Hopelessness.
• Difficulty concentrating, making decisions or thinking clearly.
• Reduced interest in activities previously enjoyed.
• Thoughts of harming yourself or your baby.
• Recurrent thoughts of suicide.

How can friends and family help women with these symptoms

A new mother may not recognize the symptoms of postpartum depression in herself. Often, women believe they are simply tired or that their depression is a normal part of parenthood. A depressed new mom also may not feel good enough to bring this up with her OB-GYN.

For a spouse, family members or friends who recognize the symptoms first, encouraging the mother to talk with a healthcare provider is a good first step. They may also offer emotional support or assist with taking care of the baby or the home.

What is postpartum depression treatment?

Treatment plans are individualized for each woman, but often include self-care, talk therapy or counseling, and treatment of symptoms, with antidepressants if necessary. Some women also find exercise to be a valuable tool in combating depression.

Therapy (psychotherapy)

In psychotherapy, also known as talk therapy, a woman will discuss her feelings and how to manage them with a mental health professional. This type of treatment can be done one-on-one, as couples’ therapy or in a support group.

Support groups can be especially helpful as a place where others understand what a woman is experiencing, and she can meet other women like her who have recovered from postpartum depression. Help lines and telephone support are also an option but should not be a substitution for professional mental care.

Related reading: Mindfulness During Pregnancy

Medication

Medication such as antidepressants works to control or balance the chemicals in the brain that affect moods. There are a number of antidepressants available; our physicians work with each new mom to find the appropriate medication or combination of medications to address her condition.

Although antidepressants are excreted in trace amounts to breast milk, most are considered safe for breastfeeding mothers. We do recommend consulting the baby’s pediatrician whenever starting a new medication while breastfeeding to ensure safety.

Unlike many diagnoses, there is no time frame for overcoming depression. Treatment times vary for each individual. Because of the individualized nature of postpartum depression, we stay in touch with each mother and monitor her progress and talk about her concerns.