Postpartum depression is a mood disorder that can effect women after childbirth. Mothers with postpartum depression experience feelings of extreme sadness, anxiety, and exhaustion that may make it difficult for them to complete daily care activities for themselves or for others.
What causes postpartum depression?
Postpartum depression does not have a single cause, but likely results from a combination of physical and emotional factors
After childbirth, the levels of hormones (estrogen and progesterone) in a woman’s body quickly drop. This leads to chemical changes in her brain that may trigger mood swings. In addition, many mothers are unable to get the rest they need to fully recover from giving birth. Constant sleep deprivation can lead to physical discomfort and exhaustion, which can contribute to the symptoms of postpartum depression.
What are the symptoms of postpartum depression?
- Feeling sad, hopeless, empty, or overwhelmed
- Crying more often than usual or for no apparent reason
- Worrying or feeling overly anxious
- · Feeling moody, irritable, or restless
- Oversleeping, or being unable to sleep even when her baby is asleep
- Having trouble concentrating, remembering details, and making decisions
- Experiencing anger or rage
- Losing interest in activities that are usually enjoyable
- Suffering from physical aches and pains, including frequent headaches, stomach problems, and muscle pain
- Eating too little or too much
- Withdrawing from or avoiding friends and family
- Having trouble bonding or forming an emotional attachment with her baby
- Persistently doubting her ability to care for her baby
- Thinking about harming herself or her baby
How is postpartum depression different than the “baby blues”?
The “baby blues” is a term used to describe the feelings of worry, unhappiness, and fatigue that many women experience after having a baby. Baby blues, which effects up to 80 percent of mothers, includes feelings that are somewhat mild, last a week or two, and go away on their own.
With postpartum depression, feelings of sadness and anxiety can be extreme and might interfere with a woman’s ability to care for herself or her family. Because of the severity of the symptoms, postpartum depression usually requires treatment. The condition, which occurs in nearly 15 percent of births, may begin shortly before or any time after childbirth, but commonly begins between a week and a month after delivery.
Are some women more likely to experience postpartum depression?
Some women are at greater risk for developing postpartum depression because they have one or more risk factors, such as:
- Symptoms of depression during or after a previous pregnancy
- Previous experience with depression or bipolar disorder at another time in her life
- A family member who has been diagnosed with depression or other mental illness
- A stressful life event during pregnancy or shortly after giving birth, such as job loss, death of a loved one, domestic violence, or personal illness
- Medical complications during childbirth, including premature delivery or having a baby with medical problems
- Mixed feelings about the pregnancy, whether it was planned or unplanned
- A lack of strong emotional support from her spouse, partner, family, or friends
- Alcohol or other drug abuse problems.
Postpartum depression can effect any woman regardless of age, race, ethnicity, or economic status.
How is postpartum depression treated?
There are effective treatments for postpartum depression. A woman’s health care provider can help her choose the best treatment, which may include:
- Counseling/Talk Therapy: This treatment involves talking one-on-one with a mental health professional (a counselor, therapist, psychologist, psychiatrist, or social worker). Two types of counseling shown to be particularly effective in treating postpartum depression are:
- Cognitive behavioral therapy (CBT), which helps people recognize and change their negative thoughts and behaviors; and
- Interpersonal therapy (IPT), which helps people understand and work through problematic personal relationships.
- Medication: Antidepressant medications act on the brain chemicals that are involved in mood regulation. Many antidepressants take a few weeks to be most effective. While these medications are generally considered safe to use during breastfeeding, a woman should talk to her health care provider about the risks and benefits to both herself and her baby. These treatments can be used alone or in combination.
What can happen if postpartum depression is left untreated?
Without treatment, postpartum depression can last for months or years. In addition to affecting the mother’s health, it can interfere with her ability to connect with and care for her baby and may cause the baby to have problems with sleeping, eating, and behavior as he or she grows.
How can family and friends help?
Family members and friends may be the first to recognize symptoms of postpartum depression in a new mother. They can encourage her to talk with a health care provider, offer emotional support, and assist with daily tasks such as caring for the baby or the home.
If you or someone you know is in crisis or thinking of suicide, get help quickly.
- Call your doctor.
- Call 911 for emergency services or go to the nearest emergency room.
- Call the toll-free 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889).
- Methodist Specialty Transplant Hospital also has psychiatric services.
Where can I find more information?
For more information on conditions that affect mental health, resources, and research, go to:
For more information on conditions that effect mental health, resources, and research, go to MentalHealth.gov or the NIMH website. In addition, the National Library of Medicine’s MedlinePlus service has information on a wide variety of health topics, including conditions that effect mental health.
Pregnancy is such an exciting time for a woman and her family and usually, women pay particular attention to their activities, diet and overall health. A healthy lifestyle and avoidance of potential risks for the mother-to-be and her baby is the ultimate goal. Here are some evidence-based recommendations for supporting a healthy lifestyle and optimal outcome for the pregnancy. Seven pregnancy do’s and don’ts that you should discuss with your obstetrician.
Prenatal vitamins provide supplemental micronutrients which may be decreased in some diets. Fortunately, in the United States, most women with a well-balanced diet may not have any deficiencies except iron, Vitamin D and folic acid (often listed on the label as folate or L-methylfolate). Over the counter and prescription prenatal vitamins are similar in the content, except there is a little more folic acid in the prescription vitamin. Over the counter, preparations are normally sufficient for supplementation.
The vitamin recommendations for women are:
- Folic acid 400-800 micrograms starting prior to pregnancy and continued through at least the first trimester.
- Iron 30mg and if the initial lab work done at the OB visit indicate anemia, an additional iron supplement may be recommended.
- Vitamin D 600international units
- Calcium 1,000mg. Taking calcium in food may be less constipating that the tablets.
Weight gain will happen! The National Academy of Medicine recommends that weight gain goals are based on the starting body mass index (BMI). Most babies will weigh 1 pound around 20-22 weeks. The rate of baby’s growth is fastest in the third trimester.
- Women who are in the normal weight range will gain 25-35
- Women who are over their ideal body weight may gain 15-25
- Women who are underweight may gain 28-40 pounds
Most women will continue with their normal diet but there are a few things to avoid. The amount of alcohol that may cause harm to the baby is unknown and therefore it should be avoided in pregnancy. Caffeine in low amounts does not seem to be a concern, therefore keeping the total daily amount to less than 300mg is encouraged. The average cup of coffee, 8 ounces of regular brew has 130mg of caffeine and a cup of tea or 12-ounce soda has approximately 50mg. Artificial sweeteners can be used in pregnancy, but as in life, moderation is the key.
A well-balanced diet will include fresh vegetables and fruit that is washed prior to eating, protein, and limited carbohydrates. Deli meats that are prepackaged and have preservatives are probably low risk, and the deli meats from a restaurant or grocery store counter may be warmed before eating, although the risk for Listeria contamination is very low. The most recent outbreak from food source infections involved other foods, so be aware of any food recalls in your area. Fish are a good source of DHA and are encouraged as a menu choice 2-3 times weekly. The type of fish should have lower mercury content. Sushi consumed in a reputable restaurant is unlikely to be a concern.
Smoking and vaping are associated with increased risk for complications of pregnancy. There is an increased risk of miscarriage, preterm delivery, growth-restricted babies and stillbirth. Vaping actually has more nicotine content and although long term studies are not available, it is thought that the risk is at least the same for cigarettes.
Exercise is encouraged throughout the pregnancy but may have to be modified by tolerance and endurance. Hydration is key so keep up with the water intake! Bedrest has not been shown to be of benefit in pregnancy and may actually increase the risk of clots in the legs. High impact activities are not recommended such as skiing, horseback riding, boxing to name a few.
Many women travel throughout pregnancy for business and pleasure. Be aware of any infectious risks such as Zika, at the planned destination. Balancing the potential risk for complications that may need to be addressed at a distant location, especially in the third trimester, should be considered when making travel arrangements.
Summertime means lots of outdoor activity and sunshine. Take care of your skin with sunscreen. DEET insect spray is encouraged to avoid mosquito bites, and enjoy the water. Swimming in the pool, lake, river or beach is safe but avoid hot tubs that may increase your core body temperature.
Pregnancy Do’s and Don’ts
These are a few pregnancy do’s and don’ts and of course, there may be specific questions or situations you may have which should be discussed with your obstetrician. Our goal is your goal—happy healthy mom and baby! Connect with one of our physicians to learn more.