Many women suffer from the “baby blues” after giving birth, including feelings of worry, sadness, and fatigue. Anywhere between 40 percent and 85 percent of women develop the baby blues just after birth. Infants require a great deal of attention for the first months of their life, leading to exhaustion and anxiety on the part of new parents. The hormonal fluctuations just after childbirth may lead a woman to experience mood swings, too, which can trigger underlying mood disorders. While the baby blues wear off after a few days to two weeks, postpartum depression can last much longer, and the symptoms can be much more serious.
Developing postpartum depression can make it harder for new parents to care for their infant and for each other. It is important to recognize the symptoms of this mood disorder as early as possible, so the condition can be treated and does not develop into long-term depression or a substance abuse disorder.
What Is Postpartum Depression? How Often Does It Occur?
Postpartum depression may develop just after the infant is born, but symptoms more often begin between one and four weeks after birth. Between 13 percent and 15 percent of women (or about one in seven) develop postpartum depression, so it is important to know the signs. This means about 600,000 women develop postpartum depression every year. However, many women experience shame because they have a hard time being new parents due to their mood changes and may refuse to seek help. Women in lower income areas of the United States may suffer from postpartum depression at rates as high as 25 percent.The most noticeable symptoms of postpartum depression include:
- Feeling overwhelmed, sad, hopeless, or empty
- Crying suddenly or more often than usual for no apparent cause
- Intense anxiety or paranoia
- Mood swings, irritability, or restlessness
- Sleep disorders, especially insomnia or oversleeping
- Difficulty concentrating, thinking clearly, making decisions, or remembering important details
- Experiencing bouts of anger or rage
- Withdrawing from family and friends
- Losing interest in activities that are normally enjoyable
- Physical pain, including muscle tension, headaches, stomach problems, or joint pain
- Eating too much or too little, leading to weight fluctuations
- Obsessively thinking about harming oneself or one’s child
- Worrying about one’s ability to care for the baby
Mild symptoms may not need treatment and are likely to resolve on their own; however, if the condition continues past the baby blues stage, becomes worse, or appears very intensely at first, it may be postpartum depression, which should receive treatment.
Factors that increase a woman’s risk of developing postpartum depression after birth include:
- Fluctuations in hormone levels, especially estrogen and progesterone
- History of other forms of depression, mood disorders, or other mental illnesses
- Family history of depression or mood disorders
- Lack of support from family and friends during the stressful early months of parenting
- Anxiety, sadness, anger, or other negative feelings about being pregnant or having children
- Physical or behavioral struggles during pregnancy
- Problems from a previous a previous pregnancy or birth
- Struggles in the marriage or partnership, including financial problems
- Other stressful life events aside from parenthood
- Being young at first pregnancy
- A history of substance abuse
A healthcare provider can diagnose postpartum depression symptoms. Anybody experiencing any of these symptoms should contact a physician or therapist to begin treatment. It is possible to manage postpartum depression until it clears up with a combination of behavioral therapy and prescription antidepressants if needed.
How Long Does Postpartum Depression Last?Mild low mood after childbirth is very common and typically resolves after one or two weeks. This is generally enough time for new parents to develop a routine with their infant, get comfortable at home, and for women’s hormone levels to return to normal. However, postpartum depression lasts longer and usually begins later.
For most new mothers, postpartum depression will begin one to three weeks after childbirth, and it will be more noticeable if baby blues symptoms worsen or do not resolve. However, episodes of postpartum depression can begin as late as one year after childbirth. Without treatment, postpartum depression can become chronic depression or worsen, becoming postpartum psychosis. If symptoms of depression, anxiety, or both do not get better after two weeks, see a physician for a diagnosis.Typical timelines for postpartum depression include:
- One to six months: Most symptoms develop during this time, with three months being the average timeframe.
- Six months to one year: Although it is rare, women may not develop symptoms for a year after childbirth. Delayed symptoms may make it harder for women to accept that they are experiencing a treatable condition, and they may be less likely to seek treatment.
- One to four years: These very long-term symptoms may be present after childbirth, but they may not get worse for years after the child is born.
Postpartum depression progresses differently for every new parent, but the typical progression begins with mild depression symptoms that get worse over several months. Exhaustion, sadness, anxiety, and mood swings, including anger or fear, are the most common symptoms that get worse.
Postpartum Depression in Men
The stresses of new parenthood, including changes in hormone levels, predominantly affect women; however, men can suffer from postpartum depression, too. Men often show declines in testosterone, one of the most important androgen hormones, throughout their partner’s pregnancy and after childbirth. Mood changes associated with hormone fluctuations can be exacerbated by a lack of sleep, big changes to living arrangements, genetics or family history, a history of substance abuse or mental health disorders, and negative feelings about being a parent.Some estimates suggest as many as 25 percent of men develop some form of depression after their partner has a new baby. This could range from mild symptoms like the baby blues to more serious postpartum depression symptoms. The condition is called paternal postnatal depression, to distinguish it from the condition suffered by new mothers.
Men with lower testosterone experience higher rates of depression compared to standard hormone levels. Low levels of testosterone contribute to:
- Lethargy or higher levels of exhaustion
- Developing anhedonia (feeling numb or losing pleasure in activities)
- Mood swings, restlessness, or irritability
However, some research has suggested that men with lower levels of testosterone make better long-term partners for women, in turn reducing the woman’s risk of postpartum depression after she gives birth. These men often provide more social support for their partners, spend more time with their children, and foster a better-quality relationship in general.
One study found that women whose partners had higher levels of testosterone reported higher rates of intimate partner aggression within six months of their child’s birth. In the same 15-month follow-up period, men with higher levels of testosterone reported feeling trapped by parenting and lacking warm feelings toward their children. Men with lower rates of testosterone appear to have a greater risk of postpartum depression, but men with higher levels of testosterone are at greater risk for experiencing stress and anxiety during the postpartum period. This, in turn, may contribute to their female partner’s risk of postpartum depression.
Substance Abuse and Postpartum Depression
Any form of depression puts the individual at greater risk of a substance use disorder, like alcohol use disorder (AUD), marijuana abuse, prescription drug abuse, and more. Problem drinking among women experiencing postpartum depression ranges from 1.5 percent to 8.4 percent, with most women struggling with both AUD and postpartum depression being Caucasian and low income.
Other drugs abused during the postpartum period include:
- Marijuana: 4.6%
- Cocaine: 0.6%
- Psychotherapeutic drugs: 2.6%
- Polydrug abuse: 3.9%
Help for Postpartum Depression Is AvailableAt least 600,000 women develop postpartum depression annually, but of those women, only 15 percent get the treatment they need. As many as 25 percent of women who develop postpartum depression continue to experience symptoms for a year or more if they do not get help. Fortunately, there are many approaches to treating this mood disorder. The best treatment approaches to postpartum depression are:
- Counseling or talk therapy: Cognitive Behavioral Therapy, interpersonal therapy, family therapy, and similar approaches can help new parents understand the causes of postpartum depression and manage symptoms when they become serious. Some therapists offer complementary therapies, like meditation or mindfulness techniques, in addition to talk therapy.
- Medication: Antidepressants help to moderate brain chemistry, making them an important part of treating any form of depression. These medications typically take up to a month to become fully effective, and not all types are safe during breastfeeding. It is important to work closely with a psychiatrist or physician on the appropriate dose and type.
A therapist or physician will use a scale, like the Edinburgh Postnatal Depression Scale (EPSD), to determine whether their patient struggles with postpartum depression and how serious it is. The EPDS is 10-item questionnaire, and a score of 12 or higher, along with an affirmative answer to question 10 which is a “yes” to suicidal ideation, will lead to a diagnosis of postpartum depression and the development of a treatment plan.
During therapy, new parents will work on reducing stress by getting help from friends and family, developing realistic expectations for themselves while caring for a newborn, and joining support groups. Reducing stress helps to alleviate anxiety, allowing new parents to focus more on their child while they also focus on their physical and mental health.
Parents struggling with both substance abuse and postpartum depression should ask their therapist or physician for a referral to an addiction treatment program specializing in parenting stresses. While a new parent may fear that getting professional help will take time away from their baby, treatment will enable them to be a better parent for their child.