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Recognizing Postpartum Depression in Mothers


Becky had built a successful career by the time she and her husband decided to become parents. At age 33, she got pregnant without any trouble and had an ordinary, healthy pregnancy. She gave birth to a baby girl without any complications and started breastfeeding successfully right away. Everything seemed great for a while—until it wasn't.

A month or so into her new life, she started feeling different. She was angry, sad, anxious, and overwhelmingly tired. She had trouble thinking clearly. It was more than just “the baby blues,” so at her six-week checkup, she mentioned how she was feeling. Her healthcare provider diagnosed her with postpartum depression and prescribed an antidepressant.

At the very least, postpartum disorders interfere with a mother's ability to care for herself and her child. At the most severe, they're life-threatening. With one in nine women experiencing postpartum depression, it's vital that healthcare providers understand postpartum depression and other disorders. Doctors need to know why they happen and learn to recognize symptoms so they can offer help and support to their patients.

What are postpartum disorders?

Having a baby is an emotional event. After the anticipation leading up to the birth, meeting your child for the first time is an incredible experience. After that, there's the stress of caring for a new baby, hormonal and physical changes, and no sleep. Most new moms experience some major highs and lows, so it’s imperative that healthcare providers understand what they are and when they're serious.

Baby Blues

Many moms experience what's called “the baby blues”—up to 80 percent, in fact. Moms who have the baby blues often experience sadness, crying spells, and difficulty sleeping. A new mom might find herself sitting alone in the bathroom crying for no apparent reason. These feelings can start two to three days after delivery—just in time for mom to be home from the hospital. The baby blues don't last long and often go away on their own.

Postpartum Depression and Anxiety

Unlike with the baby blues, women who experience postpartum depression and anxiety usually need professional help. Women with PPA and PPD have intense and longer-lasting feelings of depression and anxiety. These feelings sometimes include suicidal thoughts. In fact, suicide is the leading cause of maternal death for up to a year after delivery. Even if a mother isn't suicidal, feelings associated with PPA and PPD may hinder her ability to care for her baby or herself. Symptoms can begin between a week and a month after delivery, though they can start anytime, such as during pregnancy or within a year of having a baby.

Postpartum Psychosis

Postpartum psychosis, often thought of as the worst postpartum disorder, is relatively rare. A woman experiencing postpartum psychosis will experience symptoms such as paranoia or delusions. In a case documented by the National Institute of Mental Health, a 27-year-old mother started experiencing postpartum psychosis symptoms two days after an uncomplicated delivery of a planned pregnancy. She suspected her husband of poisoning her food, believed horses were galloping through her house, and heard voices telling her to take her infant and jump in front of a train. Fortunately, her husband took her to the ER and she received help.

Postpartum psychosis occurs in one to two out of 1,000 women within the first four weeks after delivery. When a mother develops postpartum psychosis, it's critical for healthcare providers to identify her disorder and treat her.

Are there risk factors?

When someone admits they have postpartum depression, inevitably someone they know—sometimes even a well-meaning healthcare provider—will say, "You have a beautiful baby! How could you be sad/angry/anxious/suicidal?" But having an otherwise happy life, a successful career, or a perfect baby doesn't preclude a woman from having postpartum depression, anxiety, or psychosis.

So what causes these disorders in moms? There's no definitive cause yet, but research has identified some factors that may put a woman at greater risk.

  • Hormones. After a woman has a baby, she experiences a significant drop in estrogen and progesterone, and this could contribute to postpartum disorders. That's because a decrease in estrogen and progesterone leads to chemical changes in her brain that could trigger mood swings. A woman may also have a drop in hormones produced by her thyroid gland, which could leave her feeling sluggish, depressed, and tired.
  • Sleep. New babies steal sleep from parents. And when a mom is sleep-deprived, even minor problems might seem insurmountable. Constant sleep deprivation leads to physical exhaustion and discomfort, which can result in symptoms of postpartum depression.
  • Pre-existing or previous health issues. Research shows that women who have experienced PMDD or PMS, depression or bipolar disorder, thyroid imbalance, infertility treatments, any form of diabetes, or medical complications during childbirth could be more prone to postpartum disorders.
  • Other stressors. Having an unsupportive partner, marital or financial stress, a baby in the neonatal intensive care unit, or multiple babies at once may lead to postpartum depression.
  • Major life events. Moving houses, losing or changing jobs, or the death of a family member or friend could be contributing factors to postpartum disorders.

Though there are some recognized risk factors, these don't always apply. Postpartum depression can impact any mother, regardless of who she is, what's happening in her life, or her medical history.

What are the signs of postpartum disorders?

Symptoms of postpartum disorders are broad and can vary widely from person to person. But in every case, a woman who has any of these serious signs should see her healthcare provider for an evaluation as soon as possible.

Baby Blues

These symptoms might be mild or severe. However, they usually don't last longer than a week or two after birth.

  • Anxiety
  • Irritability
  • Mood swings
  • Sadness
  • Sleep and appetite problems
  • Crying
  • Feeling overwhelmed

Experiencing the baby blues isn't uncommon—most women do. These symptoms go away on their own.

Postpartum Depression and Anxiety

Many women suffering from PPD or PPA will have some of these symptoms:

  • Intense anger or irritability
  • Excessive crying
  • Difficulty bonding with baby
  • Inability to make decisions
  • Severe anxiety or panic attacks
  • Feelings of guilt, worthlessness, hopelessness, or shame
  • Loss of interest in life
  • Thoughts of self-harm
  • Mood swings
  • Overwhelming fatigue
  • Fear of being a bad mother
  • Sleep problems—inability to sleep or sleeping too much
  • Eating too much or too little
  • Thoughts of suicide or death

Symptoms of postpartum depression and anxiety interfere with a woman's ability to care for herself and her baby and can last for months or longer.

Postpartum Psychosis

The most severe of the postpartum disorders is postpartum psychosis. Signs that a woman is suffering from postpartum psychosis include the following:

  • Hallucinations and delusions
  • Paranoia
  • Confusion and disorientation
  • Obsessive thoughts about her baby
  • Sleep disturbances
  • Attempts to harm herself or baby

A woman suffering from postpartum psychosis needs help immediately. Her life and her child's life may be at risk.

The symptoms of the baby blues, postpartum depression, postpartum anxiety, and postpartum psychosis aren't much different. But they differ in severity and timeline of symptoms. A woman suffering from anything more severe and longer-lasting than the baby blues needs help from her healthcare provider.

Do I have a postpartum disorder?

Many healthcare providers offer a 10-question quiz at a woman's six-week postpartum checkup. Called the Edinburgh Postnatal Depression Scale, it gives real insight into whether a woman is suffering from a severe postpartum disorder.

Please select the answer that comes closest to how you have felt in the past seven days:

1. I have been able to laugh and see the funny side of things.

a. As much as I always could

b. Not quite so much now

c. Definitely not so much now

d. Not at all

2. I have looked forward with enjoyment to things.

a. As much as I ever did

b. Rather less than I used to

c. Definitely less than I used to

d. Hardly at all

3. I have blamed myself unnecessarily when things went wrong.

a. Yes, most of the time

b. Yes, some of the time

c. Not very often

d. No, never

4. I have been anxious or worried for no good reason.

a. No, not at all

b. Hardly ever

c. Yes, sometimes

d. Yes, very often

5. I have felt scared or panicky for no very good reason.

a. Yes, quite a lot

b. Yes, sometimes

c. No, not much

d. No, not at all

6. Things have been getting on top of me.

a. Yes, most of the time I haven't been able to cope at all

b. Yes, sometimes I haven't been coping as well as usual

c. No, most of the time I have coped quite well

d. No, I have been coping as well as ever

7. I have been so unhappy that I have had difficulty sleeping.

a. Yes, most of the time

b. Yes, sometimes

c. Not very often

d. No, not at all

8. I have felt sad or miserable.

a. Yes, most of the time

b. Yes, sometimes

c. Not very often

d. No, not at all

9. I have been so unhappy that I have been crying.

a. Yes, most of the time

b. Yes, quite often

c. Only occasionally

d. No, never

10. The thought of harming myself has occurred to me.

a. Yes, quite often

b. Sometimes

c. Hardly ever

d. Never

This quiz is an effective and efficient way to determine whether a woman has symptoms or is at risk for postpartum disorders.

What is treatment like?

Many mothers have trouble admitting there's something wrong, even with celebrities and others opening up about their struggles with postpartum depression. So it's important for healthcare providers to recognize postpartum disorders, and offer help and treatment. Therapy or medication—sometimes both—are effective ways to combat postpartum disorders.

  • Talk therapy or counseling. This is an effective treatment for postpartum depression and anxiety. Cognitive behavioral therapy will help a woman recognize negative thoughts and behaviors and teach her how to change them. Interpersonal therapy helps women understand and work through personal relationships that may be risk factors for postpartum disorders.
  • Medication. Taking an antidepressant will regulate moods. Many are safe to take while breastfeeding, but it's important to know if a woman is nursing her child before prescribing a medication. These may take a few weeks to be effective.

If a woman doesn't seek medical treatment, symptoms of postpartum disorders can last months or years, and also affect the baby. Therapy and/or medication will effectively treat these diseases until the woman is no longer at risk.

Mothers have important jobs, and they need all the help they can get. At the very least, postpartum depression, anxiety, and psychosis will interfere with a woman's ability to care for herself and her child. But they also can be life-threatening. One in nine women experience one of these disorders, and suicide is the leading cause of maternal death in the first year after giving birth. So understanding postpartum depression and other disorders, knowing why they happen, recognizing their symptoms, and offering help and treatment are vital for healthcare providers. We could all use a helping hand sometimes.

For additional information regarding postpartum mental disorders, please visit Parenting Pod.

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