Understanding postpartum depression - Ruth Health

Understanding postpartum depression

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Fast facts:

  • 1 in 5 women experiences postpartum depression (PPD), a condition characterized by intense feelings of sadness, anxiety, or hopelessness after giving birth.
  • A diagnosis of PPD isn’t a reflection of who you are as a person or parent — it’s a health condition that can be treated with medication and therapy.
  • PPD differs from the baby blues in its intensity and duration, but initial symptoms can overlap.
  • If you or others have any concerns about your mental health, schedule an appointment with your doctor right away rather than waiting for your first postpartum check-up. Seek a second opinion if your provider doesn’t perform assessments for perinatal mood and anxiety disorders (PMADs) or is dismissive of your concerns.
  • You don’t have to navigate the challenges of postpartum life, including PPD, on your own. Loved ones, support groups, and trusted providers like Ruth Health are here for you.

Life with a newborn is filled with hormonal changes, new responsibilities, and not nearly enough sleep, so, understandably, many moms experience sadness, anxiety, or fatigue in the days after childbirth.

The baby blues, as these feelings are collectively referred to, typically improve within a week or two without treatment.

But about 1 in 5 women face a more intense and persistent mental health challenge after giving birth in the form of postpartum depression (PPD).

The condition causes ongoing mood swings, fatigue, and other symptoms that can affect your ability to take care of yourself and your baby. 

If you’re experiencing symptoms of postpartum depression, know that it’s not a reflection of who you are as a person or parent — it’s a health condition that can be treated.

Here’s how to navigate a diagnosis of postpartum depression.

"Postpartum depression is not a reflection of who you are as a person or parent. It’s a health condition that can be treated."

The baby blues vs. postpartum depression

Your first postpartum days can be a whirlwind of emotions, with rapid changes in hormone levels as estrogen and progesterone decrease and the breastfeeding-related hormones prolactin and oxytocin increase.

For about 80% of new moms, this leads to what’s known as the baby blues — mood swings, sadness, crying spells, and anxiety. In many cases, the baby blues first begin within 2-3 days after childbirth and last for up to two weeks.

This short-term mental health challenge typically resolves itself without any treatment as you begin to settle into your new routine and your hormones stabilize.

While treatment usually isn’t required, sleeping as much as possible, eating well, and asking for help can make the baby blues easier to navigate.

The persistence of these emotional highs and lows beyond two weeks may be an indication that you have postpartum depression.

One potential challenge to be mindful of is that the initial symptoms of postpartum depression overlap with those of the baby blues, though the level of intensity is often greater. Sometimes this can lead to a delay in getting treatment for postpartum depression.

The intensity of the postpartum transition can bring many feelings to the surface, including some that you may not have been aware of before.

If any mental health issues surface in the days following childbirth, reach out to your doctor — even if you think it’s only the baby blues. This is especially important for those with a history of mental health disorders.

Here are some signs that may be indicative of postpartum depression rather than the baby blues.

  • Symptoms persist beyond two weeks and appear to be intensifying.
  • You are having trouble caring for yourself or your baby and/or completing daily tasks.
  • You have thoughts of harming yourself or your baby.

What is postpartum depression?

Postpartum depression is a mental health disorder that occurs in mothers after giving birth and, less commonly, in their partners. It is characterized by intense feelings of sadness, anxiety, or hopelessness that interfere with daily life.

It’s possible to experience both depression during pregnancy (prenatal depression) and the postpartum period. The two types of depression may be collectively referred to as perinatal depression.

Causes of postpartum depression

There are many different factors involved in the development of postpartum depression, including both hormonal changes and an individual’s health history, stress levels, and access to support.

  • Estrogen and progesterone — two hormones that play a big part in the healthy development of your baby — decrease significantly after childbirth. These changes can trigger depression similar to how smaller fluctuations in hormone levels can lead to PMS.
  • In many cases, a history of mood disorders — or even a history of mood disorders in your family — can increase your chances of developing postpartum depression. However, about 50% of all women diagnosed with PPD have never previously experienced a mood disorder.
  • Postpartum depression is common in mothers giving birth for a second or subsequent time who experienced it after their first pregnancy. If you are planning to grow your family and have concerns about developing postpartum depression again, your doctor can help you prepare for potential mental health challenges.
  • Emotional stressors like grief, financial issues, pregnancy complications, or a lack of support can also lead to a greater risk of postpartum depression.

If you have experienced a mood disorder at any point in your life, it’s important to discuss your mental health history with a healthcare provider — for example, your OB/GYN or your primary care provider — early on in your pregnancy or even as you begin planning for a family.

This is both to prevent postpartum depression and to determine if any modifications should be made to your mental health treatment plan during pregnancy.

Symptoms of postpartum depression

Postpartum depression brings emotional, physiological, and behavioral changes. 

Here are some common symptoms of postpartum depression.

  • Feeling depressed the majority of the time
  • Feelings of panic, fear, shame, or guilt
  • Severe mood swings
  • Severe fatigue
  • Atypical changes in appetite (complete disinterest in food or overeating)
  • Rapid weight loss or gain
  • Difficulty sleeping
  • Difficulty concentrating or making decisions
  • Trouble bonding with your baby
  • Thoughts of hurting yourself or your baby
  • Suicidal ideation

Your friends and family members may observe changes in your mood or behavior suggestive of postpartum depression — in some cases ones that you haven’t yet noticed.

If you or others have any concerns about your mental health, it’s important to schedule an appointment with your doctor right away rather than waiting for your first postpartum check-up.

Symptoms of postpartum depression often first appear within a few weeks of childbirth, but in some cases, they don’t develop until several months later. The severity of symptoms may vary from one individual to another, and sometimes even from one day to another.

Postpartum psychosis is at the more severe end of the spectrum. This rare form of postpartum depression — it affects 1-2 women per 1,000 after giving birth — involves a detachment from reality, with both visual and aural hallucinations. It is more common in those with a history of mood disorders including bipolar disorder.

It’s important to seek treatment immediately if any of the following symptoms appear:

  • Delusions, hallucinations, or disorientation
  • Feelings of rage without an apparent reason
  • Rapidly shifting moods
  • Suicidal ideation or behavior
  • Intrusive thoughts about your baby

Diagnosing and treating postpartum depression

Postpartum depression isn’t a character flaw, which also means that it’s not something that you should feel you need to manage or improve on your own. Speaking candidly about your experiences with a doctor is the first step to getting important support.

Your doctor will do a depression screening at your appointment, which typically includes a questionnaire. The most frequently used screening tool for postpartum depression is the Edinburgh Postnatal Depression Scale (EPDS).

It consists of 10 questions about your thoughts and emotions throughout the past seven days and accounts for the spectrum of symptom severity.

Rather than simply asking if you’ve been anxious or unhappy, you are asked how often you’ve experienced those states. If your provider does not perform an assessment for perinatal mood and anxiety disorders (PMADs) or is dismissive of your concerns, seek a second opinion.

Sometimes additional tests are involved in the diagnosis process to see if other factors are contributing to your postpartum depression symptoms, like an underactive thyroid, which can lead to fatigue and depression.

The good news is that postpartum depression is very treatable. So many moms have successfully overcome PPD, and so can you.

Often, a combination of medications — usually antidepressants — and therapy is used to treat the condition. Staying physically active and leaning on others for support can also aid in your recovery process.

Medication

Antidepressants are used to treat many types of depression including postpartum depression. With many of these medications, it can take several weeks before you start to feel a difference.

Not all antidepressants are safe to take while breastfeeding. As you discuss your treatment options for PPD, make sure your healthcare provider knows if you’ve chosen to breastfeed.

Therapy

While medication can address the underlying physical aspects of depression, therapy can help you work through your thoughts and feelings with a mental health professional and discuss coping strategies. 

For many individuals with PPD, a combination of medication and therapy is an effective treatment strategy. Everyone’s needs and experiences with therapy are different. You may have a short-term relationship with your therapist, or you may continue sessions for several months or longer. 

The important thing is to listen to what you need and to be patient during the process. Consistency is a big factor in the effectiveness of therapy.

Self-care

Taking it easy isn’t always so easy, especially as a mom juggling so many responsibilities and navigating all the transitions of the postpartum journey. But seriously, go easy on yourself. 

Allow yourself plenty of “me time” — even if it’s a quick walk around the block or simply taking a minute to yourself to sit and breathe — but stay connected to the people who care about you. Don’t be afraid to ask directly for what you need.

During this time, prioritize your rest and recovery, eat nourishing foods, and stay hydrated — all the staples of self-care. Try to get a little exercise each day, under the guidance of your doctor. 

And most importantly, remember that you don’t have to face postpartum depression on your own. In addition to leaning on your loved ones, consider joining a support group for women who know exactly how it feels.

We’re here for you

At Ruth Health, we understand that nobody knows what you need better than you. We’re here to help you prioritize self-care while navigating postpartum life, including challenges like PPD, and to ensure that you’re never alone in this journey.

We provide expert, evidence-based maternal advice so that you can make the best decisions for yourself. Learn more about pregnancy, postpartum, and everything in between at ruthhealth.com.

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