Welcoming a new baby can be a joyful experience, but it can also bring unexpected emotional challenges. Postpartum depression is one of the most common complications associated with pregnancy and childbirth, yet many people hesitate to talk about it.
Understanding the signs, symptoms of postpartum depression and postpartum psychosis can help families get the care they need.
What is postpartum depression?
Postpartum depression is a perinatal mental health condition that can develop after childbirth. It is more than the temporary emotional ups and downs known as the “baby blues.”
Postpartum depression can interfere with a parent’s ability to function, care for themselves, bond with their baby and enjoy daily life. It often requires professional support and treatment.
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How common is postpartum depression?
Postpartum depression can affect up to 1 in 5 who deliver within the first year after childbirth.
What is the difference between the baby blues and postpartum depression?
The baby blues are a temporary response to hormonal changes after childbirth. Eighty percent of people do experience the baby blues, marked by mood swings, tearfulness and emotional sensitivity during the first few weeks after delivery. These feelings are typically temporary and parents are still able to care for themselves and their baby.
Postpartum depression is different. Symptoms are more persistent, often occurring most days of the week, and may not improve with support from family and friends alone. The condition can leave parents feeling emotionally overwhelmed.
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What causes postpartum depression?
Hormonal changes following childbirth are one of the most common contributors. After delivery, levels of estrogen and progesterone drop rapidly, which can affect mood and emotional well-being. While these hormonal shifts are normal, some people are more sensitive to them than others.
Postpartum depression can develop in people with no previous mental health history. In fact, about half of those who experience a perinatal mental health condition have never had a mental health concern before.
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What are the symptoms of postpartum depression?
Common symptoms may include:
- Feeling sad, down or losing interest in activities once enjoyed.
- Increased irritability or anger.
- Excessive guilt, worry or self-blame.
- Difficulty bonding with the baby.
- Sleep or appetite changes that are not solely related to caring for a newborn.
- Trouble concentrating or completing everyday tasks.
- Feeling overwhelmed much of the time.
- Intrusive/obsessive thoughts.
It is not a common symptom of postpartum depression to have thoughts about harming your baby.
Who is at greater risk for postpartum depression?
Several factors may increase the risk for postpartum depression, including:
- A personal or family history of depression or anxiety disorders.
- Experience with postpartum depression in a previous pregnancy.
- A history of endocrine shift sensitivity, including premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD), or having mood symptoms associated with taking hormone contraception or IVF hormones.
- Limited social support.
- Those with high Adverse Childhood Experiences (ACEs) history.
- Financial, housing or employment challenges.
- Single parenting.
- High levels of stress or major life changes such as moving or changing jobs during the pregnancy or the postpartum period.
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How is postpartum depression diagnosed?
The American College of Obstetricians and Gynecologists (ACOG) recommends that healthcare providers screen all patients for depression and anxiety at the initial prenatal visit, later in pregnancy and at postpartum visits, occurring no later than 12 weeks after birth.
ACOG also recommends more frequent monitoring in:
- Those with a history of depression or other mental health conditions.
- Those who have previously taken psychiatric medications.
- Those who have screened positive for depression or anxiety in a pregnancy/postpartum episode.
The following screenings are used at UC Davis Health:
- The Edinburgh Postnatal Depression Scale is a 10-question tool or Patient Health Questionnaire-9 (PHQ-9), a nine-question tool to identify possible symptoms of postpartum depression.
- The Perinatal Anxiety Screening Scale (PASS) is a 31-item tool to screen for and measure the severity of anxiety in those who are pregnant and postpartum.
- A diagnostic interview asks about how they are sleeping, eating and checking in on their feelings of guilt, worthlessness and feelings about the baby.
UC Davis Health recommends that patients who score higher on depression or anxiety screenings during pregnancy have a two-week postpartum visit for an early mood check.
Patients with a positive screening for depression or anxiety may be referred to a psychiatrist, therapist or behavioral health specialist for a more comprehensive evaluation and treatment plan.
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How is postpartum depression treated?
Postpartum depression is one of the most stigmatized but easily treated conditions.
It can be treated with medication, including Zuranolone (sold under the brand name Zurzuvae). Zuranolone is a U.S. Food and Drug Administration-approved, 14-day oral medication for treating postpartum depression in adults.
It can also be treated with antidepressant medications like selective serotonin reuptake inhibitors (SSRIs) and therapy. Group therapy, one-on-one therapy or cognitive behavioral therapy are great therapy options to help postpartum depression.
Can postpartum depression go away without treatment?
Postpartum depression can go away on its own eventually, but it can take a long time. During that time, bonding between the parent with postpartum depression and their baby can be interrupted. It can affect the baby’s attachment to their parent, which can have long-term consequences for the child in life.
Can postpartum depression be prevented?
There is no guaranteed way to prevent postpartum depression, but several steps may help reduce the risk:
- Manage existing mental health conditions with your healthcare team.
- Build a strong support network.
- Ask for and accept help with childcare, meals and household tasks.
- Learn the warning signs of perinatal mental health conditions.
What is postpartum psychosis?
Postpartum psychosis is a rare but serious perinatal mental health condition that can occur after childbirth. It affects a person’s ability to distinguish what is real and what is not.
Postpartum psychosis is considered a psychiatric emergency that requires immediate medical attention. It is often associated with bipolar spectrum disorders, especially bipolar 1 disorder, characterized by bouts of mania followed by depression.
How common is postpartum psychosis?
It occurs in 1 to 2 out of every 1,000 births.
How is postpartum psychosis different from postpartum depression?
Postpartum psychosis involves severe symptoms such as delusions, hallucinations and confusion. The onset of postpartum psychosis can strike within the first three days after delivery to the first three weeks. People are at risk for the first year after delivery. People experiencing postpartum psychosis may lose touch with reality, which can place the parent and baby at risk.
Postpartum depression, on the other hand, has the same clinical symptoms as any depressive episode. These include feeling sad, having interrupted sleep or eating habits and increased irritability.
How is postpartum psychosis diagnosed?
Those with postpartum psychosis cannot be diagnosed with anxiety or depression screening tools. Postpartum psychosis has features similar to schizophrenia, but more often reveals itself associated with symptoms of mania.
What are the warning signs of postpartum psychosis?
Warning signs may include:
- Thoughts of harming yourself or your children.
- Hearing voices or seeing things that others do not.
- Extreme restlessness, irritability or reckless behavior.
- Functioning on very little sleep while feeling energized.
- Delusional thoughts, defined as “fixed false beliefs.” The delusions are not always centered around harming yourself or others.
If these symptoms occur, see your physician right away. If you’re in a crisis, call or text 988 or go to the nearest emergency department.
Who is at risk for postpartum psychosis?
Risk is higher for those with a personal or family history of bipolar disorder or other serious mental health conditions.
Can postpartum psychosis be treated?
Yes. Postpartum psychosis is often more rapidly treated than anxiety or depression. The psychotic features can clear in as little as a few days with antipsychotic medication. Ongoing treatment (with prescription mood stabilizers and/or antipsychotic medications) and proper diagnosis moving forward is key to maintaining wellness.
Postpartum psychosis should not be treated with antidepressants or the condition can get worse.
With prompt diagnosis and treatment, recovery from postpartum psychosis is possible with ongoing maintenance of wellness.
This blog was medically reviewed by perinatal psychiatrist Shannon Clark.
