Postpartum depression: causes, symptoms, and treatments

Postpartum depression is a form of depression that starts while a woman is still pregnant or after childbirth. It is not classified as a specific diagnosis but as a major depressive disorder that occurs at a specific time. While baby blues also occur in the postpartum period, their symptoms are not severe and go away within a few days.

Causes of postpartum depression include a combination of factors such as hormones, lack of sleep, anxiety, and self-image.

Symptoms of postpartum depression include strong mood swings or depressed mood, crying excessively, insomnia, excessive fatigue, anxiety attacks, hopelessness, restlessness, and feelings of worthlessness, shame, guilt, or inadequacy. 

Treatments for postpartum depression include psychotherapy and antidepressants. Patients with postpartum depression need a strong support system for a successful recovery. 

What is postpartum depression?

Postpartum depression (PPD) is depression that begins during pregnancy or after giving birth. This type of depression represents a complex mix of emotional, behavioral, and physical changes that patients experience after having a baby.

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by the American Psychiatric Association considers PPD as a major depressive episode along with the peripartum onset. It specifies that the onset of mood symptoms either occurs during pregnancy or during four weeks after delivery. It is not a separate disease, but a major depressive disorder (MDD) that occurs at a specific time.

However, the International Classification of Diseases for Mortality and Morbidity Statistics, 11^th Revision (ICD-11) by the World Health Organization (WHO) classifies PPD under mental or behavioral disorders, presenting with depressive symptoms associated with pregnancy, childbirth, or the puerperium (commencing within six weeks after delivery), without psychotic features. 

Even though postpartum depression is associated with mothers, it can affect fathers too. Dr. Jonathan R. Scarff from the Kenner Army Health Clinic in Fort Lee, Virginia wrote in his paper, from the May 2019 issue of Innovations in Clinical Neuroscience, that 8% to 10% of fathers develop PPD usually within three to six months postpartum. At this point, there are no established criteria for PPD in men.

What is the other term for postpartum depression?

The other term for postpartum depression is postnatal depression. The term peripartum depression is also used because depression related to having a baby often starts during pregnancy according to The American Psychiatric Association.

When does postpartum depression start?

Postpartum depression usually starts after childbirth. Planned Parenthood suggests that the symptoms of PPD start one to three weeks after giving birth. According to the American College of Obstetricians and Gynecologists, PPD occurs up to one year after having a baby, but one to three weeks postpartum is average. There is no universally accepted answer to a question such as when does PPD start. For example, Medical News Today explains that this condition occurs within four to six weeks of giving birth. Depression doesn’t just occur after childbirth, it can occur during pregnancy as well, Mayo Clinic reveals.

Where is postpartum depression most common?

Postpartum depression is most common in Southern Africa, Asia, and South America. The highest prevalence of PPD was recorded in Asia and South America according to a comparative study that D.D. Affonso et al. published in the September 2000 issue of the Journal of Psychosomatic Research. The study revealed that European and Australian women had the lowest scores of PPD symptoms, women from the United States fell at the midpoint, and women from Asia and South America had the highest scores. 

A review by F. Abdollahi et al. from the Autumn-Winter 2011 issue of the Iranian Journal of Psychiatry and Behavioral Sciences reported that the prevalence rate of PPD was lowest in Sweden (between 13% and 15.2%), the U.S. came in between (37% to 29.5%), and the highest rates were recorded in Taiwan (73.7% to 60.8%) at four and six weeks of postpartum respectively. 

Z. Wang et al. published a systematic review in the October 2021 issue of Translational Psychiatry, which showed the highest prevalence of PPD is in Southern Africa (39.96%), followed by Southern Asia (22.32%), South America (21.71%), Western Asia (19.83%), Northern Africa (18.75%), Eastern Asia (17.39%), Northern America (17.01%), Eastern Europe (16.62%), Western Africa (13.62%), South-Eastern Asia (13.53%), and Oceania (11.11%). The prevalence of PPD significantly varied among countries ranging from 6.48% in Denmark to 60.93% in Afghanistan.

How common is postpartum depression?

Postpartum depression is a common mental health problem, which may affect one in seven women. According to a post, last updated in October 2022 by S. Mughal et al. on the website of the National Library of Medicine, suggests that PPD affects between 6.5% and 20% of women. CDC reported one in eight women experience symptoms of PPD. 

In a study by R. Anokye et al, published in the May 2018 issue of Annals of General Psychiatry, the prevalence of PPD among 257 mothers was 7%. The same paper reports that the prevalence of PPD could be from 10% to 15% and it lasts longer than six months in 25% to 50% of cases. 

R. Abdulqader Alrehaili and R. Albelowi reported in their study from the February 2022 issue of Cureus that major depression was found in 77 (31.68%) out of 243 participants. At the same time, 50 (20.57%) women had mild depression.

What are the causes of postpartum depression?

The causes of postpartum depression are complex and still unclear. A combination of multiple factors could play a role. According to Mayo Clinic, these factors include genetics, physical changes, and emotional issues. The causes of postpartum depression are listed below:

• Hormones
• Lack of sleep
• Anxiety
• Self-image

1. Hormones

Hormones are chemical messengers that travel in the bloodstream to tissues and organs where they coordinate specific functions. So far, scientists have identified over 50 hormones in the human body. Hormones regulate functions such as our metabolism and fertility, but they also exhibit a major impact on brain chemistry, mood, and mental health.

Hormones become the cause of postpartum depression because their imbalances affect feelings and emotions. Dr. C. Edler Schiller et al. reported in their paper from the February 2015 issue of the journal CNS Spectrums that reproductive hormones influence almost every biological system involved in the development of PPD. Reproductive hormones play a role in basic emotion processing, arousal, motivation, and cognition thereby influencing psychological and social risk factors contributing to PPD. 

In a paper published in the July-September 2019 issue of Acta Endocrinologica (Bucharest, Romania), S. Trifu et al. confirmed the role of hormone changes in PPD and emphasized that several hormones play a role, such as estrogen and progesterone, cortisol, oxytocin, and thyroid hormones.

2. Lack of sleep

Lack of sleep, or sleep deprivation, is a state that results from inadequate quantity or quality of sleep, including voluntary or involuntary sleepiness and circadian rhythm sleep disorders. Sleep deprivation harms both physical and mental health; it can also cause PPD. 

Lack of sleep becomes a cause of postpartum depression because it affects emotions and changes how people feel. In a study from the November 2016 issue of the Journal of Research in Medical Sciences, S. Iranpour et al. found that the risk for depression in women with poor sleep quality was 3.34 times higher than in those with good sleep quality. After controlling for risk factors, the researchers confirmed the link between lack of sleep and PPD. Insufficient sleep changes how a person feels through actions on neurotransmitters including serotonin. Impaired levels of serotonin are associated with depression, reported The Guardian.

Lack of sleep is one of the causes of postpartum depression because it causes hormone imbalances. Lack of sleep can affect reproductive hormones such as estradiol (estrogen) and progesterone. Partial sleep deprivation may increase estradiol levels, according to a paper that A. Baumgartner et al. published in the August 1993 issue of Psychiatry Research. Higher levels of estrogen disrupt sleep. The changes in estrogen levels affect emotions and moods, thereby contributing to symptoms of depression. Sleep deprivation can reduce testosterone levels, according to a study that L. Su et al. published in the December 2021 issue of Sleep Medicine. Low testosterone can affect mood and contribute to depression.

3. Anxiety

Anxiety is a feeling of unease, worry, fear, or panic that can range from mild to severe. Occasional anxiety is normal because it is a reaction to certain events that people have in their lives. Persistent anxiety causes mental health issues, including PPD. 

Anxiety becomes a cause of postpartum depression because it shares a lot of similarities with depression. In a paper in the May 2020 issue of The American Journal of Psychiatry, Ned H. Kalin MD explains that anxiety and depression have a lot in common, and may coexist during the same timeframe; both disorders are heritable. They even have similar risk factors, such as childhood trauma and neglect, parenting style, and current stress exposure. Both anxiety and depression involve alterations in the prefrontal-limbic pathways that participate in emotion regulation. 

Anxiety is one of the causes of postpartum depression because it contributes to emotions and behaviors that pave the way to depressive symptoms.

4. Self-image

Self-image is how a person perceives oneself. Cleveland Clinic refers to self-image as an internal dictionary that describes the characteristics of the self. These characteristics can be positive or negative. A negative self-image affects a person’s quality of life and contributes to mental health problems, including PPD.

Self-image becomes a cause of postpartum depression because it may result from anxiety. Anxiety makes a person feel bad about oneself, and their self-esteem becomes worse. A negative self-image may lead to feelings of guilt, which contribute to anxiety and depression. Guilt can be a driving factor for depression and reinforce its symptoms.

Self-image is one of the causes of postpartum depression because it generates body-image issues. In a review from the June 2015 issue of the Archives of Women’s Mental Health, M.L. Silveira et al. confirmed that body image dissatisfaction predicted incident prenatal and PPD. The link between body image and depression depends on the extent to which a pregnant woman can accept differences from their established self-image throughout her pregnancy.

Who is at risk for postpartum depression?

Women with a history of depression, bipolar disorder, and a history of PPD after a previous pregnancy are at risk for PPD. Other risk factors for PPD, according to Mayo Clinic, include a family history of depression and other mood disorders, experiencing stressful events during the past year, and having health problems in a baby or having a baby with special needs. Further risk factors include multiple births (twins or triplets and more children), difficulty breastfeeding, relationship problems, a weak support system, and financial problems.

In their narrative review from the August 2017 issue of the Journal of Education and Health Promotion, M. Ghaedrahmati et al. confirmed that negative attitudes toward recent pregnancy, history of sexual abuse, the reluctance of the baby’s gender, and low self-esteem with the impact on parenting stress are risk factors for postpartum depression. 

The same review confirmed biological factors such as young age during pregnancy, glucose metabolism disorders during pregnancy, impaired concentration of oxytocin, and fluctuations in estrogen levels could increase the risk for PPD. 

Social risk factors include domestic violence, low education and income, and smoking during the prenatal period. Lifestyle-related risk factors include sleep deprivation, lack of exercise, and low intake of vitamin B6, fish oil (Omega-3 fatty acids), zinc, and selenium.

What are the symptoms of postpartum depression?

Symptoms of postpartum depression are listed below:

• Strong mood swings or a depressed mood
• Crying excessively
• Insomnia, often known as sleeplessness or sleeping excessively
• Excessive fatigue or lack of energy
• Anxiety attacks and severe anxiety
• Hopelessness
• Restlessness
• Feelings of worthlessness, shame, guilt, or inadequacy

1. Strong mood swings or a depressed mood

Strong mood swings are extreme or sudden and intense changes in mood, while the depressed mood is a feeling of sadness and loss of interest. People experience mood swings or a depressed mood for many reasons, including mental illnesses such as PPD. 

Strong mood swings or a depressed mood become a symptom of postpartum depression due to low levels of serotonin. Since PPD may include low serotonin, the patients experience symptoms such as mood swings or depressed mood. Medical News Today explains that feeling unusually irritable or down for no apparent reason could indicate low serotonin activity because this neurotransmitter regulates mood.

Strong mood swings or a depressed mood are one of the symptoms of postpartum depression because new parents tend to feel overwhelmed. During the postpartum period, parents (especially mothers) experience hormone fluctuations, lose sleep, and feel sad, tired, and anxious. In these situations, a parent feels overwhelmed, which may reflect on their mood. They become depressed or sad and exhibit strong mood swings. 

As a symptom of postpartum depression, strong mood swings or a depressed mood is identified as an abrupt switch from feeling happy and upbeat to feeling sad, angry, and irritable.

2. Crying excessively

Crying excessively is frequent, uncontrollable, or unexplained crying that is emotionally and physically exhausting. Medical News Today explains people cry excessively for many reasons, including depression. Patients with PPD may experience this symptom too. 

Crying excessively becomes a symptom of postpartum depression because it is a behavioral response to emotional stress. Crying becomes a mechanism to express emotions and experience relief. A paper by A. Gračanin et al. in the May 2014 issue of Frontiers in Psychology suggests that the body releases endorphins and oxytocin when a person is crying. These chemical messengers alleviate emotional distress and thereby support self-soothing behavior. 

Crying excessively is one of the symptoms of postpartum depression due to physical reactions that intensify emotional processing and lead to crying. For instance, PPD is associated with a lack of sleep, which can be one of the causes and symptoms of this condition. When a person is sleep deprived, their amygdala goes into overdrive. As a result, it produces more intense emotional reactions to difficult situations. This could explain why people with PPD cry excessively as they’re overwhelmed after childbirth.

As a symptom of postpartum depression, crying excessively is identified as crying more than normal, trouble identifying the reason for crying, and crying over small things.

3. Insomnia, often known as sleeplessness, or sleeping excessively

Insomnia is a common sleep disorder that causes difficulty falling asleep or staying asleep. Sleeping excessively (hypersomnia) is difficulty in staying awake or alert during the day. Both insomnia and hypersomnia can be symptoms of PPD.

Insomnia, often known as sleeplessness, or sleeping excessively becomes a symptom of postpartum depression due to changes in circadian rhythm. This is particularly the case with hypersomnia whose relationship with depression is complex and bidirectional, as per Y. Dauvilliers et al. who published their paper in the March 2013 issue of BMC Medicine. Impaired circadian rhythm is a potential mechanism through which depression causes hypersomnia. Decreased circadian amplitude for up to 12 weeks after birth and altered time patterns of activity and rest compared to pre-pregnancy indicate that maternal rest or activity rhythms become desynchronized after childbirth, as reported by a paper by K. Hall et al. in the December 2022 issue of Sleep Science and Practice. The paper also confirmed the relationship between disruptions in circadian rhythm and PPD. 

Insomnia, often known as sleeplessness, and sleeping excessively are one of the symptoms of postpartum depression due to the multifactorial changes in PPD that affect sleep. These changes are physiological, psychological, and behavioral. Physiological changes include impaired brain chemistry/activity, hormones, and neurotransmitters. Sleeping serves as a soothing mechanism to deal with emotional pain. Psychological changes revolve around stress. High-stress levels prolong how long it takes to fall asleep and fragment a person’s sleep. Behavior changes that may interrupt sleep patterns include increasing screen time in the evening or drinking coffee during the night. This can occur as babies tend to wake up over the night, which means a parent is awake too. While these habits may seem entirely harmless, they may put a person’s sleep cycle in jeopardy and contribute to sleeplessness.

As a symptom of postpartum depression, insomnia, often known as sleeplessness, and sleeping excessively, are identified as struggling to fall asleep, waking up frequently during the night, shorter periods of REM sleep, and feeling tired throughout the day. Excessive sleeping manifests itself through sleeping all night and still not feeling energetic. A person experiences a strong desire to sleep during the day and feels unusually tired and drowsy, despite napping.

4. Excessive fatigue or lack of energy

Excessive fatigue or lack of energy is extreme tiredness that affects daily functioning. Fatigue is a weakness that can be physical, mental, or both and it doesn’t go away with rest. 

Excessive fatigue or lack of energy becomes a symptom of postpartum depression due to sleep loss. In a study that S.J. Kim et al. published in the October 2019 issue of the Journal of Psychiatric Research, higher insomnia symptoms, daytime sleepiness, depressive symptoms, and longer habitual sleep duration independently predicted higher fatigue scores. 

Excessive fatigue or lack of energy is one of the symptoms of postpartum depression due to physical consequences or mechanisms underlying this condition such as inflammation and hormonal imbalances. A paper titled “The Role of Inflammation in Depression and Fatigue” from the July 2019 issue of Frontiers in Immunology suggests that increased inflammation is observed in the periphery in both depression and fatigue. Inflammation can affect sleep and lead to circadian sleep disorders, Science Daily reported in October 2018. Additionally, depression may affect hormones such as cortisol. Fatigue tends to be present in people with higher or lower than normal cortisol levels, according to an April 2018 post at Endocrine Today. 

As a symptom of postpartum depression, excessive fatigue or lack of energy is identified as reduced activity, low energy, tiredness, reduced physical endurance, heaviness, general weakness, slowness or sluggishness, reduced attention, slowed thinking, and decreased mental endurance.

5. Anxiety attacks and severe anxiety

Anxiety attacks and severe anxiety are feelings of sudden and intense anxiety. Postpartum depression can cause symptoms of severe anxiety and panic.

Anxiety attacks and severe anxiety become a symptom of postpartum depression due to excessive worry after having a baby. A person with postpartum depression tends to worry a lot about their symptoms and a baby’s wellbeing. When worry and fear happen regularly, a person could experience anxiety attacks and severe anxiety.

Anxiety attacks and severe anxiety are one of the symptoms of postpartum depression due to chemical imbalances in the brain that occur in PPD. J. Waider et al. explain in their paper from the April 2019 issue of Frontiers in Neuroscience that brain serotonin system dysfunction is involved in exaggerated fear responses that trigger stress, anxiety, and trauma-related disorders. Impaired functioning of serotonergic transmission can heighten a reaction to negative stimuli and cause anxiety or panic attacks. 

As a symptom of postpartum depression, anxiety attacks or severe anxiety are identified as feeling nervous or restless, having a sense of impending doom or danger, increased heart rate, rapid breathing, trembling, sweating, weakness or tiredness, and trouble concentrating.

6. Hopelessness

Hopelessness is an emotion indicated by a lack of optimism, hope, and passion. Feelings of hopelessness occur due to a wide range of reasons including postpartum depression.

Hopelessness becomes a symptom of postpartum depression because it may be an emotional response to major stress. In a study by S. Assari and M. Moghani Lankarani in the May 2016 issue of Frontiers in Public Health, hopelessness positively correlated with depression and suicidality and negatively correlated with happiness and appropriate adjustment to stress. Individuals who maintain hope are more resilient to stress because it serves as a motivator. Since PPD affects how a person deals with stress, it may contribute to hopelessness. 

Hopelessness is one of the symptoms of postpartum depression due to anhedonia (lack of interest). In mood disorders, lack of interest is associated with a reduction in dopamine transmission and a failure within reinforcement systems. Reduced motivation is yet another mechanism behind the lack of interest, according to a study by J.A. Cooper et al. in the August 2018 issue of Current Opinion in Behavioral Sciences. 

As a symptom of postpartum depression, hopelessness is identified as seeing no hope to get better, a strong desire to isolate, and feeling helpless and powerless.

7. Restlessness

Restlessness is the feeling of needing to constantly move or being unable to calm the mind. People feel restless due to alcohol or drug abuse, and mental health conditions such as depression or bipolar disorder. PPD can also lead to restlessness.

Restlessness becomes a symptom of postpartum depression due to anxiety and the inability to process emotional stress or burden. When a person is anxious, they tend to have more of a fear response first when dealing with negative stimuli. For that reason, they experience rapid heartbeat, sweating, and nervousness. Discomfort associated with those experiences may cause agitation or restlessness, according to an October 2020 post on the website of Calm Clinic. 

Restlessness is one of the symptoms of postpartum depression due to the influence of other symptoms and chemical changes that patients experience. Other symptoms of PPD, such as mood swings and disrupted sleep, can cause nervousness, restlessness, or agitation. The patient can’t process their feelings properly and their reaction to negative stimuli or stressful situations is impaired. Moreover, PPD is associated with low levels of serotonin, which contributes to symptoms of anxiety including restlessness. Imbalances in hormones, which are common in PPD, can contribute to restlessness too.

Restlessness, as a symptom of postpartum depression, is identified as increased nervousness, inability to focus, wandering mind, and difficulty to relax. 

8. Feelings of worthlessness, shame, guilt, or inadequacy 

Feelings of worthlessness, shame, guilt, or inadequacy are defined as a sense of being insignificant, ashamed, incompetent, or inadequate in life generally or a specific aspect of life. A person may also hold a lot of guilt. These emotions may be symptoms of mental illnesses including PPD.

Feelings of worthlessness, shame, guilt, or inadequacy become a symptom of postpartum depression due to low self-esteem. A negative self-image is one of the driving forces behind PPD. A major aspect of reduced self-esteem is the belief of being worthless or not good enough. Worthlessness is strongly associated with core aspects of depression such as self-blaming, lack of interest, and hopelessness, according to a paper by P. Harrison et al. in the May 2022 issue of Frontiers in Psychiatry. Low self-esteem and depressive symptoms such as lack of energy or mood swings can also lead to feelings of guilt. 

Feelings of worthlessness, shame, guilt, or inadequacy are one of the symptoms of postpartum depression due to the depletion of serotonin. This neurotransmitter plays a role in the social behavior of an individual. Depletion of serotonin enhances feelings of guilt in empathetic individuals, according to a study by J.W. Kanen et al. in the February 2021 issue of Translational Psychiatry. 

As a symptom of postpartum depression, feelings of worthlessness, shame, guilt, or inadequacy are identified as feeling insignificant or small and irrelevant, insecurity, feeling embarrassed, and thoughts of not being good enough. Parents with PPD may feel unworthy, compare themselves with others, and experience nervousness and frustration over their condition.

What can I expect from postpartum depression?

A wide spectrum of symptoms can be expected from postpartum depression. Women with postpartum depression may experience eating problems such as excessive appetite or no appetite, problems doing tasks at home or work, loss of interest in activities once enjoyed, and social isolation or feeling withdrawn or unconnected. 

Women with PPD tend to be unable to care for themselves and the baby or they are excessively worried about the baby’s health. Mothers with PPD may have negative feelings or little interest in the infant. These negative feelings can become so severe that a mother fears being alone with the baby, according to What to Expect.

Persons with PPD can expect their condition to last for months unless they see the doctor and adhere to the treatment. Untreated PPD may cause complications with the baby such as language delays, behavioral problems, and excessive crying. Mothers are also at risk of complications; their PPD lasts longer and may become an ongoing depressive disorder. They may stop breastfeeding or have problems bonding with the baby and their suicide risk is also higher, Mayo Clinic explains.

How is postpartum depression diagnosed?

Postpartum depression is diagnosed after a physical and psychiatric evaluation. Cleveland Clinic explains that there is no specific test to diagnose PPD. Healthcare providers tend to schedule visits at two or three weeks postpartum to screen for depression. During the visit, the healthcare provider may discuss a patient’s health history, emotions, and feelings after childbirth and recommend a physical exam which includes a pelvic exam and lab tests. The purpose of a physical exam is to rule out physical causes that may cause similar symptoms to those of PPD. Good examples are thyroid conditions and hormonal imbalances.

The psychiatric evaluation or assessment may include discussing feelings, thoughts, and mental health. The goal is to determine whether a patient has a short-term case of postpartum baby blues or a more severe form of depression, Mayo Clinic reports. A patient may need to do a depression screening and fill out a questionnaire. The most common screening test for PPD is the Edinburgh Postnatal Depression Scale (EPDS), which consists of 10 short statements. The patient needs to explain how often they felt a certain way (described in each statement) in the past seven days.

Since postpartum depression isn’t a separate diagnosis, patients must meet the criteria for major depressive disorder and the criteria for the peripartum-onset specifier. A healthcare professional will diagnose postpartum depression when a patient develops symptoms of MDD during pregnancy or within four weeks of delivery.

What are the available treatments for postpartum depression?

The available treatments for postpartum depression are listed below:

• Psychotherapy
• Antidepressants

1. Psychotherapy

Psychotherapy is a term that refers to treatments that help a patient identify and change troubling behaviors, emotions, and thoughts. There are many kinds of psychotherapy such as cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), or interpersonal therapy. 

Psychotherapy helps to treat postpartum depression because it gives the opportunity to identify the factors that contribute to depression and to effectively deal with the symptoms of PPD. Psychotherapy such as CBT empowers a patient to identify negative or distorted thinking patterns that contribute to symptoms of depression such as feelings of hopelessness and helplessness. 

Psychotherapy is one of the best treatments for postpartum depression because it is goal-oriented; it aims to help a person change their thinking pattern and become their own therapist. K. Fenn et al. explained in their research article from the September 2013 issue of InnovAiT that how people feel is determined by the ways they interpret situations rather than by the situations themselves. A person with depression tends to be excessively negative in their interpretations of events. Additionally, in patients with depression the negative automatic thoughts (NATs) center on themselves, uselessness, and low self-esteem. For that reason, CBT equips a patient with tools to change their maladaptive cognitive and behavioral problems. 

Psychotherapy is an effective treatment for postpartum depression and its benefits are confirmed in a study that L. Huang et al. published in the October 2018 issue of PLoS One wherein they focused on CBT. The study showed that CBT significantly improved short-term and long-term symptoms of postnatal depression. 

The most recent piece of evidence on the efficacy of CBT for postpartum depression was published by D. Pettman et al. in the March 2023 issue of BMC Psychiatry. The paper showed that cognitive-behavioral therapy led to improvements in PPD, stress, anxiety, and perceived social support.

A study by N.P. Amiri et al. in the April 2021 issue of Revista Brasileira de Ginecologia e Obstetricia found that DBT reduced the levels of PPD and anxiety. Dialectical behavior therapy is a type of CBT adapted for people who feel emotions very intensely. The main goal of DBT is to help patients understand and accept their difficult feelings and learn skills to manage them.

It takes six to 24 (or between five and 20) sessions of CBT to take effect for patients with postpartum depression. Interpersonal therapy is usually delivered in 12 to 16 sessions, although short courses of three to eight sessions may also work. DBT takes at least six months to a year.

2. Antidepressants

Antidepressants are a class of medications that treat depression, but also help with other mental illnesses such as anxiety. There are several types of antidepressants, but the most commonly prescribed are selective serotonin reuptake inhibitors (SSRIs). 

Antidepressants help treat postpartum depression by increasing the levels of neurotransmitters such as serotonin or norepinephrine. The exact mechanism of action depends on the type of antidepressant. SSRIs block or inhibit reuptake of serotonin. As a result, a higher level of serotonin is available to pass further messages between nearby nerve cells, according to NHS Inform. 

Antidepressants are one of the best treatments for postpartum depression because they work well with psychotherapy or may increase its effectiveness. Researchers at Uppsala University from Uppsala, Sweden found that a combination of SSRIs and CBT is even more effective and leads to changes in the brain, as reported by the university’s website in October 2022. Moreover, a study by J.R. Strawn et al. in the February 2022 issue of the Journal of Affective Disorders, confirmed the superiority of a combined CBT and SSRI approach. Antidepressants combined with therapy led to rapid and greater relief in symptoms of depression and anxiety.

Antidepressants are effective for the management of PPD and perform better than placebo, according to a meta-analysis that J.V.E. Brown et al. published in the February 2021 issue of The Cochrane Database of Systematic Reviews. 

Additionally, the January 2018 issue of Therapeutic Advances in Psychopharmacology published a paper by S.S. Clevenger et al. who confirmed that antidepressants are effective at managing depression and preventing relapse, especially SSRIs. The most effective SSRI, according to this paper, was escitalopram but the differences between other SSRIs were insignificant. 

Antidepressants may need one to two weeks to take effect, without missing a dose. However, it may take four to eight weeks to get full benefits from antidepressant medications.

What are the complications of postpartum depression treatment?

Complications of postpartum depression treatment are side effects of antidepressants that patients may experience. 

According to an August 2021 post on the Harvard Health Publishing website, patients who are taking SSRIs may develop side effects such as insomnia, skin rash, headache, pain in muscles and joints, stomach upset, diarrhea, and nausea. These adverse reactions tend to be mild and temporary or both. SSRIs can reduce sexual interest, desire, performance, and satisfaction.

In a study by C. Cartwright et al. in the July 2016 issue of the journal Patient Preference and Adherence, about 73.5% of long-term users of antidepressants experienced withdrawal effects whereas 71.8% reported sexual problems. Patients who used antidepressants for three to 15 years also experienced side effects such as weight gain (65.3%), feeling emotionally numb (64.5%), and addiction (43%).

H. Miidera et al. published a study in the February 2020 issue of Diabetes Care wherein they confirmed that long-term antidepressant use may increase the risk of type 2 diabetes in a time- and dose-dependent manner. Antidepressants may increase type 2 diabetes risk due to weight gain, altered glucose regulation, increased insulin resistance, and inhibited insulin secretion. 

In September 2022, the University of Bristol from Bristol, UK issued a press release regarding their study, which showed that long-term antidepressant use could increase the risk of coronary heart disease and death from cardiovascular disease and from any cause. These risks were higher for people who were taking non-SSRI antidepressants. The findings of this study were published by N. Bansal et al. in the September 2022 issue of the British Journal of Psychiatry Open (BJPsych Open).

Can postpartum depression be treated?

Yes, postpartum depression can be treated and it is possible to achieve full recovery with proper treatment, according to the UK’s NHS. A study by M. Moshki et al. in the July-September 2015 issue of the Journal of Family Medicine and Primary Care also confirms that PPD is both a preventable and curable mental illness and a majority of depressed mothers achieve full recovery and return to their normal life through early diagnosis and treatment.

How to prevent postpartum depression?

In order to prevent having postpartum depression, it is important to get educated about this condition. Education on this subject is important because it allows a woman to recognize the symptoms of PPD and seek treatment immediately. 

Make sure to get enough sleep. K. O’Leary et al. reported in their paper from the December 2017 issue of Cognition and Emotion that sleep disturbances precede depression. Lack of sleep may increase the risk of depressive symptoms due to cognitive deterioration, emotional deficits, or emotion regulation difficulties. 

Increase physical activity levels through regular exercise. According to a study by Y. Huang et al. in the January 2020 issue of Translational Psychiatry, sedentary behavior is positively associated with depression. The CDC advises that pregnant and postpartum women should do at least 150 minutes of moderate-intensity aerobic physical activity during the week. 

Try not to make major life changes during or after pregnancy. Major life changes are stressful and may worsen mental health, particularly for new parents or parents-to-be. 

Be prepared for childbirth by taking a class or reading books and articles intended for parents who are expecting a baby. The more a woman is informed, the more confident she becomes. This confidence can positively influence her mental well-being.

Get help with the household during the postpartum period. A new mom should focus on herself and her baby, which could support her recovery and improve her mental health. 

Try CBT, online or in-person. X. Qin et al. published a study in the December 2022 issue of the International Journal of Environmental Research and Public Health where they revealed that an app-based CBT program can help prevent PPD and reduce the risks of depressive symptoms during the early postpartum period.

Consider breastfeeding. A paper titled “The Relationship between Postpartum Depression and Breastfeeding” from the March 2012 issue of the International Journal of Psychiatry in Medicine reported that women who breastfeed their infants had a lower risk of developing PPD. The protective effects of breastfeeding were maintained over the first four months of postpartum.

How to deal with postpartum depression?

In order to deal with postpartum depression it is necessary to exercise and increase the levels of physical activity. A.J. Daley et al. reported in their paper from the 2007 issue of the Journal of Midwifery and Women’s Health that exercise is a useful treatment for women with PPD. 

Eat a well-balanced diet. O. Pano et al. reported in their paper from the November 2021 issue of the World Journal of Psychiatry that a healthy diet is associated with better symptom management in people with depression. Eat fruits, vegetables, healthy fats such as Omega-3 fatty acids, and an abundance of protein, fiber, vitamins, and minerals. Avoid heavily processed items laden in sugar, too much salt, or rich in unhealthy fats. 

Sleep more. Lack of sleep can contribute to or worsen depressive symptoms. A woman with PPD may want to aim for more rest. 

Socialize more. Social isolation contributes to and it’s one of the symptoms of PPD. Spend more time with people including the partner, family, and friends, join a support group for moms with PPD, or share experiences with other moms within one’s social circle. 

Build a secure bond with the baby. Building a secure bond with the baby may take time, but it’s beneficial because close contact with the infant releases oxytocin. There are many ways to build an emotional bond with the baby; such as skin-to-skin contact, baby massage, singing, and smiling to a baby to get a smile back, according to Medical News Today.

Focus on hygiene. Poor hygiene has a negative impact on confidence and self-esteem thereby worsening symptoms of PPD. For that reason, focus on hygiene and practice it regularly. 

Ask for help. It is okay to admit to not doing well or asking close ones to help. Asking for help isn’t a sign of weakness. Instead, getting help is a sign of strength and courage.

How long does postpartum depression last?

Postpartum depression lasts anywhere from several weeks to 12 months after giving birth. There is no specific answer to how long postpartum depression can last. Healthline explains there is no average duration of this condition. 

A review that N. Vliegen et al. published in the January-February 2014 issue of Harvard Review of Psychiatry revealed that cases resolve three to six months after the symptoms start, however at any time point between four months and three years postpartum, about 30% of mothers diagnosed with this condition still meet diagnostic criteria.

What is the difference between postpartum depression and baby blues?

The difference between postpartum depression and baby blues is that the symptoms of PPD are a lot more severe. Baby blues are feelings of sadness in the first few days after having a baby. When it comes to baby blues vs. PPD, there are many differences that set them apart.

The onset of the symptoms is where PPD and baby blues differ. Baby blues occur a few days after having a baby, but PPD starts within one to three weeks up to a year after giving birth. It’s possible to develop symptoms of PPD during pregnancy, which doesn’t happen with baby blues.

Postpartum depression lasts longer. A mother with baby blues is likely to feel better by the time her baby is one to two weeks old. Postpartum depression isn’t a short-term condition and doesn’t go away on its own. 

Baby blues aren’t as severe or serious as PPD is. Cleveland Clinic explains that it’s common to feel sad or teary for no apparent reason, but if these feelings become intense and interfere with day-to-day life, it could indicate the presence of a more serious problem such as PPD. 

The fourth difference is the lack of enjoyment during the postpartum period. Baby blues don’t rob a new mother of the enjoyment related to the new arrival. Postpartum depression is indicated by the lack of enjoyment.

Baby blues doesn’t include thoughts of self-harm or harming the baby. A woman with postpartum depression experiences more pronounced symptoms which also include thoughts of harming the baby or herself.