• En

New mothers have a lot to deal with once they leave the hospital and come home with their baby. Getting into a new rhythm, which includes breastfeeding and nappy changes, can take time. Most mothers find these changes overwhelming in the beginning, and that’s completely natural. What can complicate things further is postpartum depression.

Postpartum depression is a serious mental illness which affects many new mothers. This condition is very different from baby blues, which is what most new mothers who feel exhausted, sad, anxious, frustrated and overwhelmed go through. Baby blues can last for about five days to two weeks, but if these feelings continue or worsen after a period of two weeks, it’s known as postpartum depression.

While most mothers go through baby blues, being diagnosed with postpartum depression can come as a shock and immediate treatment should be started. This type of depression affects the physical and emotional well-being of both the mother and the child. If a mother is unable to care for her baby or herself, and experiences harmful feelings towards herself and her loved ones, it can impair the emotional bond between mother and child and cause behavioural complications in the child in later years too.

The thing everybody needs to understand about postpartum depression is that the mother has done nothing to cause it, but needs your care and attention to treat it properly and completely. A psychologist or psychiatrist can guide you through the required treatment, depending on the diagnosis of postpartum depression. But complete recovery depends on the care and support provided by the family and friends of the patient in these cases. Here is everything you need to know about postpartum depression.

  1. Types of postpartum depression
  2. Symptoms of postpartum depression
  3. Causes of postpartum depression
  4. Treatment of postpartum depression
  5. Risk factors for postpartum depression
  6. Are antidepressants safe during breastfeeding?
  7. Postpartum depression in fathers
  8. Mental health tips for new parents

There are six types of postpartum depression or mood disorders that can affect you after the birth of your child. Each of these types has unique progressions, complications and treatments, so proper diagnosis by a trained and experienced mental health care professional is key.

Ample support from family and friends is needed for all these disorders, but a few severe cases also require suicide support. In some cases, women can experience major depressive episodes that may not have sadness as a symptom. These episodes can be alarming but a woman who has had a major depressive episode is in urgent need of medical help.

The following are the six types of postpartum depression you should be aware of:

Baby blues

This is the most common and mildest type of postpartum mood disorder. It can affect 5-85% of new mothers. Baby blues happen within days of giving birth and generally don't last beyond two weeks. Baby blues can even disappear within a few hours, depending on how soon the mother’s body and mind adapt to the changes in her life, physiology and hormone levels.

Baby blues don’t interfere with a mother’s ability to care for her baby and herself, and her functionality is barely affected beyond a few days at the most. It does not leave a lasting impact on her, the baby or the family, and is therefore considered to be normal in women after delivery.

You might also be interested in: Baby FAQs in the first week after birth

Postpartum anxiety

Since anxiety is part and parcel of a new mother’s life, many people fail to diagnose postpartum anxiety as a separate mood disorder. But postpartum anxiety disorder can be more severe and persistent in nature. Like baby blues, it can naturally disappear after a few weeks, but it can also last for months without the proper care. The following are the predominant signs of postpartum anxiety:

  • Inability to relax
  • Persistent and illogical fears and worries
  • High levels of tension and stress

You might also be interested in: Vaccines for newborns, infants and children

Postpartum obsessive compulsive disorder (OCD)

This type of postpartum mood disorder affects 3-5% of postpartum women, and can be very disturbing. Its symptoms include intrusive and persistent thoughts and compulsive behaviours like repetitive cleaning and diaper changing of the baby. Most mothers affected by postpartum OCD tend to be ashamed or embarrassed by their behaviour, and therefore try to hide it from others in the family. This is one of the major reasons why this type of postpartum mood disorder goes undiagnosed and untreated.

However, it’s important to be aware of this disorder, because it can take a turn for the worse. Some mothers might think about harming their child, and though they may not act on these impulses, the horror of these thoughts can have a long-lasting impact on the mother, child and family.

You might also be interested in: Baby development in the first month after birth

Postpartum panic disorder

This severe type of mood disorder affects roughly 10% of all postpartum women, and can cause extreme anxiousness and panic attacks. Women with a history of severe anxiety and panic attacks are at a greater risk of developing this type of postpartum disorder after delivering their baby. Hypothyroidism and other thyroid dysfunctions can also increase the risk of postpartum panic disorder. The following are the major symptoms of this type of mood disorder:

  • Shortness of breath
  • Tightness in the chest
  • Heart palpitations
  • Consistent and excessive fears about the mother or the child dying, losing control or going mad

Postpartum post-traumatic stress disorder (PTSD)

Postpartum PTSD is a severe form of postpartum mood disorder which affects over 9% of postpartum women. Like general PTSD, postpartum PTSD occurs when there’s a real or perceived threat to the mother’s life before or during pregnancy, or while giving birth. Women who have suffered through the following traumas are at a greater risk of developing postpartum PTSD:

  • Birth complications
  • Unplanned C-section
  • Injuries suffered during delivery
  • Baby sent to NICU soon after birth
  • Past sexual assault or violence

The following are some of the main symptoms of postpartum PTSD:

  • Reliving the trauma in flashbacks and memories
  • Avoiding triggers that remind the patient of the trauma they suffered
  • Severe anxiety and panic attacks
  • Irritability
  • Lack of sleep
  • Detachment from reality

Since this is a very serious form of postpartum depression, it should be diagnosed and treated as soon as possible to minimise the lifelong effects it can have on the mother, the child and the rest of the family. Suicide support should also be provided to women suffering from this type of postpartum mood disorder.

Postpartum psychosis

Though extremely rare, postpartum psychosis is the most severe form of postpartum mood disorder. Approximately one or two mothers in 1,000 are at risk of developing this type of postpartum depression which is comparable to the manic behaviour of someone with bipolar disorder.

Women with a history of bipolar disorder and other psychotic illnesses are at a greater risk of developing this condition within days or weeks of giving birth.

In this type of postpartum disorder, mothers are unaware of their own actions and behaviours, so there’s an increased risk of suicide or infanticide. This is why immediate care, hospitalization and treatment is required in these cases. The following are some of the symptoms that show up in women with postpartum psychosis:

Getting the specific diagnosis of which type of postpartum depression a new mother is suffering from is of the utmost importance. Such a specialised diagnosis can only be done by a trained and experienced mental health care professional.

People around a new mother should, however, be aware of the most common symptoms of postpartum depression. Once these symptoms are identified, the postpartum mother should be provided with ample help, support, care and treatment so that her recovery can be speeded up. The following are some of the common symptoms of postpartum depression:

  • Feeling sad, hopeless, overwhelmed or empty
  • Worrying or feeling excessively anxious
  • Feeling irritable, moody or restless
  • Crying for no apparent reason 
  • Sleeping too much or not being able to sleep when the baby is sleeping
  • Experiencing excessive anger or rage
  • Eating too little or too much
  • Having trouble concentrating or making decisions
  • Lack of interest in routine activities or activities which previously gave pleasure
  • Eating too little or overeating
  • Withdrawal from family and friends
  • Suffering from persistent headaches, body aches and indigestion
  • Trouble bonding with the baby
  • Persistent doubts about being able to take care of the baby or being a perfect mother
  • Thinking about harming self or the baby

Postpartum depression isn’t necessarily caused by one factor. It can occur due to a combination of multiple factors which can be physical, biological and emotional in nature. It’s important to remember that postpartum depression does not happen because of something that a mother does or does not do. The following are some of the common causes of postpartum depression.

  • Hormonal changes: The levels of female hormones like estrogen and progesterone are the highest they’ll ever be during pregnancy. Within hours of giving birth, these hormone levels rapidly drop. Levels of thyroid hormones are also likely to drop after giving birth. These changes can lead to depression just like hormone changes during menstruation lead to mood swings. Only, the postpartum changes are more drastic.
  • Fatigue: Childbirth can be very tiring. Add to that the need to care for a newborn baby, and the mother can become sleep- and rest-deprived. too. This inevitably leads to fatigue, and regaining normal strength and stamina can become more difficult. This can also lead to body aches, inability to concentrate or eat, sadness and frustration and may lead to postpartum depression.
  • Emotional factors: Whether a pregnancy was planned or unplanned, being a new mother can emotionally overwhelm or exhaust a mother. There are life changes to deal with, and making a baby the primary centre of attention can take time to get used to. The added pressure of being a perfect mother can aggravate this feeling of inadequacy. Parents of babies who are born sick, premature or with other complications also go through feelings of sadness, anger and guilt. These emotions can take a toll and lead to postpartum depression.
  • History of depression: Women who have had depression, anxiety and panic attacks at any time before or during the pregnancy - or those who are being currently treated for depression - are more at risk of suffering from postpartum depression.
  • Lifestyle factors: Lack of support or care from the spouse, family and friends can increase feelings of inadequacy, persecution and guilt. Critical remarks about the mother’s appearance or the baby’s gender or looks can also trigger these feelings and ultimately lead to postpartum depression.

Postpartum depression can affect any mother of any age, race, region or economic status. It’s important to remember that though the condition of a woman suffering from postpartum depression is serious, there are effective treatments available for this disorder. Depending on the postpartum woman’s diagnosis, either of the following two methods of treatment (or a combination of both) can be prescribed to her by a mental health care professional.

  • Talk therapy: This is one of the non-invasive types of therapy which involves one-on-one counselling provided by a qualified counsellor, therapist, psychologist or psychiatrist. There are two types of talk therapy that have been found to be effective in treating postpartum depression. Cognitive behavioural therapy (CBT) helps people recognise and change their negative thoughts and behaviours. Interpersonal therapy (IPT) helps people understand and work through problematic interpersonal relationships. 
  • Antidepressants: Antidepressants are medications that can balance the chemicals in the brain that determine moods. These drugs are prescribed to women with postpartum depression only in the most severe cases, since antidepressants can be transferred to the baby during breastfeeding. This is the reason why antidepressants should only be taken when a doctor prescribes them, and in the precise dose prescribed. It’s important to remember that antidepressants can take three to four weeks to take effect, so patience is important in the meantime.

Some women are at a greater risk of developing postpartum depression after giving birth. These women and their loved ones should be aware of this risk and take precautions to prevent triggers, enable the quick diagnosis of depression and get treatment without any delay. The following are some of the risk factors associated with postpartum depression.

  • If the new mom showed any symptoms of depression during and after a previous pregnancy.
  • If the new mom has a history of depression, bipolar disorder or any other mental illness.
  • If a close family member has suffered from depression or a mental illness.
  • If the new mom had a stressful life event before, during or right after childbirth, like personal illness, loss of job, death of a loved one or domestic violence.
  • If the new mom had medical complications during childbirth, like premature labour.
  • If there are any health problems in the child, including birth defects like spina bifida or congenital heart defect.
  • If the new mom had mixed feelings about pregnancy, whether it was planned or unplanned.
  • If there is a lack of strong and consistent support from spouse, partner, family and friends.
  • Alcohol abuse or drug abuse prior to or during pregnancy.

Many women who suffer from postpartum depression choose talk therapy over antidepressants because of the belief that all medications that new mothers take are secreted into the breast milk and a breastfed baby can get affected by them. This is true. 

All medications - antidepressants, antipsychotic agents, mood stabilizers and benzodiazepines - do indeed make their way to the breast milk, although the precise concentrations of these agents can vary. The amount of medication to which a breastfed infant can get exposed depends on the following factors:

  • The specific medication
  • Dosage of the medication
  • Frequency of dosing
  • Frequency of infant feedings
  • Rate of maternal drug metabolism

Despite these factors, antidepressants - especially selective serotonin reuptake inhibitors (SSRIs) like sertraline and paroxetine - are considered to be relatively safe for use during breastfeeding when clinically prescribed. These drugs have been tested in multiple clinical trials, and very low levels could be detected in breast milk and in the blood of infants. 

It’s also important to remember that postpartum depression can turn very severe if not treated, which can ultimately harm the baby. So, it is up to the doctor to diagnose the severity of postpartum depression in the mother, recommend a course of treatment, and check if antidepressants are needed. If the doctor believes your case needs a higher dose of these drugs for appropriate treatment, he or she can ask you to stop breastfeeding and shift to formula if needed. In other cases, medications can be started after four to six months, when the baby can be weaned anyway if needed.

No, fathers do not go through pregnancy and labour and they don’t have to breastfeed. But this does not mean that men are not at risk of developing postpartum depression, too. Unfortunately, there isn't much research available on postpartum depression in men.

Postpartum depression in fathers can be equally debilitating and can have just as much of an effect on the family's short- and long-term well-being as postpartum depression in mothers. Here are a few things we know about postpartum depression in men. 

Symptoms of postpartum depression in men

According to a study published in Innovations in Clinical Neuroscience in 2019, approximately 8-10% of new fathers develop postpartum depression within three to six months of the delivery of their baby. The occurrence can also peak over a year after a baby is born. The following are some of the symptoms listed in this study:

  • Feeling sad, empty, lonely or hollow
  • Appearing tearful or crying
  • Diminished or complete lack of interest and pleasure in activities
  • Significant weight loss or weight gain (thereby eating too much or too little)
  • Insomnia or hypersomnia
  • Fatigue and lethargy
  • Feelings of worthlessness or guilt
  • Inability to concentrate or make decisions
  • Recurrent thoughts of death or self-harm

Causes of postpartum depression in men

Another study, published in the Journal of Family Issues in 2019, lists the following causes of postpartum depression in men:

  • Lack of education about reproductive health and child care
  • Adhering to gendered expectations
  • Repressed feelings
  • Being overwhelmed emotionally and financially
  • Feelings of resentment towards the baby
  • Experiencing neglect from the new mother, family and friends

According to the study cited earlier, the one published in Innovations in Clinical Neuroscience, the reasons for postpartum depression in men include: "Sleep deprivation and disrupted circadian rhythm, which have been positively correlated with depressive symptoms in women, might also increase a man’s risk of developing PPD". Further, the study adds, men also experience an increase in estrogen and prolactin hormones after the birth of their baby - these hormonal changes could also be behind their postpartum depression.

You might also be interested in: Tips on getting more sleep when you have a newborn baby at home

Risk factors of postpartum depression in men

A number of risk factors can increase the chances of postpartum depression in men. The following are some of the leading risk factors:

  • History of depression
  • Marital discord
  • Poverty
  • Maternal depression
  • Unplanned pregnancy
  • Sleep deprivation
  • Hormonal changes (low testosterone, cortisol, and vasopressin)
  • Prohibiting father-child bonding

Treatment of postpartum depression in men

Because it is understudied and underdiagnosed, effective treatment options for postpartum depression in men are not completely understood yet. Yet, just like in the case of women, postpartum depression in men is treatable. The following treatments have shown results:

  • Cognitive behavioural therapy (CBT) and interpersonal therapy (IPT)
  • Daily morning light therapy to improve sleep patterns 
  • Educational programs to address feelings and conflicts
  • Paternity leave to get used to being a father

Postpartum depression affects about 10% of all new moms and new dads. Therefore, it is a good idea to be informed about the types of postpartum depression - from baby blues to psychosis. There are also some other ways to create a safe and secure home environment where all issues related to parenthood can be addressed without fear and judgements. Here are a few tips that both parents can use for this:

  • Create an emotional bond with your child by increasing interactions and skin-to-skin contact for both parents. Mothers can do so while breastfeeding, but fathers - instead of feeling excluded - should learn how to change diapers, bathe the baby, soothe him or her and put the baby to sleep. Both parents should play with the baby as often as possible.
  • Lean on each other as well as family members and friends for support. Exhaustion, sleep deprivation, unhealthy eating habits or lack of nutrition, lack of exercise and social isolation can all be prevented if you create a circle of support after childbirth. 
  • Take care of yourself and your partner. It can seem difficult to manage, especially with a newborn in the house. But just making sure that you both eat, sleep, exercise and maintain personal hygiene can go a long way to help you feel less overwhelmed. The postpartum stage is full of many changes that can be overwhelming, but forming a routine as soon as possible can make adapting to your new life much easier. (Read more: Baby bedtime routine)
  • Make time for each other. Simply because you have a baby now does not mean either of you should feel neglected or unloved. While it’s not recommended to have penetrative sex until six weeks after delivery, both parents should be intimate and feel secure with each other. Keep communicating with each other, and plan the future together. (Read more: Sex after pregnancy)
  • Take some time off from work to focus on just the family. This focus is very important in the initial months and should be done by both parents. Maternity and paternity leaves should both be fully utilised to ensure that both parents feel engaged in the upbringing of the baby, while feeling loved and content on the home front before rejoining work.
  • If any signs of postpartum depression show up in either parent, both should seek help to treat the condition. Remember, you are a unit and no issue can be dealt with just on the individual level any more. Getting therapy as a couple can also minimise the chances of either parent getting worse or suffering from postpartum depression for a prolonged period.

References

  1. National Institute of Mental Health [Internet]. National Institutes of Health; Bethesda, Maryland, United States; Postpartum Depression Facts
  2. Office on Women's Health [internet]: US Department of Health and Human Services; Postpartum depression
  3. American College of Obstetricians and Gynecologists. [internet], Bethesda (MD), USA; Postpartum Depression
  4. Nemours Children’s Health System [Internet]. Jacksonville (FL): The Nemours Foundation; c2017. Postpartum Depression
  5. MedlinePlus Medical Encyclopedia [Internet]. US National Library of Medicine. Bethesda. Maryland. USA; Postpartum Depression
  6. Centers for Disease Control and Prevention [internet], Atlanta (GA): US Department of Health and Human Services; Depression Among Women
  7. Scarff, Jonathan R. Postpartum Depression in Men. Innov Clin Neurosci. 2019 May 1; 16(5-6): 11–14. PMID: 31440396
  8. Eddy, Brandon. et al. Forgotten Fathers: Postpartum Depression in Men. Journal of Family Issues, Volume: 40 issue: 8, page(s): 1001-1017.
  9. MGH Center for Women's Mental Health [Internet]. Perinatal and Reproductive Psychiatry Program. Boston. Massachusetts. USA; Breastfeeding and Psychiatric Medications
cross
Ask your health query now and get connected with a doctor within 10 minutes!