What causes postpartum depression? The large drop in estrogen and progesterone immediately following childbirth can cause depression, much like the smaller changes in hormone levels around the time of the menstrual cycle can contribute to stress or mood swings. Other risk factors for the development of postpartum depression include low infant birth weight, baby admission to the neonatal ICU, tobacco use during the last 3 months of pregnancy, physical abuse and partner, traumatic, or financial stressors during pregnancy. A history of depression prior to pregnancy is also a risk factor.
What’s the difference between the baby blues and postpartum depression? Postpartum blues generally begin 2-3 days after childbirth. The symptoms involve feelings of sadness, guilt or anger toward themselves, their baby or their partner. A woman may cry for no reason, wonder if she is capable of caring for her newborn, and be unable to sleep. These symptoms differ from postpartum depression in that they are generally more mild and resolve on their own in 1-2 weeks. However, postpartum depression usually doesn’t begin until 1-3 weeks postpartum (although it may take as long as a year before it develops), and it involves intense feelings of sadness, despair or anger that keep a woman from being able to do her daily activities.
How is postpartum depression treated? Often antidepressants are a first line of treatment. Talk therapy with a mental health care professional may also be appropriate. Very rarely is hospitalization required, and this is generally reserved for patients who may be at risk to harm themselves or others.
Tell me more about antidepressants. SSRIs (selective serotonin re-uptake inhibitors) are usually the type of antidepressant used first, and it may take up to 3-4 weeks before these medications become effective. Side effects are usually mild and may include weight gain, decreased libido, drowsiness, and GI distress. Be sure to notify your provider if you experience suicidal or homicidal thoughts or ideation. Although these medications may be passed through breast milk, the concentration of antidepressants in breast milk is typically very low. Be sure to let your doctor know if you are breastfeeding while taking these medications as well as notifying the doctor for your baby.
Does this mean I have to take medications for the rest of my life? If your mood stabilizes, then a trial of weaning your antidepressant may be appropriate. This may be an option as soon as 3-6 months after starting the medication, or it may be better to continue for at least a year. Before stopping or weaning your antidepressant, be sure to discuss your treatment plan with the provider who prescribed the medication for you.
What to watch out for: Be sure to seek care immediately if you have thoughts of harming yourself, your baby or another person, or if you begin to see things that aren’t really there. A partner may also notice concerning symptoms that aren’t apparent to you, and if this is the case, it is prudent to seek further evaluation.
Remember, just because you experience postpartum depression, that doesn’t make you a bad mother or “not normal.” More than 1 in 10 mothers will require treatment for postpartum depression following pregnancy, and that’s ok. Help can be found at your doctor’s office, support groups, your hospital, and of course, your family. Having postpartum depression is nothing to be ashamed of; not seeking help is.