Why are you feeling sad?
You’ve just had your first baby and were super excited to welcome him home. Now, several days later, you’ve started feeling sad, overwhelmed, and anxious. You’ve also been crying a lot. What’s going on? Aren’t you supposed to be happy? Is it something serious?
Definition
When you have a baby, there are many emotions that you experience. One that many people don’t expect is depression. This is called postpartum depression because it typically starts in the postpartum period (begins with the child’s birth and lasts at least six weeks). There isn’t a single cause, but physical and emotional issues are thought to play a role. Physical changes are most likely related to the dramatic drop in hormones (estrogen and progesterone) in your body that happen after birth. Other hormones produced by your thyroid gland also may drop sharply, which can make you feel tired, sluggish, and depressed. Emotional issues can be correlated to being sleep-deprived, anxious, and overwhelmed. These can make it challenging to handle even minor problems. Also, you may feel less attractive, struggle with your sense of identity, or feel that you’ve lost control over your life.
Postpartum depression is divided into three levels. The first is known as baby blues, which begin within the first two to three days after delivery and can last for two weeks. Symptoms of baby blues are mood swings, anxiety, sadness, irritability, feeling overwhelmed, crying, reduced concentration, appetite problems, and trouble sleeping.
The second level is postpartum depression, and this is often mistaken for baby blues at first but is usually more intense and lasts longer. Symptoms of postpartum depression typically appear within the first few weeks after delivery but can begin during pregnancy or up to a year after birth. Sometimes, it can interfere with your ability to care for your baby and do other daily tasks. Symptoms of postpartum depression include depressed mood, severe mood swings, excessive crying, difficulty bonding with your baby, withdrawing from family/friends, loss of appetite or eating much more than usual, inability to sleep (insomnia) or sleeping too much, overwhelming fatigue, loss of energy, reduced interest and pleasure in activities you used to enjoy, intense irritability and anger, fear that you’re not a good mother, hopelessness, feelings of worthlessness/ shame/guilt/inadequacy, diminished ability to think clearly/concentrate/make decisions, restlessness, severe anxiety, panic attacks, thoughts of harming yourself or your baby, and recurrent thoughts of death or suicide. If left untreated, postpartum depression may last for many months or longer.
The third level is rare and develops within the first week after delivery. It’s called postpartum psychosis and has severe symptoms, which are confusion/disorientation, obsessive thoughts about your baby, hallucinations/delusions, sleep disturbances, excessive energy/agitation, paranoia, and attempts to harm yourself or your baby. The condition requires immediate treatment.
Any new mother can have postpartum depression. Also, it can occur after the birth of any child, not just your first one. Your chances of developing it are higher if you have a history of depression (either during pregnancy or at other times), bipolar disorder, postpartum depression after a previous pregnancy, family members who’ve had depression or other mood disorders, experienced stressful events during the past year (pregnancy complications, illness or job loss), a baby that has health problems or other special needs, twins, triplets or other multiple births, difficulty breastfeeding, issues in your relationship with your spouse or significant other, a weak support system, or financial problems. Another major factor is if the pregnancy was unplanned or unwanted.
It’s important to note that new fathers can have postpartum depression too! It’s referred to as paternal postpartum depression and has the same negative impacts on relationships and child development as postpartum depression in mothers. Typically, the same symptoms are the same as new mothers, such as feeling sad/fatigued/overwhelmed, experience anxiety, or have changes in their usual eating and sleeping patterns. Fathers who are young, have a history of depression, experience relationship problems, or are struggling financially are most at risk.
If not treated, postpartum depression can interfere with bonding and cause family problems. For mothers, it can progress to a chronic depressive disorder. It’s vital to note that even when treated, postpartum depression increases a woman’s risk of future episodes of major depression. When a new mother is depressed, the risk of depression in the baby’s father also increases. For fathers with postpartum depression, it causes emotional strain for everyone close to a new baby. For children, they’re more likely to have emotional and behavioral problems, like sleeping and eating difficulties, excessive crying, and delays in language development.
Treatment
Postpartum depression treatment depends on the severity. With baby blues, they usually go away on their own within the first few weeks. During this time, get as much rest as you can, accept help from family and friends, connect with other new moms, create time to take care of yourself, and avoid alcohol and recreational drugs (can make mood swings worse).
For postpartum depression, the typical treatment is psychotherapy, medication, or both. With psychotherapy, you can talk through your concerns with a psychiatrist, psychologist, or other mental health professional. They can help you find better ways to cope with your feelings, solve problems, set realistic goals, and respond to situations positively. If needed, your doctor may recommend an antidepressant. Many new mothers are concerned about this if they’re breastfeeding. However, most antidepressants can be used with little risk of side effects for your baby. While postpartum depression typically improves with appropriate treatment, sometimes, it continues and becomes chronic depression. This is why it’s imperative to continue treatment after you begin to feel better because stopping it too early may lead to a relapse.
Treatment for postpartum psychosis is typically done at the hospital because of its emergent nature. Usually, it involves a combination of medications to control symptoms, like antipsychotic medications, mood stabilizers, and benzodiazepines. Another form of treatment is electroconvulsive therapy (ECT), which is only done if symptoms don’t respond to the medications. ECT is a procedure in which small electrical currents are passed through the brain, intentionally triggering a brief seizure. This causes changes in brain chemistry that can reduce the symptoms. Obviously, the condition and treatment can impact the mother’s ability to bond and breastfeed her baby. Your doctor can help you work through these challenges.
Prevention
When it comes to preventing postpartum depression, it’s essential to take care of yourself. A key component is to make healthy lifestyle choices by including physical activity in your daily routine. This can be something simple like walking with your baby. Also, try to get adequate rest by sleeping when your baby is sleeping. Be sure to eat healthy foods and avoid alcohol. It’s vital to set realistic expectations and not pressure yourself to do everything. Remember, you don’t have to have the perfect house. Another essential item is to make time for yourself and get out of the house to do something that you enjoy, visit with friends, or have alone time with your partner. This may mean asking a family member to take care of the baby or arranging for a sitter. It’s crucial to avoid isolation, so talk with your partner, family, and friends about how you’re feeling. Don’t be afraid to ask for help. In addition, if someone offers to babysit, take them up on it.
If you have a history of depression, especially postpartum depression, tell your doctor if you’re planning on becoming pregnant or as soon as you find out you’re pregnant. This way, during pregnancy, they can monitor you closely for symptoms of depression. Sometimes mild depression can be managed with support groups or counseling. Other times, your doctor may recommend antidepressants. After your baby is born, you should do an early postpartum checkup to screen for signs of postpartum depression. The key is early detection so that you can begin treatment. If you have a history of postpartum depression, your doctor may suggest antidepressants or psychotherapy immediately after delivery.
Postpartum depression is a very serious condition that is often not talked about, but it should be. If you have any questions or concerns about postpartum depression, please speak with your doctor. If you would like more information, please visit the Office of Women’s Health’s Postpartum Depression page at https://www.womenshealth.gov/mental-health/mental-health-conditions/postpartum-depression