Postpartum depression part 1: Signs and symptoms

Key Takeaways:

• Postpartum depression is one of the most common obstetrical complications.
• It can start immediately after birth and can even be present before birth.
• Symptoms include feeling sad and depressed, mood problems, trouble focusing and concentrating, and being less interested in the things you previously enjoyed.

Postpartum depression happens to a lot of women. In fact, it is one of the most common obstetrical complications.

Unfortunately, there’s a lot of stigma in the mental health field around depression with this false belief that it is a sign of weakness and something that we should be able to overcome on our own. 

Getting past that stigma and seeking help when you see the signs are important.

In this blog, we’re going to define postpartum depression and explain its signs and symptoms.

What are postpartum depression and the baby blues?

Postpartum depression is better thought of as peripartum depression.  It is a depressive episode that begins during pregnancy or in the postpartum period, after delivery. 

It is important to distinguish peripartum depression for postpartum blues, also known as baby blues.  

Baby blues are a normal occurrence after delivery and occur in around one in four women.  With baby blues, you can feel tearful, emotional, overwhelmed, and anxious. But it doesn’t have that same functional impairment, meaning you can still do the things you need to do daily and handle daily life, caring for yourself, your family, finances, and other daily responsibilities.

With peripartum or postpartum depression, the symptoms are so severe that functioning is impaired.  It is more than just feeling down, worried, or emotional.  It keeps you from functioning, and everyday tasks feel like too much.  

How common are they?

The data vary, but approximately one-in-seven women experience a major depressive episode during pregnancy or in the postpartum period.  This differs from the rates of baby blues, which occur in about 75 percent of women.

What causes postpartum depression?

There are a lot of different factors that are thought to contribute to postpartum depression. 

One is the rapid shift in hormones you experience during pregnancy and in the postpartum period. 

If somebody has a history of depression before pregnancy or during pregnancy, they’re at a greater risk of experiencing depression in the postpartum period.  A family history for depression is also a risk factor. 

Different social factors and environmental factors can contribute to postpartum depression risk. Intimate partner violence and relationship strain, poor social support, and financial stressors also increase the risk of peripartum depression. 

Also, if the pregnancy was unplanned – not necessarily an unwanted pregnancy, but unplanned pregnancy – that can increase the risk of postpartum depression as well.

How soon can it start after birth?

It can start immediately after birth, but it can also be present before delivery. With peripartum depression, symptoms will be present nearly every day.  It can then last for weeks, months, or a year, especially without appropriate treatment. 

Again, it’s distinct from postpartum blues, which start within 24-48 hours of delivery and last for about two weeks.

The risk of having a peripartum or postpartum depressive episode is elevated for upwards of a year after delivery.

How long does it last?

It is hard to predict how long it will last. Without treatment, most episodes resolve within a few months.  However, for some women, around 30 percent, symptoms continue for a year, and for a minority, even longer.  Again, this differs from postpartum blues, that self-resolve within two weeks. 

The goal of treatment for peripartum depression is to improve and hopefully resolve the symptoms more quickly.  We want depression to no longer get in the way of everyday life, so that mothers can care for themselves, bond with their baby, and keep up with daily tasks.  

What are the symptoms?
The symptoms of peri- and postpartum depression are similar to a major depressive episode outside of pregnancy, although there are some distinct features.  Symptoms include feeling sad and depressed, sleeping problems, trouble focusing and concentrating, and being less interested in the things you previously enjoyed. 

With a new baby, there are a lot of time commitments. You might not be engaging in some of the behaviors and things you used to enjoy doing because of time constraints, but with peripartum depression, you may find you do not enjoy caring for your child or spending time with your child. 

It may be associated with feelings of guilt and inadequacy, like you’re not a good mother to your child. 

It may also be associated with sleeping difficulty, and it’s already hard to sleep when you have a newborn around the house.

In more severe cases, it may be associated with thoughts of self-harm or thoughts of harming the baby or others.

When should I talk to my doctor?

If you are experiencing low mood, loss of interest, or significant anxiety, and the symptoms are getting to the point where you feel like you can’t do things, you’re having a hard time taking care of yourself, you’re having a hard time motivating yourself to take care of the baby, or if you’re having thoughts of not wanting to harm yourself or of hurting anybody else, it is time to reach out to your doctor.  

You should also talk to your doctor if you have a personal history or family history of mental health conditions, as getting appropriate screening in place is critical.  

It is also helpful to come up with a plan to potentially decrease the risk of an episode, as well as an action plan should symptoms emerge.  

More to come

In the second part of this series, we talk about postpartum depression diagnosis and treatment.