Postpartum depression: Recognizing the signs and symptoms
While up to 20% of new mothers in the United States suffer from postpartum depression (PPD), no two cases are identical: A woman’s personal and family mental health history, her financial resources and access to support, the difficulty of her childbirth, and her physical health habits before and after pregnancy can all influence her symptoms.
Since severity of PPD varies among women with the condition, it’s important to be aware of typical symptoms and what differentiates the disorder from less severe baby blues. Knowing about PPD may help you recognize it and prompt you to speak to a healthcare professional on behalf of yourself or a friend. Here’s a closer look at postpartum depression and how to manage it:
What is postpartum depression (PPD)?
Postpartum depression is a mood disorder that can affect new or expectant moms—half of all PPD episodes start prior to delivery—as well as about 10% of dads, says Brandon Eddy, Ph.D., assistant professor at University of Nevada, Las Vegas's Couple and Family Therapy Program. People with PPD experience sadness and anxiety with great intensity than experienced with typical baby blues, which usually last for two weeks or less. Postpartum depression symptoms also include feelings of worthlessness, guilt or shame, as well as social withdrawal—and sometimes intrusive thoughts about harming yourself or your baby.
It’s normal to feel overwhelmed, tearful, self-doubting, fatigued, or irritable after giving birth, Eddy says. After all, you’ve experienced a massive shift in hormones, a tiny baby needs you 24/7, and you’re likely running on little sleep. But when these feelings don’t go away within a few weeks, and they keep you from caring for yourself or your baby, you may be suffering from postpartum depression. This doesn’t indicate a lack of love for your baby, Eddy says—the love you have for your baby is buried beneath a treatable set of symptoms.
What causes postpartum depression?
There’s no single cause of postpartum depression, but certain factors increase your risk of experiencing it:
Women with a history of depression are 20 times more likely to experience PPD, and family history increases risk, too. Anxiety, life stresses, not having a partner, or having relationship problems are also strong risk factors.
Gestational diabetes is linked to a 50% increase in risk of PPD. Having a baby prematurely, experiencing mental and physical problems during pregnancy or delivery, and difficulty breastfeeding can also increase the likelihood of PPD.
Support plays a role, too. Not having someone to encourage, reassure, or help you care for the baby can make new moms more vulnerable to PPD, says Florida-based psychiatrist William Upshaw, MD. The same goes for living at or below the poverty line: Being unable to afford medical care, psychiatric support, or child care can take a huge toll on mothers’ mental health.
Postpartum depression symptoms and signs
PPD symptoms can crop up any time from before giving birth to many months post-delivery. Women diagnosed with PPD experience at least five of the following symptoms for two weeks or more and have significantly impaired daily functioning or ability to bond with and care for their baby. If you recognize any of these in yourself, it would be worth reaching out to your doctor.
1. Depressed mood
Feeling empty, sad, angry, hopeless, or helpless, or crying constantly (often for no understandable reason) are hallmark PPD symptoms, Dr. Upshaw says. So too are unrelenting worry and constant anxiety.
2. Diminished interest, pleasure, or motivation
When activities you once enjoyed stop feeling pleasurable, and you lose interest in doing much of anything, pay attention. A persistent lack of desire to do things after childbirth coupled with an absence of enjoyment during most activities could indicate PPD, Dr. Upshaw says. This lack of motivation and diminished ability to feel pleasure can also cause new moms to isolate from friends, family, or other social outlets, he adds.
3. Significant, rapid change in weight
Weight changes are normal following childbirth, Dr. Upshaw says. But rapid weight change (think: weight gain or loss of more than 5% of your weight in one month or less), a change in your appetite (think: feeling constantly hungry or losing your appetite) could indicate PPD.
4. Sleeping too much or too little
Some sleep loss is expected after childbirth—being on alert for baby’s distress and being awoken by crying will do that—but finding it difficult to get to sleep, feeling tired and irritable during the day, or not being able to concentrate due to tiredness could indicate PPD, Dr. Upshaw says. While some PPD sufferers experience insomnia, others find themselves sleeping far more than usual but feeling rested.
5. Restlessness and agitation or feeling slowed down
It’s normal to get a bit stir crazy when stuck at home tending to a baby. But intense restlessness and agitation, especially if noticed by others, can signal PPD, Dr. Upshaw says. PPD can also manifest as feeling extremely slowed down, “like you’re moving your limbs through molasses,” he says.
6. Extreme fatigue
Many PPD sufferers feel more than just exhausted by caring for a newborn. Even after a few weeks of getting their sleep schedules slightly back on track, new moms with PPD may feel utterly depleted and overwhelmed by fatigue, Dr. Upshaw says.
7. Feeling worthless or excessively guilty
Many new moms doubt their ability to be perfect parents. (Spoiler alert: No one lives up to this impossible standard!) But constant feelings of worthlessness (like you have nothing to offer baby or others) or excessive guilt (blaming yourself for every single thing, feeling that you’re a failure) could indicate PPD, Dr. Upshaw says.
8. Difficulty thinking, concentrating, or making decisions
PPD can cloud thinking and ability to concentrate, making it difficult to focus and to remember things—that pediatrician’s number, say, or the location of that daycare. While there is no cause for concern when brain fog happens once or twice a day, it could be a sign of PPD if it’s happening multiple times daily for more than two weeks after your baby’s birth.
9. Difficulty making decisions
Unrelenting indecisiveness—think: being paralyzed when trying to make small choices, like what to eat, what clothes to dress the baby in, or which towel to use when washing the baby—could be a PPD symptom.
10. Thoughts of death, harming yourself, or harming the baby
People who are depressed may have intrusive thoughts of death and dying, including suicidal ideation and in some cases actual plans to self-harm or attempt suicide. With PPD, new moms may experience these disturbing thoughts in addition to thoughts about harming their babies, Dr. Upshaw says. What’s more, the shame they feel about such thoughts can worsen their suffering.
How does postpartum depression affect weight?
Most women lose around 13 pounds during delivery—this includes a lot of fluid loss, the weight of the placenta and, well, the exit of a newborn from your body. New moms will lose additional fluid weight in the first week after childbirth, which is normal, says family physician Nikola Djordjevic, MD, currently based in Bor, Serbia. Most new moms want to return to their pre-pregnancy weight as soon as they can, but PPD can impact weight by increasing or diminishing appetite, Dr. Djordjevic says.
Increased appetite or turning to food as a coping mechanism can cause additional weight gain, and possibly worsen depression. Body image following childbirth can also take a dive, especially when new moms feel that their body doesn’t look or feel the way they’d expected. Dissatisfaction with body image may make PPD more likely and PPD may, in turn, worsen a woman’s view of her body.
1. Postpartum weight gain
If PPD increases your appetite, you might consume more calories than you burn, Dr. Djordjevic says, which will of course lead to weight gain. Together with low motivation to get active or make healthier food choices, managing post-delivery weight becomes more challenging. Lack of sleep—due insomnia that can accompany PPD, or your infant keeping you awake—can also make it harder to lose weight because this lowers blood levels of the appetite-suppressing hormone leptin and increases levels of the appetite-stimulating hormone ghrelin.
Some antidepressant medications for treating PPD can contribute to weight gain, possibly by increasing appetite and slightly lowering the amount of energy the body needs each day—though not everyone who takes antidepressants gains weight, Dr. Djordjevic says.
2. Postpartum weight loss
“Women struggling with postpartum depression may skip meals or forget to eat because they’re so overwhelmed with the responsibilities of caring for their baby; have no appetite; or feel too anxious to eat,” says New York City-based perinatal psychiatrist Dr. Carly Snyder, MD. Some medications that treat PPD might promote some weight loss by reducing appetite and increasing satiety.
How long does postpartum depression last?
Without treatment, PPD can last for months or even years, Dr. Djordjevic says. Unfortunately, many PPD sufferers are undiagnosed and therefore do not get treatment—a consequence of inadequate screening, stigma, and lack of awareness among health care professionals, Eddy says. However, women who are diagnosed and treated with antidepressants may see improvements in their symptoms within six to eight weeks after starting antidepressants—one reason why it’s important to get screened as soon as symptoms crop up.
Postpartum depression vs. baby blues
What distinguishes PPD from baby blues is the severity of symptoms and their duration, Dr. Upshaw says. Baby blues affect up to 70% of women after they give birth and the symptoms are relatively mild, usually passing in a matter of days or a couple of weeks, Dr. Upshaw explains. A mom with baby blues may feel overwhelmed and irritable and gain or lose weight, but she still has the motivation to get out of bed despite feeling tired and will care for her baby and herself, even though she feels low or anxious. What differentiates PPD is a sense of hopelessness that left untreated, can last for many months.
Postpartum depression treatment
PPD symptoms are assessed through questionnaires designed to detect the disorder, like the Edinburgh Postnatal Depression Scale and the Postpartum Depression Screening Scale. Treatment for PPD includes medication, lifestyle, and talk therapy approaches. Here are six options new moms can consider:
Antidepressants can be used to treat PPD, and several have been shown to be safe for moms choosing to breastfeed. In March of 2019 the FDA approved the first drug specifically for treating PPD—it is given intravenously over 60 hours and moms must be closely monitored at a healthcare facility.
Several types of psychotherapy can help people with PPD. One of these is cognitive behavioral therapy (CBT), which is based on the idea that unhelpful and unrealistic thinking leads to negative behavior. CBT aims to break this cycle and find new ways of thinking that can help people behave in a more positive way.
Therapists who use Interpersonal psychotherapy (IPT) believe a depressed mood is a response to current difficulties in everyday interactions with others; they help patients improve these interactions to alleviate psychological symptoms.
3. Natural supplements
Pregnancy demands and depletes a woman’s store of essential fats, and low levels of omega-3 fats are thought to be linked to mood disorders. Some studies suggest that supplementing omega-3 fatty acid—especially via fish oil throughout pregnancy—can help alleviate PPD symptoms. A fish oil supplement or a vegan source of the type of omega-3 fats found in fish oil helps restore low levels more quickly than would normally happen after pregnancy.
Additionally, vitamin D supplements may have a slight effect on reducing symptoms of depression since low blood levels of vitamin D are linked to the condition. Because supplements can interact with other medications and cause side effects, consult with your doctor before taking any.
4. Dietary changes
Eating oil-rich fish once or twice a week will also help improve your body stores of omega-3 fats and vitamin D. Research suggests a Mediterranean-type diet rich in unsaturated fats (nuts, olive oil, avocados), fish, vegetables, whole grains, and legumes may help make PPD symptoms less severe by ensuring an adequate intake of micronutrients that support mood and cognitive function.
What’s more, eating regularly and including protein and a starchy carb, preferably whole grain, with each meal can help prevent low blood sugar that worsens irritability, Dr. Snyder says.
5. Lifestyle changes
We all know that sleep is fundamentally important to mood, but a new baby makes getting enough good-quality rest a real challenge, says Natasha K. Sriraman, MD, MPH, associate professor of pediatrics at Eastern Virginia Medical School in Norfolk, Virginia, who specializes in maternal mental health. Ask your partner or others to watch your child so you can have a break and perhaps take a nap. Getting outside, especially in green space, is good for the mind, and going for regular walks will help, too, says Djordjevic. Joining a support group and interacting with others can also improve mental well-being: Research shows that even online support can be helpful for women with PPD.
6. Complementary and alternative medicine approaches
Research suggests that yoga may help PPD symptoms. The same goes for mindfulness meditation, which encourages a nonjudgmental acceptance and awareness of the present moment, and massage. Transcranial magnetic stimulation has also been found to alleviate symptoms and, though results are mixed, studies suggest light therapy could offer some PPD sufferers relief.
Postpartum depression assessment
It’s important to consult with a medical or mental health professional if you suspect you have PPD. But you can complete an assessment online and discuss your results with a healthcare provider.
Reaching out for postpartum depression help
PPD can place mothers and babies at risk of emotional and physical health issues. Luckily, Dr. Upshaw says, “postpartum depression usually responds very well to treatment.” That’s why it’s crucial to reach out for help if you’re experiencing PPD symptoms and to know you’re absolutely not alone and that you can get better.
Getting support may seem daunting, so if you’re not sure where to start, consider these resources:
Your primary care physician, OBGYN, or local hospital can also provide you with additional resources to help you to understand and manage PPD symptoms.
The upshot: Do I have symptoms of postpartum depression?
PPD is more severe than baby blues. After childbirth it’s normal to notice changes in your mood and motivation, appetite, sleep habits, and energy levels. But when these changes prevent you from bonding with your baby or caring for yourself, it’s best to consult a professional. Needing help to manage how you feel is nothing to be ashamed of, and feeling depressed doesn’t mean you’re a bad parent or don’t love your baby. Many treatment options exist and getting the right support matters. If you’re experiencing PPD symptoms give yourself—and your baby—what you deserve: the care you need to be your best and healthiest self.
Katherine Schreiber, MFA, LMSW, is a freelance writer and social worker based in Manhattan, where she specializes in working with adults with severe mental illnesses, like schizophrenia. Her first book, The Truth About Exercise Addiction: Understanding the Dark Side of Thinspiration is published by Roman & Littlefield and is available in hardcover and paperback.