What is postpartum depression

Postpartum depression also called postnatal depression, is the name given to depression that develops one month and up to one year after the birth of your baby ¹. “Postpartum” means the time after childbirth. Most women get the postpartum “baby blues”, where they’ll feel sad, teary, anxious, moody or empty, within a few days of giving birth. For many women, the baby blues go away in 3 to 5 days, but may last for up to two weeks. The support of your partner, family and friends is usually enough to help you get through “baby blues”. However, if your baby blues don’t go away or you feel sad, hopeless, or empty for longer than 2 weeks, you may have postpartum depression ². Feeling hopeless or empty after childbirth is not a regular or expected part of being a mother.

Here’s what you need to know about postpartum depression:

• It’s not your fault. You didn’t do anything to cause postpartum depression. It doesn’t make you a bad person or a bad mother.
• You are not alone. Many women have postpartum depression.
• If you think you may have postpartum depression, see a health care provider right away. Your provider can be the person who delivered your baby, like an obstetrician, family practice doctor or certified nurse-midwife. Or she could be your primary care provider or your baby’s provider. Or she can be a mental health professional, like a social worker, psychologist, psychiatrist or psychiatric nurse practitioner.
• Treatment can help you feel better. If you think you have postpartum depression, tell your health care provider.

Depression is a common problem after pregnancy. One in 7 new mothers and and up to 1 in 10 new dads in United States has postpartum depression ³. All parents go through a period of adjustment as they try to handle the huge changes a baby brings. For most people, this time of adjustment will be temporary and will not be overly distressing.

• Postpartum depression is the most common complication for women who have just had a baby.
• Mothers can also experience anxiety disorders during or after pregnancy.
• Rarely, an extreme mood disorder called postpartum psychosis also may develop after childbirth.

Postpartum depression can happen any time after childbirth. It often starts within 1 to 3 weeks of having a baby. Postpartum depression is a medical condition that needs treatment to get better.

Postpartum depression is a serious mental illness that involves the brain and affects your behavior and physical health. If you have postpartum depression, then sad, flat, or empty feelings don’t go away and can interfere with your day-to-day life. You might feel unconnected to your baby, as if you are not the baby’s mother, or you might not love or care for the baby. These feelings can be mild to severe.

Postpartum depression isn’t a character flaw or a weakness. Sometimes it’s simply a complication of giving birth.

Causes of postpartum depression are likely to include hormone changes, previous experience of depression and/or anxiety, personality, timing of pregnancy and many other factors. If you have postpartum depression, prompt treatment can help you manage your symptoms and help you bond with your baby.

Specific risk factors significantly increase rates of postpartum major depression for a subset of women. The strongest risk factor is a history of postpartum major depression with a previous pregnancy. Studies report that 25 to 50 percent of women who experience postpartum major depression will have a recurrence after a subsequent pregnancy ⁴. Other important risk factors include antenatal depressive symptoms, a history of major depressive disorder, poor social support, major life events or stressors during pregnancy and a family history of postpartum major depression ⁵. Women with gestational diabetes ⁶ and who give birth to multiples may also be at higher risk of postpartum major depression ⁷. Socioeconomic status and obstetric complications have not been shown consistently to be risk factors for postpartum major depression ⁸.

Recent research has found women with a partner who is caring, considerate and appreciative are less likely to have depression symptoms six months after the birth of their baby. But if they experience their partner to be very controlling and domineering then they are more likely to have symptoms at six months.

The relationship is also important to getting better. A woman’s experience of the strength of the relationship with her intimate partner is closely related to recovery from the symptoms of postpartum depression (postnatal depression).

Couples also need to recognize the importance of communicating with each other at this time. Often if they sit down and talk there is a lot they didn’t realize. Having a baby is a huge adjustment for both of them.

To improve maternal mental health in the postpartum (after birth) period, interventions need to address partner relationships and have to involve both partners. A lot of work in the past has focused on the mother, but this research highlights interventions need to focus on both parents.

The sooner you see your provider about postpartum depression, the better. You can get started on treatment to make you feel better so you can take good care of yourself and your baby.

These are treatments your doctor may suggest:

• Counseling. This also is called therapy. It’s when you talk about your feelings and concerns with a mental health professional. She helps you understand your feelings, solve problems and cope with things in your everyday life.
• Support groups. These are groups of people who meet together or go online to share their feelings and experiences about certain topics. Being part of a support group may help you feel better. Your provider can help you find a postpartum depression support group near you or tell you about online groups.
• Medicine. postpartum depression often is treated with medicine.

Support groups can be found at local hospitals, family planning clinics, or community centers. The hospital where you gave birth or your health care provider may be able to assist you in finding a support group. Useful information about postpartum depression can be found on the following web sites:

• National Women’s Health Information Center: https://www.womenshealth.gov/mental-health/mental-health-conditions/postpartum-depression
• Postpartum Progress: http://www.postpartumprogress.com/
• National Alliance on Mental Illness: https://www.nami.org/
• National Suicide Prevention Lifeline: https://suicidepreventionlifeline.org/
• Postpartum Support International: http://www.postpartum.net/

Medicines to treat postpartum depression include:

• Antidepressants. These are medicines used to treat many kinds of depression, including postpartum depression. Some have side effects, like having a dry mouth or gaining weight. And some are not safe to take if you’re breastfeeding. Talk to your provider to find out about these medicines and decide if one is right for you.
• Estrogen. This hormone plays an important role in your menstrual cycle and pregnancy. During childbirth, the amount of estrogen in your body drops quickly. To help with postpartum depression, your provider may suggest you wear an estrogen patch on your skin to replace the estrogen your body lost. If you are breastfeeding, check with your provider to see if the patch is safe for you to use. You can pass estrogen to your baby through breast milk.

If you’re taking medicine for postpartum depression:

• Don’t stop taking any medicines for postpartum depression without your provider’s OK. It’s important that you take all your medicine for as long as your provider prescribes it. Some medicines used to treat depression have side effects if you stop taking them too soon. Follow your provider’s instructions about how to take your medicine.
• Some medicines used to treat postpartum depression aren’t safe for your baby if you’re breastfeeding. Talk to your doctor to make sure what you’re taking is best for you and your baby.
• Some people use an herb called St. John’s wort to treat depression. Scientists don’t know how safe this herb is for women with postpartum depression. More research is needed. Until researchers know more about it, don’t take St. John’s wort for postpartum depression.

Left untreated, postpartum depression can interfere with mother-child bonding and cause family problems.

• For mothers. Untreated postpartum depression can last for months or longer, sometimes becoming a chronic depressive disorder. Even when treated, postpartum depression increases a woman’s risk of future episodes of major depression.
• For fathers. Postpartum depression can have a ripple effect, causing emotional strain for everyone close to a new baby. When a new mother is depressed, the risk of depression in the baby’s father may also increase. And new dads are already at increased risk of depression, whether or not their partner is affected.
• For children. Children of mothers who have untreated postpartum depression are more likely to have emotional and behavioral problems, such as sleeping and eating difficulties, excessive crying, and delays in language development.

Postpartum depression in new fathers

New fathers can experience postpartum depression, too. They may feel sad or fatigued, be overwhelmed, experience anxiety, or have changes in their usual eating and sleeping patterns ― the same symptoms mothers with postpartum depression experience.

Fathers who are young, have a history of depression, experience relationship problems or are struggling financially are most at risk of postpartum depression. Postpartum depression in fathers ― sometimes called paternal postpartum depression ― can have the same negative effect on partner relationships and child development as postpartum depression in mothers can.

If you’re a new father and are experiencing symptoms of depression or anxiety during your partner’s pregnancy or in the first year after your child’s birth, talk to your health care professional. Similar treatments and supports provided to mothers with postpartum depression can be beneficial in treating postpartum depression in fathers.

Is postpartum depression the same as the baby blues?

No. postpartum depression lasts longer and is more serious than baby blues. Baby blues are feelings of sadness you may have in the first few days after having a baby. Baby blues can happen 2 to 3 days after you have your baby and can last up to 2 weeks. You may have trouble sleeping, be moody or cranky, and cry a lot. If you have feelings that last longer than 2 weeks, tell your provider. She can check to see if you may have postpartum depression.

Table 1. Distinguishing Between “Baby Blues” and Postpartum Major Depression

Characteristic	Baby blues	Postpartum major depression
Duration	Less than 10 days	More than two weeks
Onset	Within two to three days postpartum	Often within first month; may be up to one year
Prevalence	80 percent	5 to 7 percent
Severity	Mild dysfunction	Moderate to severe dysfunction
Suicidal ideation	Not present	May be present

[Source ⁹]

You may have postpartum depression if you have five or more signs of postpartum depression that last longer than 2 weeks. These are the signs to look for:

Changes in your feelings:

• Feeling depressed most of the day every day
• Feeling shame, guilt or like a failure
• Feeling panicky or scared a lot of the time
• Having severe mood swings

Changes in your everyday life:

• Having little interest in things you normally like to do
• Feeling tired all the time
• Eating a lot more or a lot less than is normal for you
• Gaining or losing weight
• Having trouble sleeping or sleeping too much
• Having trouble concentrating or making decisions

Changes in how you think about yourself or your baby:

• Having trouble bonding with your baby
• Thinking about hurting yourself or your baby
• Thinking about killing yourself

If you think you may have postpartum depression, call your health care provider right away. There are things you and your provider can do to help you feel better. If you’re worried about hurting yourself or your baby, call your emergency services number.

When does postpartum depression start?

Most women get the postpartum “baby blues”, where they’ll feel sad, teary, anxious, moody or empty, within a few days of giving birth. For many women, the baby blues go away in 3 to 5 days, but may last for up to two weeks. However, if your baby blues don’t go away or you feel sad, hopeless, or empty for longer than 2 weeks, you may have postpartum depression ². Postpartum depression can also occur up to 1 year after having a baby, but it most commonly starts about 1–3 weeks after childbirth.

Can postpartum depression affect my baby?

Yes. postpartum depression can make it hard for you to take care of your baby. If you have postpartum depression, your baby may:

• Have problems bonding with you
• Cry a lot
• Be slow in learning to talk
• Have behavior problems

If you see these signs in your baby, tell your doctor. Getting treatment early can help both you and your baby.

Researchers believe postpartum depression in a mother can affect her child throughout childhood, causing ¹⁰:

• Delays in language development and problems learning
• Problems with mother-child bonding
• Behavior problems
• More crying or agitation
• Shorter height ¹¹ and higher risk of obesity in pre-schoolers ¹²
• Problems dealing with stress and adjusting to school and other social situations ¹³

What can happen if postpartum depression is not treated?

Untreated postpartum depression can affect your ability to parent. You may:

• Not have enough energy
• Have trouble focusing on the baby’s needs and your own needs
• Feel moody
• Not be able to care for your baby
• Have a higher risk of attempting suicide

Feeling like a bad mother can make depression worse. It is important to reach out for help if you feel depressed.

How long does postpartum depression last?

Recovery time vary depending on the severity of your postpartum depression, the associated risk factors and your individual needs. If you have an underactive thyroid or an underlying illness, your doctor may treat those conditions or refer you to the appropriate specialist. Your doctor may also refer you to a mental health professional.

Here are some things that may make you more likely than other women to have postpartum depression:

• You’re younger than 20.
• You’ve had postpartum depression, major depression or other mood disorders in the past. You may have been treated for these conditions. Or you may have had signs of them, but never saw a health care provider for treatment.
• You have a family history of depression. This means that one or more people in your family has had depression.
• You’ve recently had stressful events in your life.

Stressful life events can include:

• A difficult pregnancy or childbirth, or your baby was born with a health problem
• The death of a loved one
• Illness in you or a loved one
• Problems with your partner, including being abused by your partner
• Little support from family or friends
• Money problems
• An unplanned or unwanted pregnancy
• Trouble adjusting to life as a mom
• Smoking, drinking alcohol or using street drugs

What can I do to feel better while seeing a doctor for postpartum depression?

Here’s what you can do to help the treatment from your provider work better:

Stay healthy and fit:

• Do something active every day. Go for a walk or get back to the gym.
• Eat healthy foods. These include fruits, vegetables, whole-grain breads and lean meats. Try to eat fewer sweets and salty snacks.
• Get as much rest as you can. Try to sleep when your baby sleeps.
• Don’t drink alcohol. This includes beer, wine, wine coolers and liquor. Alcohol is a depressant, which means it can slow your body down and make you feel more depressed. It also can interact with the medicine you’re taking for postpartum depression. It’s never a good idea to drink alcohol if you’re breastfeeding. This is because you can pass alcohol to your baby through your breast milk.
• Don’t take street drugs. These affect the way your body works and can cause problems with the medicine you’re taking for postpartum depression. You also can pass street drugs to your baby through breast milk.

Ask for and accept help:

• Keep in touch with people you care about and who care about you. Tell your partner, family and friends how you’re feeling.
• Take time for yourself. Ask someone you trust to watch the baby so you can get out of the house. Visit a friend, get outside or do something you enjoy. Plan for some time alone with your partner.
• Let others help around the house. Ask your friends and family to watch the baby, help with housekeeping or go grocery shopping. Don’t be afraid to tell them what you need.
• Make time to go out, visit friends, or spend time alone with your partner.
• Talk about your feelings with your partner, supportive family members, and friends.
• Talk with other mothers so that you can learn from their experiences.
• Join a support group. Ask your doctor or nurse about groups in your area.

It can also help to have a partner, a friend, or another caregiver who can help take care of the baby while you are depressed. If you are feeling depressed during pregnancy or after having a baby, don’t suffer alone. Tell a loved one and call your doctor right away.

Lower your stress:

• Do the things you liked to do before you had your baby. Listen to music, read a good book or take a class.
• Do the things that used to make you feel good about yourself before you got pregnant.
• Try not to make any major changes in your life right after having your baby. These include moving or changing jobs. Major changes can add stress to your life that you don’t need right now.
• Talk to your boss about going back to work. Maybe you can work at home or part-time when you first go back to work.
• Don’t make any major life changes right after giving birth. More major life changes in addition to a new baby can cause unneeded stress. Sometimes big changes can’t be avoided. When that happens, try to arrange support and help in your new situation ahead of time.

Postpartum depression signs and symptoms

Some normal changes after pregnancy can cause symptoms similar to those of depression. Many mothers feel overwhelmed when a new baby comes home. But if you have any of the following symptoms of depression for more than 2 weeks, see your doctor, nurse, or midwife.

Baby blues symptoms

Signs and symptoms of baby blues — which last only a few days to a week or two after your baby is born — may include:

• Mood swings
• Anxiety
• Sadness
• Irritability
• Feeling overwhelmed
• Crying
• Reduced concentration
• Appetite problems
• Trouble sleeping

Postpartum depression symptoms

Postpartum depression may be mistaken for baby blues at first — but the signs and symptoms are more intense and last longer, and may eventually interfere with your ability to care for your baby and handle other daily tasks. Symptoms usually develop within the first few weeks after giving birth, but may begin earlier ― during pregnancy ― or later — up to a year after birth.

Postpartum depression signs and symptoms may include:

• Feeling restless or moody
• Feeling sad, hopeless, or overwhelmed
• Crying a lot
• Having thoughts of hurting the baby
• Having thoughts of hurting yourself or suicide
• Not having any interest in the baby, not feeling connected to the baby, or feeling as if your baby is someone else’s baby
• Having no energy or motivation
• Eating too little or too much
• Sleeping too little or too much
• Having trouble focusing or making decisions
• Having memory problems
• Feeling worthless, guilty, or like a bad mother
• Losing interest or pleasure in activities you used to enjoy
• Withdrawing from friends and family
• Having headaches, aches and pains, or stomach problems that don’t go away

Some women don’t tell anyone about their symptoms. New mothers may feel embarrassed, ashamed, or guilty about feeling depressed when they are supposed to be happy. They may also worry they will be seen as bad mothers. Any woman can become depressed during pregnancy or after having a baby. It doesn’t mean you are a bad mom. You and your baby don’t have to suffer. There is help. Your doctor can help you figure out whether your symptoms are caused by depression or something else.

There are many signs that someone may be struggling with postpartum depression. Some of the more common ones include:

• having a very low mood
• feeling inadequate and a failure as a mother
• having a sense of hopelessness about the future
• feeling exhausted, empty, sad and teary
• feeling guilty, ashamed or worthless
• feeling anxious or panicky
• having trouble sleeping, sleep for too long or have nightmares
• worrying excessively about their baby
• feeling scared of being alone or going out

In some cases, women may experience thoughts about leaving their family or worried that their partner may leave them. They could also have ideas about self-harm or doing harm to their partner or baby. In situations like this, you should seek professional help straight away.

It is also common to experience symptoms of anxiety at the same time as depression.

Untreated, postpartum depression may last for many months or longer.

Postpartum psychosis

With postpartum psychosis — a rare condition that typically develops within the first week after delivery — the signs and symptoms are severe. Signs and symptoms may include:

• Confusion and disorientation
• Obsessive thoughts about your baby
• Hallucinations and delusions
• Sleep disturbances
• Excessive energy and agitation
• Paranoia
• Attempts to harm yourself or your baby

Postpartum psychosis may lead to life-threatening thoughts or behaviors and requires immediate treatment.

What causes postpartum depression

There is debate about the causes of postpartum depression (postnatal depression), but they are likely to include:

• Hormone changes of pregnancy and childbirth (which affect some women more than others)
• Personality
• Lack of social support
• Childhood abuse
• Timing of the pregnancy
• Previous experience of depression and anxiety
• Low income
• Low self-esteem
• Relationship quality
• Other life stressors

Hormonal changes may trigger symptoms of postpartum depression. When you are pregnant, levels of the female hormones estrogen and progesterone are the highest they’ll ever be. In the first 24 hours after childbirth, hormone levels quickly drop back to normal, pre-pregnancy levels. Researchers think this sudden change in hormone levels may lead to depression ¹⁴. This is similar to hormone changes before a woman’s period but involves much more extreme swings in hormone levels.

Levels of thyroid hormones may also drop after giving birth. The thyroid is a small gland in the neck that helps regulate how your body uses and stores energy from food. Low levels of thyroid hormones can cause symptoms of depression. A simple blood test can tell whether this condition is causing your symptoms. If so, your doctor can prescribe thyroid medicine.

Other feelings may contribute to postpartum depression. Many new mothers say they feel:

• Tired after labor and delivery
• Tired from a lack of sleep or broken sleep
• Overwhelmed with a new baby
• Doubts about their ability to be a good mother
• Stress from changes in work and home routines
• An unrealistic need to be a perfect mom
• Grief about loss of who they were before having the baby
• Less attractive
• A lack of free time

These feelings are common among new mothers. But postpartum depression is a serious health condition and can be treated. Postpartum depression is not a regular or expected part of being a new mother.

Having negative thoughts and feelings about being a mom also can lead to postpartum depression. Being a new mom can be overwhelming. Tell your health care provider if you:

• Have doubts that you can be a good mom
• Put too much pressure on yourself to be a perfect mom
• Feel that you’re no longer the person you were before you had your baby
• Feel that you’re less attractive after having your baby
• Have no free time for yourself
• Aren’t sleeping well or getting enough sleep

Don’t be afraid to talk to your provider. She’s there to help you and your baby be healthy.

Risk factors for developing postpartum depression

Any new mom can experience postpartum depression and it can develop after the birth of any child, not just the first. However, your risk increases if:

• You have a history of depression, either during pregnancy or at other times
• You have bipolar disorder
• You had postpartum depression after a previous pregnancy
• You have family members who’ve had depression or other mood disorders
• You’ve experienced stressful events during the past year, such as pregnancy complications, illness or job loss
• Your baby has health problems or other special needs
• You have twins, triplets or other multiple births
• You have difficulty breast-feeding
• You’re having problems in your relationship with your spouse or significant other
• You have a weak support system
• You have financial problems
• The pregnancy was unplanned or unwanted

Postpartum depression prevention

Postpartum depression cannot be prevented or avoided. However, if you have a history of depression or postpartum depression after giving birth to other children, you can prepare. Preparation might include keeping your mind and body healthy. Eat healthy during your pregnancy, exercise, and learn stress reduction strategies. Once you baby is born, stay away from alcohol and caffeine. Continue making healthy lifestyle decisions. See your doctor earlier in your pregnancy or sooner after giving birth if you are worried you will have postpartum depression.

Additionally, the American Academy of Family Physicians recommends screening for depression in the general adult population. This includes pregnant and postpartum women. Screening efforts should focus on ensuring accurate diagnosis, effective treatment, and appropriate follow up.

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.

• During pregnancy, your doctor can monitor you closely for signs and symptoms of depression. He or she may have you complete a depression-screening questionnaire during your pregnancy and after delivery. Sometimes mild depression can be managed with support groups, counseling or other therapies. In other cases, antidepressants may be recommended — even during pregnancy.
• After your baby is born, your doctor may recommend an early postpartum checkup to screen for signs and symptoms of postpartum depression. The earlier it’s detected, the earlier treatment can begin. If you have a history of postpartum depression, your doctor may recommend antidepressant treatment or psychotherapy immediately after delivery.

Postpartum depression diagnosis

Your doctor will usually talk with you about your feelings, thoughts and mental health to distinguish between a short-term case of postpartum baby blues and a more severe form of postpartum depression. Don’t be embarrassed ― postpartum depression is common. Share your symptoms with your doctor so that a useful treatment plan can be created for you.

As part of your evaluation, your doctor may:

• Do a depression screening that may include having you fill out a questionnaire
• Order blood tests to determine whether an underactive thyroid (hypothyroidism) is contributing to your signs and symptoms
• Order other tests, if warranted, to rule out other causes for your symptoms

Postpartum depression screening

According to the American College of Obstetricians and Gynecologists, screening for antepartum or postpartum depression should be strongly considered, although evidence is lacking to support a recommendation for universal screening ¹⁵. Patients with identified risk factors may be selected for screening. Preparation for postpartum care and consideration of prophylactic treatment have been recommended in these women ¹⁶. Prophylactic treatment may involve psychotherapy beginning in the third trimester or medication offered immediately postpartum. Sertraline (Zoloft) has been shown to decrease the recurrence of postpartum major depression when started immediately after delivery ⁴. The most commonly used validated screening tool for postpartum depression is the Edinburgh Postnatal Depression Scale (Figure 1). The scale has 10 questions, including a question on suicidal ideation. Each question is scored on a scale from zero to three. In women without a history of postpartum major depression, a score above 12 has a sensitivity of 86 percent and specificity of 78 percent for postpartum major depression ¹⁷. One study reported that 80 percent of women with a history of postpartum major depression who relapsed within one year of a subsequent delivery scored above nine at four weeks postpartum ¹⁸.

Instructions for using the Edinburgh Postnatal Depression Scale:

1. The mother is asked to check the response that comes closest to how she has been feeling in the previous 7 days.
2. All the items must be completed.
3. Care should be taken to avoid the possibility of the mother discussing her answers with others. (Answers come from the mother or pregnant woman.)
4. The mother should complete the scale herself, unless she has limited English or has difficulty with reading.

Figure 1. Edinburgh Postnatal Depression Scale

Footnote: The Edinburgh Postnatal Depression Score should not override clinical judgment. A careful clinical assessment should be carried out to confirm the
diagnosis. The Edinburgh Postnatal Depression Scale indicates how the mother has felt during the previous week. In doubtful cases it may be useful to repeat the test after 2 weeks. The scale will not detect mothers with anxiety neuroses, phobias or personality disorders.

[Source ¹⁹]

Edinburgh Postnatal Depression Scale Scoring

QUESTIONS 1, 2 and 4 (without an *)

• Are scored 0, 1, 2 or 3 with top box scored as 0 and the bottom box scored as 3.

QUESTIONS 3, 5 to 10 (marked with an *)

• Are reverse scored, with the top box scored as a 3 and the bottom box scored as 0.

Edinburgh Postnatal Depression Scale Interpretation

• Maximum score: 30
• Possible Depression: 10 or greater
• Mothers who score above 13 are likely to be suffering from a depressive illness of varying severity.
• Always look at item 10 (suicidal thoughts)

Postpartum depression treatment

Treatment and recovery time vary, depending on the severity of your postpartum depression and your individual needs. If you have an underactive thyroid or an underlying illness, your doctor may treat those conditions or refer you to the appropriate specialist. Your doctor may also refer you to a mental health professional.

Baby blues

The baby blues usually fade on their own within a few days to one to two weeks. In the meantime:

• 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.
• Avoid alcohol and recreational drugs, which can make mood swings worse.

Postpartum depression

Postpartum depression is often treated with psychotherapy (also called talk therapy or mental health counseling), medication or both.

• Psychotherapy. It may help to talk through your concerns with a psychiatrist, psychologist or other mental health professional. Through therapy, you can find better ways to cope with your feelings, solve problems, set realistic goals and respond to situations in a positive way. Sometimes family or relationship therapy also helps.
• Antidepressants. Your doctor may recommend an antidepressant. If you’re breast-feeding, any medication you take will enter your breast milk. However, most antidepressants can be used during breast-feeding with little risk of side effects for your baby. Work with your doctor to weigh the potential risks and benefits of specific antidepressants.

With appropriate treatment, postpartum depression symptoms usually improve. In some cases, postpartum depression can continue, becoming chronic depression. It’s important to continue treatment after you begin to feel better. Stopping treatment too early may lead to a relapse.

Strategies for new parents

• Know that everyone finds it challenging to learn how to care well for a baby and manage a home with a baby – you are not alone
• Ask a maternal and child health nurse for practical advice, such as how to establish a feed-play-sleep routine of care for your baby
• Talk to your partner about how to share the increased workload at home – avoid criticizing each other
• Share baby tasks – babies benefits from receiving care, e.g. bathing, nappy changing and settling from both parents
• Accept practical help from friends and family if they offer
• Identify what you miss from how life used to be and work out how you can begin to replace that activity or interest, maybe in a changed way

Strategies to support a new parent

For partners:

• Be actively involved in caring for your baby
• Share increased household work in ways that feel fair
• Listen to each other’s needs – be kind and encouraging
• Avoid criticism – it undermines confidence
• Help manage visitors keen to see you and meet your baby so you don’t become overtired
• Support each other in having some time away from day-to-day responsibilities

For family and friends:

People with depression may not recognize or acknowledge that they’re depressed. They may not be aware of signs and symptoms of depression. If you suspect that a friend or loved one has postpartum depression or is developing postpartum psychosis, help them seek medical attention immediately. Don’t wait and hope for improvement.

• Be upfront in offering help – most new parents find it difficult to ask for help with practical tasks
• Offer practical support e.g. pick up an older child from childcare, buy groceries, prepare a meal, hang out washing
• Invite them to tell you how they are finding things and help to work out solutions to difficulties
• Help them find ways to make new friends at the same life stage
• Give lots of praise and encouragement

Home remedies

In addition to professional treatment, you can do some things for yourself that build on your treatment plan and help speed recovery.

• Make healthy lifestyle choices. Include physical activity, such as a walk with your baby, and other forms of exercise in your daily routine. Try to get adequate rest. Eat healthy foods and avoid alcohol.
• Set realistic expectations. Don’t pressure yourself to do everything. Scale back your expectations for the perfect household. Do what you can and leave the rest.
• Make time for yourself. Take some time for yourself and get out of the house. That may mean asking a partner to take care of the baby or arranging for a sitter. Do something you enjoy, such as a hobby or some form of entertainment. You might also schedule some time alone with your partner or friends.
• Avoid isolation. Talk with your partner, family and friends about how you’re feeling. Ask other mothers about their experiences. Breaking the isolation may help you feel human again.
• Ask for help. Try to open up to the people close to you and let them know you need help. If someone offers to baby-sit, take them up on it. If you can sleep, take a nap, or maybe you can catch a movie or meet for coffee with friends. You may also benefit from asking for help with parenting skills that can include caregiving techniques to improve your baby’s sleep and soothe fussing and crying.

Remember, taking care of your baby includes taking care of yourself.

Coping and support

The already stressful, exhausting period following a baby’s birth is more difficult when depression occurs. But remember, postpartum depression is never anyone’s fault. It’s a common medical condition that needs treatment.

So, if you’re having trouble coping with postpartum depression, talk with a therapist. Ask your doctor or therapist about local support groups for new moms or women who have postpartum depression.

The sooner you get help, the sooner you’ll be fully equipped to cope with depression and enjoy your new baby.

What Helps Depression Get Better?

Depression can get better with the right attention and care — sometimes more easily than a person thinks. But if it’s not treated, things can stay bad or get worse. That’s why people who are depressed shouldn’t wait and hope it will go away on its own.

If you think you might be depressed, talk to a parent or other adult about getting the right help. The right help can mean doing all of these things:

Get a Medical Checkup

A doctor can check for any health conditions that might cause symptoms of depression. For example, hypothyroidism can cause a depressed mood, low energy, and tiredness. Mono can make a person feel tired and depressed.

Talk to a Counselor

Having meetings with a counselor or therapist is called talk therapy. Talk therapy can help people overcome depression. Talk therapy works by helping people to:

• understand their emotions, put feelings into words, and feel understood and supported
• build the confidence to deal with life’s struggles
• work out problems they face
• change negative thinking patterns that are part of depression
• increase self-esteem and become more self-accepting
• increase their positive emotions and feel happier

Overcoming depression might include talk therapy, medication, or both. A therapist might also recommend daily exercise, exposure to daylight, or better ways of eating. A therapist might teach relaxation skills to help someone get a good night’s sleep.

Get Support

Many people find that it helps to open up to parents or other adults they trust. Simply saying something like, “I’ve been feeling really down lately and I think I’m depressed” can be a good way to begin the discussion.

If a parent or family member can’t help, turn to your school counselor, school nurse, or a helpline.

Let friends and other people who care about you offer their support. They can:

• listen and talk, showing that they understand what you’re feeling
• remind you that things can get better, and that they are there for you through the downs and ups
• help you see the things that are already good about your life, even when it’s hard for you to notice
• keep you company and do enjoyable or relaxing things with you
• give you honest compliments and help you find things to laugh or smile about

Postpartum psychosis

Postpartum psychosis requires immediate treatment, usually in the hospital. Treatment may include:

• Medication. Treatment may require a combination of medications — such as antipsychotic medications, mood stabilizers and benzodiazepines — to control your signs and symptoms.
• Electroconvulsive therapy (ECT). If your postpartum depression is severe and you experience postpartum psychosis, ECT may be recommended if symptoms do not respond to medication. ECT is a procedure in which small electrical currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can reduce the symptoms of psychosis and depression, especially when other treatments have been unsuccessful.

Treatment for postpartum psychosis can challenge a mother’s ability to breast-feed. Separation from the baby makes breast-feeding difficult, and some medications used to treat postpartum psychosis aren’t recommended for women who are breast-feeding. If you’re experiencing postpartum psychosis, your doctor can help you work through these challenges.

Postpartum depression medication

Selective serotonin reuptake inhibitors have become the mainstay of treatment for moderate to severe postpartum major depression because of their favorable adverse effect profiles and relative safety in overdose compared with tricyclic antidepressants ¹⁶. Table 2 lists the most commonly used antidepressants, adverse effect profiles, and starting and target dosages ¹⁶. No evidence suggests that one antidepressant is superior to others in treating postpartum major depression.

For breastfed infants of mothers treated for postpartum major depression, a pooled analysis of available data found that infant serum levels of sertraline, paroxetine (Paxil), and nortriptyline (Pamelor) were usually undetectable ²⁸. Detectable levels of fluoxetine (Prozac) and citalopram (Celexa) have been found in infant serum, but the milk-to-plasma ratio remains well below the standard acceptable ratio of 0.1 ²⁸. Case reports cite adverse effects in some breastfed infants of mothers taking fluoxetine, citalopram, or bupropion (Wellbutrin), but overall evidence of harm to infants is lacking ²⁹. Measurement of medication levels in infant serum or breast milk is not currently recommended ³⁰.

Before prescribing an agent for postpartum major depression, physicians should consider the patient’s experience with antidepressants. If the patient has previously responded well to a specific agent, that medication should be the first choice unless there is evidence of potential harm ³¹. Although breastfed infants are unlikely to experience adverse effects from antidepressant medications, infants should be monitored for symptoms, such as persistent irritability, decreased feeding, or poor weight gain. Maternal depression or problems within the mother-infant dyad can also be associated with these symptoms ³². Formula feeding should be considered in women with severe postpartum major depression that requires medication implicated in adverse effects for the infant.

Because postpartum women may have increased sensitivity to adverse effects of medications, a reasonable strategy is to start at low dosages for the first four days and then titrate up ⁴. The Edinburgh Postnatal Depression Scale can be used to monitor progress over time. After symptoms are in remission, treatment is typically continued for six to nine months of euthymia before tapering the medication. Tapering over two weeks, especially for paroxetine, extended-release venlafaxine (Effexor XR), and extended-release desvenlafaxine (Pristiq), can prevent the influenza-like symptoms of discontinuation syndrome.

Estrogen therapy has been studied as a treatment for postpartum major depression. Three studies have reported positive results, but each has had notable limitations ³³. Although estrogen therapy is not currently recommended for postpartum major depression, further research is needed ³⁴.

Table 2. Antidepressant Medications for Postpartum Major Depression

Drug	Starting dosage	Usual treatment dosage	Maximal dosage	Adverse effects
Selective serotonin reuptake inhibitors (SSRIs)
Citalopram (Celexa)	10 mg	20 to 40 mg	60 mg	Headache, nausea, diarrhea, sedation, insomnia, tremor, nervousness, loss of libido, delayed orgasm
Escitalopram (Lexapro)	5 mg	10 to 20 mg	20 mg
Fluoxetine (Prozac)	10 mg	20 to 40 mg	80 mg
Paroxetine (Paxil)	10 mg	20 to 40 mg	50 mg
Sertraline (Zoloft)	25 mg	50 to 100 mg	200 mg
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Desvenlafaxine, extended release (Pristiq)	50 mg	50 mg	100 mg	Headache, nausea, diarrhea, sedation, insomnia, tremor, nervousness, loss of libido, delayed orgasm, sustained hypertension
Duloxetine (Cymbalta)	20 mg	30 to 60 mg	60 mg	Same as selective serotonin reuptake inhibitors
Venlafaxine, extended release (Effexor XR)	37.5 mg	75 to 300 mg	300 mg	Same as desvenlafaxine
Other antidepressants
Bupropion, extended release (Wellbutrin XL)	150 mg	150 to 300 mg	450 mg	Seizures (0.4 percent), agitation, dry mouth, sweating, nausea
Bupropion, sustained release (divided, twice per day)	100 mg	200 to 300 mg	450 mg

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[Source ⁹]

Risks and Benefits of Treatment

Women who are pregnant or breastfeeding may be reluctant to start medication for fear of harming their child. A thorough risk-benefit discussion with each patient is essential before deciding on treatment for postpartum major depression. With the physician’s help, the patient should be encouraged to make a list of the potential benefits of treatment. This will allow her to envision her own recovery and set appropriate goals. The physician should then explain the risks of pharmacologic treatment, such as the penetrance of medication into breast milk (if applicable for the medication selected), as well as the risks of persistent depressive symptoms, such as infant sleep disturbance ³⁵, poor mother-infant bonding, delays in infant growth and IQ, and an increased risk of anxiety or depressive symptoms for the infant later in life ³⁶.

Can antidepressants cause side effects?

Antidepressants can cause side effects, but most are temporary and go away after a short time. If you have severe or unusual side effects that get in the way of your normal daily habits, notify your health care provider. You may need to try another type of antidepressant. If your depression worsens soon after starting medication or if you have thoughts of hurting yourself or others, contact your health care provider or emergency medical services right away.

Can antidepressants be passed to my baby through my breast milk?

If a woman takes antidepressants, they can be transferred to her baby during breastfeeding. The levels found in breast milk generally are very low. Breastfeeding has many benefits for both you and your baby. Deciding to take an antidepressant while breastfeeding involves weighing these benefits against the potential risks of your baby being exposed to the medication in your breast milk. It is best to discuss this decision with your health care provider.

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