Postpartum Depression Symptoms: Critical Signs to Recognize

Understanding Postpartum Depression Symptoms

Postpartum depression, also called postnatal depression, is a type of depression that affects up to 15% of new mothers. It causes symptoms such as mood changes, sadness, and excessive crying. In some severe forms, it can present psychotic symptoms that can be dangerous for both mother and child.

Postpartum depression is not a character flaw or weakness, and it does not mean the new mom is not a good mother. It is simply a psychiatric complication of giving birth and occurs due to hormonal changes, physical changes, and emotional issues related to childbirth.

Sometimes symptoms of depression can develop during pregnancy and continue after giving birth. This is called peripartum depression or perinatal depression.

Also, keep in mind that postpartum depression is not the same as baby blues. Even though these two conditions may share similar symptoms, postpartum depression is much more severe and lasts longer.

What Are Normal Postpartum Symptoms?

The postpartum period starts immediately after childbirth and lasts for 6-8 weeks. Some of the symptoms that are normal and expected during this time include:

Physical Symptoms: Soreness and pain in the genital area, vaginal discharge, afterbirth pains due to the uterus shrinking back to its normal size, swollen and painful breasts, nipple pain, increased sweating, constipation, hair loss, and a healing incision if you have a C-section (cesarean section).
Emotional Symptoms: Baby blues (feeling overwhelmed, sad, and anxious) and having mood swings, crying spells, trouble sleeping, and changes in appetite.

Importance of Recognizing Symptoms Early

It’s important to recognize the symptoms of postpartum depression and get timely treatment because untreated postpartum depression can cause:

Problems in the ability of a new mother to bond and care for themselves and the infant.
A higher risk of major depression.
A risk of self-harm (suicide).
Emotional strain on the other parent/partner.
Behavioral and emotional effects in older children in the family.
Psychotic symptoms

Common Warning Signs of Postpartum Depression: What Does Postpartum Depression Look Like?

Physical Symptoms

Increased or decreased appetite
Sleep problems (insomnia or sleeping too much)
Tiredness
Low energy

Emotional Symptoms

Severe mood swings
Extreme sadness
Depressed mood
Hopelessness
Worthlessness
Anxiety
Panic attacks
Irritability
Restlessness
Anger
Fear
Shame or guilt
Recurring thoughts of death, self-harm (suicide), or harming the baby

Mental Symptoms

Decreased concentration
Inability to think clearly
Trouble with decision-making
Poor judgment

Behavioral Symptoms

Frequent crying spells
Trouble bonding with the baby
Withdrawing from friends and family
Loss of interest in pleasurable activities

Find Savings On Your Postpartum Depression Medications

Causes and Risk Factors

Potential Causes of Postpartum Depression

A combination of genetics, emotional issues, and hormonal changes can lead to the development of postpartum depression.

Genetics: Research suggests that postpartum depression may run in families. If a close family member (mother, grandmother, sister) had postpartum depression, especially major depression, you may be at increased risk of experiencing it too.
Emotional issues: New mothers are often sleep-deprived and exhausted, which can make minor problems feel overwhelming. Also, many new mothers are anxious about their ability to care for the infant. Post-pregnancy, it’s common to feel less attractive and feel like you’re losing your identity and sense of control. These emotional changes can trigger postpartum depression.
Hormonal changes: A drop in the levels of estrogen and progesterone hormones in a woman’s body after giving birth can lead to postpartum depression. In addition, thyroid hormones fall after childbirth, leading to tiredness, sluggishness, and depression.

Risk Groups and Factors

Any new mother can experience postpartum depression. It can develop in first-time moms and moms who did not experience symptoms of postpartum depression after giving birth to older kids. A woman’s risk of feeling depressed after giving birth is higher when there is:

A personal history of depression at any time pre-pregnancy.
A personal history of postpartum depression after a previous pregnancy.
A personal history of mental disorders, such as bipolar disorder.
A family history of postpartum depression, depression, or other mood disorders.
An unwanted or unplanned pregnancy.
Twins, triplets, or multiple births.
Birth defects, health problems, or other special needs in the baby.
Problems with breastfeeding after the child’s birth.
Stressful events in the past year, such as financial difficulties, job loss, or pregnancy complications.
Relationship problems with a spouse or partner.
Poor support system

Note: It’s not only new mothers, but new fathers too who can experience symptoms of depression after their spouse or partner gives birth. This is sometimes called paternal postpartum depression. Symptoms can be similar to those in the mother. Risk factors for depression in the father include a history of depression or other mental health conditions, financial troubles, relationship difficulties, and postpartum depression in the mother. It is equally important to treat depression in the new father as it is in the new mother.

Differences Between Baby Blues and Postpartum Depression

Baby Blues vs Postpartum Depression vs Postpartum Psychosis

Most new mothers experience baby blues symptoms after delivery. This can include symptoms such as mood swings, sleep problems, and anxiety. Baby blues usually appear within 2-3 days of childbirth and can last for up to 2 weeks.

Some women develop symptoms of depression and anxiety that last for more than two weeks after delivery. This is called postpartum depression. It can last for several months and may even progress to a major depressive disorder.

Postpartum psychosis is a rare but serious mental health problem that affects a small number of new mothers. People with psychosis are unaware of their actions due to their altered perception of reality.

Postpartum psychosis usually occurs during the first few weeks after delivery, with symptoms such as confusion, delusions, hallucinations, paranoia, hyperactivity, and extreme agitation, potentially leading to attempts at self-harm and harming the infant. Therefore, urgent treatment by a mental health provider, even hospitalization, is crucial.

Duration and Intensity Comparison

Baby blues last for up to 2 weeks after delivery. Postpartum depression lasts for more than two weeks, often several months, and can progress to a major depressive disorder.

Severity of Emotional Symptoms

Compared to baby blues, new mothers with postpartum depression have more severe symptoms, including suicidal thoughts and ideation (thoughts of self-harm) and thoughts of harming the infant.

When To Seek Medical Help from a Mental Health Professional

You should seek medical help from your primary care provider or OB/GYN if you experience symptoms of baby blues or postpartum depression. It is especially important to seek care if:

Your symptoms last more than 2 weeks.
Your symptoms are worsening.
You are struggling to care for your baby and complete daily tasks.

If you are feeling hopeless, having painful thoughts, or thoughts of harming yourself or your baby, seek help immediately:

Call 988 - Suicide and Crisis Lifeline provides free and confidential emotional support 24 hours a day to people in emotional distress and suicidal crisis
Call 911
Go to the nearest emergency department

Seek emergency medical care for symptoms of postpartum psychosis such as:

Confusion.
Feeling lost or not knowing where you are or what you’re doing.
Delusions (believing things that aren’t true).
Obsessions (recurrent thoughts).
Hallucinations (seeing or hearing things that aren’t there).
Paranoia (abnormal suspicions about others).
Excessive energy.
Thoughts of harming yourself or your baby.

Note: The U.S. Preventive Services Task Force, Centers for Disease Control and Prevention, and Substance Abuse and Mental Health Services Administration recommend depression screening in women during pregnancy and the postpartum period. Talk to your OB/GYN about depression before and after giving birth and ways to treat postpartum depression. This is especially important if you have a personal or family history of experiencing postpartum depression. If you suspect a loved one may be suffering from postpartum depression, be sure to monitor them for any of these symptoms, and encourage them to seek treatment if symptoms should appear.

Available Treatment Options

Treatment of Baby Blues

Most women with baby blues feel better within 1-2 weeks and don’t require any specific treatment. Strategies to manage this mood disorder include:

Consult a healthcare provider or lactation specialist for any problems with breastfeeding.
Get adequate rest.
Seek support from family and friends.
Spend some me-time on self-care.
Connect with other new mothers.
Avoid alcohol and recreational drugs, which can harm the baby and worsen your mood swings.

How is Postpartum Depression Treated?

The mainstay of treatment for postpartum depression is psychotherapy (talk therapy or mental health counseling) and/or antidepressant medications.

Talk therapies: Psychotherapy modalities such as cognitive behavioral therapy (CBT) and interpersonal therapy can help you learn ways to cope with the physical and emotional changes of motherhood, learn problem-solving skills, and replace negative thoughts with positive ones. Talk therapy can also help couples experiencing relationship difficulties.
Antidepressants: Your healthcare provider may prescribe an antidepressant medication if you have severe postpartum depression. Most antidepressants can be safely used while breastfeeding. However, you should talk to your healthcare provider about the benefits versus risks.
Other medications: Some new mothers may benefit from taking medicine (for example, an anti-anxiety drug) for short-term treatment of severe anxiety or insomnia.
Brexanolone (Zulresso): Brexanolone is the first FDA-approved drug specifically used to treat postpartum depression. It slows down the rate at which hormone levels fall to pre-pregnancy levels after a woman gives birth. However, brexanolone treatment requires monitoring by a healthcare team and a stay in a healthcare facility. The medicine is administered intravenously over a period of 60 hours.
Zuranolone (Zurzuvae): The U.S. Food and Drug Administration (FDA) has approved an oral medication, zuranolone (Zurzuvae), after two phase 3 clinical trials (conducted by an expert in postpartum depression, Dr. Samantha Metzer-Brody, and others). These clinical trials found that zuranolone rapidly improves postpartum depression symptoms by day 15, with improvements seen as early as 3 days and sustained for up to 45 days. It is the first oral medication approved for postpartum depression. The recommended dose of zuranolone (Zurzuvae) is 50 mg once daily for 14 days.

Treatment for Postpartum Psychosis

Postpartum psychosis is a serious mental health condition that requires emergency medical attention and, usually, treatment in a healthcare setting. Treatment options include medications such as antidepressants, benzodiazepines (anti-anxiety medicines), mood stabilizers, and antipsychotics.

Severe cases of postpartum psychosis that do not respond to medications may be recommended to undergo electroconvulsive therapy (ECT). During ECT, small electrodes are used to pass gentle electrical currents to the brain. This starts a short-lived seizure and can lead to changes in brain chemistry and reduced psychotic symptoms.

Self-Care Strategies To Manage Symptoms of Postpartum Depression

It’s important to seek professional medical treatment for postpartum depression. However, you can also do the following to manage the symptoms:

Healthy lifestyle choices: Eat a healthy diet, get regular physical activity, ensure enough rest and sleep, and avoid alcohol and recreational drugs.
Help from others: Don't try to do it all alone. New parents should share responsibilities and seek help from family members and friends whenever possible.
Realistic expectations: Don’t put undue pressure on yourself to do everything perfectly. Do your best and let the rest go.
Self-care: A baby can take up a lot of your time, but it’s important to make some time for yourself. Remember, to care for your baby well you need to first care for yourself. Arrange for your partner or a sitter to care for the baby while you spend time with friends or do the things you enjoy. Also, schedule alone time with your partner.
Support groups: Connect with other new moms through online forums so you don’t feel alone. Hearing about other mothers’ experiences and social support from new friends will make you feel less isolated.