What is Postpartum depression?

Postpartum depression

What is postpartum depression?

Postpartum depression is an illness that you can get after having a baby. It's just like depression, which you can get at other times. But it comes at a time when you are expected to feel happy. If you get postpartum depression, you may find it hard to enjoy being with your baby and find it difficult to care for him or her.

Postpartum depression nearly always gets better on its own. But if the depression goes on for a long time, you may not bond properly with your baby. And your baby may not develop as well as he or she should. There are treatments that may help you feel better faster. So, it's important to see your doctor and get treatment early.

Key points for women with postpartum depression

It's normal to feel low, irritable or anxious for a few days after your baby is born. But if these feelings don't go away or they get worse, you may have postpartum depression.
Postpartum depression is common. About 10 to 15 in every 100 new mothers get it.
Postpartum depression is an illness. It is not a sign that you don't love your baby or can't look after him or her properly.
There are lots of treatments that may help.
It's important to see your doctor early on. The sooner you get help, the sooner you are likely to feel better and start enjoying being a mother.
If you have strange thoughts and feelings about your baby, or hear or see things that aren't real, you may have a more serious illness called postpartum psychosis. You will need to be looked after in the hospital.

What's normal after having a baby?

To understand what goes wrong in postpartum depression, it helps to know a little about what feelings are normal after you have a baby.

Postpartum depression is a common condition.

Having a baby involves huge changes in your life and your body. And they happen very quickly.

You suddenly have to care 24 hours a day for a human being who completely depends on you.
Your

hormones
Hormones are chemicals that are made in certain parts of the body. They travel through the bloodstream and have an effect on other parts of the body. For example, the female sex hormone estrogen is made in a woman's ovaries. Estrogen has many different effects on a woman's body. It makes the breasts grow at puberty and helps control periods. It is also needed to get pregnant.

hormones rise to very high levels during pregnancy. But they fall suddenly in the few days after your baby is born.

Source:
Zonana J, Gorman JM.
The neurobiology of postpartum depression.
CNS Spectrums. 2005; 10: 792-799, 805.

¹ To read more, see Hormone changes after childbirth.
Being a mother will affect almost every aspect of your life, including your work and your relationships.
You have to cope with having less sleep.
If you are in a relationship, you and your partner have to switch instantly from being a couple to being parents.
If you are a single parent, you might feel even greater pressure to cope and do things well with less support.

These are a lot of changes to deal with. So, it's hardly surprising that many new mothers get a condition called the baby blues for a week or so after giving birth.

Source:
Clay EC, Seehusen DA.
A review of postpartum depression for the primary care physician.
Southern Medical Journal. 2004; 97: 157-161.

² This is when you have mild problems with your mood. To learn more, see The baby blues.

But the baby blues usually go away within 10 days after you have given birth. If your sadness goes on for more than two weeks, you may have postpartum depression instead. This is when how you feel becomes a more serious problem.

What goes wrong in postpartum depression?

One of two things may happen if you have postpartum depression:

Source:
Wisner KL, Parry BL, Piontek CM.
Clinical Practice. Postpartum depression.
New England Journal of Medicine. 2002; 347: 194-199.

You may keep feeling depressed after the baby blues should have stopped
Or you may start feeling depressed later in your baby's first year, usually in the first three months.

Some women even start feeling depressed during pregnancy. We don't know as much about depression before the birth of a baby as we do about the postpartum kind.

Source:
Evans J, Heron J, Francomb H, et al.
Cohort study of depressed mood during pregnancy and after childbirth.
BMJ. 2001; 323: 257-260.

⁴ And for some women, postpartum depression is probably

depression
Depression is a mental illness in which your mood is low and you feel sad much of the time. It can range from a mild illness through to a severe one in which you lose interest in life and may be suicidal.

depression continuing from before they got pregnant.

Source:
Chaudron LH.
Postpartum depression: What pediatricians need to know.
Pediatric Review. 2003; 24: 154-161.

⁵

The symptoms of postpartum depression are just like the symptoms of the depression you can get at other times. To learn more, see What are the symptoms of postpartum depression?

Some symptoms, such as sleep problems, weight changes and loss of energy, are also a normal part of being a new mother. This explains why doctors and other health professionals often don't spot postpartum depression.

We don't know what causes postpartum depression. Some researchers think it may be because of:

Source:
Cooper PJ, Murray L.
Fortnightly Review: Postnatal depression.
BMJ. 1998; 316: 1884-1886.

⁶

Source:
Bloch M, Rotenberg N, Koren D.
Risk factors associated with the development of postpartum mood disorders.
Journal of Affective Disorders. 2005; 88: 9-18.

⁷

Changes in your hormone levels
Problems with your

thyroid gland
Your thyroid gland is a small organ that sits in your neck, just in front of your windpipe. It sends out a hormone called thyroxine. This acts on receptors within cells. By acting on the receptors it gives the cells a message to speed up their metabolism and work harder.

thyroid gland
Changes in your

immune system
The immune system is made up of the parts of the body that are devoted to fighting infection. The body is constantly being threatened by infections from things like bacteria, viruses and parasites. The immune system fights these infections in different ways. At the microscopic level, the immune system uses antibodies and white blood cells, which travel in the blood and target infectious agents, such as bacteria. These microscopic parts of the immune system either kill the infectious agent directly, or take it to other parts of the body, like the spleen, where it can be dealt with. The lymph nodes are another important part of the immune system. Within them, white blood cells filter through the foreign material that has entered the blood, to see if there are any infections. When you have a swollen gland during a cold, this is actually a lymph node that is reacting to the infection. Unfortunately, it is possible for the immune system to become confused and to use its destructive powers to target healthy parts of the body. Diseases that result from this type of situation are called autoimmune diseases.

immune system from stress.

There is not much evidence to prove these ideas though. For most women, postpartum depression is more likely to be caused by things in their personal and family life.

But changes in your body might well play a part in causing a much rarer and severe illness called postpartum psychosis. This is most likely to come on suddenly in the first two weeks after your baby is born. It's so serious that most women have to be looked after in the hospital.

Women with postpartum psychosis often have big mood swings and think and behave abnormally. They may also have

hallucinations
If you have hallucinations, you perceive things that aren't really there. You may see things that don't exist or hear voices when nobody's talking. Or you may get a crawling feeling on your skin when there isn't anything on it. Hallucinations can make you feel frightened and agitated.

hallucinations and fantasies that show they can't tell what is real and what isn't.

Source:
Wisner KL, Parry BL, Piontek CM.
Clinical Practice. Postpartum depression.
New England Journal of Medicine. 2002; 347: 194-199.

³ For more information, see Postpartum psychosis.

Why me?

We don't know why some women get postpartum depression and others don't. But there are things that increase your chance of getting it. These are called risk factors.

Having a risk factor doesn't mean that you will definitely get postpartum depression. It just means you are more likely to get it than a woman who doesn't have that risk factor.

Source:
O'Hara MW, Swain AM.
Rates and risks of postpartum depression: a meta-analysis.
International Review of Psychiatry. 1996; 8: 37-54.

⁸

The main risk factors for postpartum depression are:

Source:
O'Hara MW, Swain AM.
Rates and risks of postpartum depression: a meta-analysis.
International Review of Psychiatry. 1996; 8: 37-54.

⁸

Source:
Beck CT.
A meta-analysis of predictors of postpartum depression.
Nursing Research. 1996; 45: 297-303.

⁹

Source:
Wilson LM, Reid AJ, Midmer DK, et al.
Antenatal psychosocial risk factors associated with adverse postpartum family outcomes.
Canadian Medical Association Journal. 1996; 154: 785-799.

¹⁰

Source:
Robertson E, Grace S, Wallington T, et al.
Antenatal risk factors for postpartum depression: a synthesis of recent literature.
General Hospital Psychiatry. 2004; 26: 289-295.

¹¹

You've had depression or other mental health problems before
You don't have much help or support from your family and friends
Your relationship with your husband or partner is poor
You have difficult things going on in your life.

To read more, see Risk factors for postpartum depression.

Sources for the information on this page:

Zonana J, Gorman JM.The neurobiology of postpartum depression.CNS Spectrums. 2005; 10: 792-799, 805.

Clay EC, Seehusen DA.A review of postpartum depression for the primary care physician.Southern Medical Journal. 2004; 97: 157-161.

Wisner KL, Parry BL, Piontek CM.Clinical Practice. Postpartum depression.New England Journal of Medicine. 2002; 347: 194-199.

Evans J, Heron J, Francomb H, et al.Cohort study of depressed mood during pregnancy and after childbirth.BMJ. 2001; 323: 257-260.

Chaudron LH.Postpartum depression: What pediatricians need to know.Pediatric Review. 2003; 24: 154-161.

Cooper PJ, Murray L.Fortnightly Review: Postnatal depression.BMJ. 1998; 316: 1884-1886.

Bloch M, Rotenberg N, Koren D.Risk factors associated with the development of postpartum mood disorders.Journal of Affective Disorders. 2005; 88: 9-18.

O'Hara MW, Swain AM.Rates and risks of postpartum depression: a meta-analysis.International Review of Psychiatry. 1996; 8: 37-54.

Beck CT.A meta-analysis of predictors of postpartum depression.Nursing Research. 1996; 45: 297-303.

Wilson LM, Reid AJ, Midmer DK, et al.Antenatal psychosocial risk factors associated with adverse postpartum family outcomes.Canadian Medical Association Journal. 1996; 154: 785-799.

Robertson E, Grace S, Wallington T, et al.Antenatal risk factors for postpartum depression: a synthesis of recent literature.General Hospital Psychiatry. 2004; 26: 289-295.

This information was last updated on Mar 06, 2009

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