What is postpartum depression?
Postpartum depression (PPD) is a non-psychotic depression that women may experience shortly after childbirth.
PPD is different from the “baby blues,” which begin
within the first three or four days of giving birth, require no
treatment and lift within a few hours or days. PPD is a deeper
depression that lasts much longer. It usually starts within the first
month after childbirth (although it can occur any time within the first
year) and can last weeks to months. In more serious cases, it can
develop into chronic episodes of depression.
Apart from the fact that it happens
soon after childbirth, PPD is clinically no different from a depressive
episode that occurs at any other time in a woman’s life. PPD symptoms
are the same as in general depression and must meet the same criteria
for diagnosis. However, not surprisingly, the content of the symptoms of
PPD often focuses on motherhood or infant care.
What are the signs & symptoms of postpartum depression?
Every woman is different, but these are some of the more common signs and symptoms of PPD:
- depressed mood or depression with anxiety
- anhedonia, which involves a loss of interest in things that would normally bring pleasure, including the baby
- changes in weight or appetite, which may involve gaining or losing weight
- sleep disturbance and fatigue—common symptoms of depression but very difficult to gauge, since both are normal for new mothers
- physical feelings of being slowed down or restlessness, jumpiness and edginess
- excessive feelings of guilt or worthlessness, which can be
exacerbated by not bonding with the baby, when feelings of extreme joy,
and love are expected
- diminished concentration, inability to think clearly, which can be worsened by sleep deprivation
- recurrent thoughts of death or suicide. For example, the woman may
catch herself thinking that the baby and she are better off dead, or
that “the world is such an awful place to bring a new child into that we
would be better out of it.”
Signs of depression are often missed in new mothers because
significant changes in sleeping patterns, interests, cognitions, energy
levels, moods and body weight are a normal part of new motherhood.
New mothers often resist acknowledging these signs even to themselves
because of the pressure to meet societal expectations of what it means
to be a “good mother,” including how she should be feeling, thinking and
What are the causes & risk factors of postpartum depression?
Although it is not known what causes depression (and therefore PPD),
it is believed that there is no single cause. Physical, hormonal,
social, psychological and emotional factors may all play a part in
triggering the illness. This is known as the biopsychosocial model of
depression, and is accepted by most researchers and clinicians. The
factor or factors that trigger PPD vary from one woman to another. For
example, sleep deprivation resulting from having a new baby can make a
woman vulnerable to other factors that trigger depression.
What is the treatment for postpartum depression?
Treatment of PPD is generally the same as that for depression
that occurs any other time in a woman’s life. Treatments include
psychotherapy, social support and antidepressant medications. PPD if
prolonged and untreated is detrimental to the mother’s health and can
disrupt family relations, undermine infant-mother attachment and impair
the child’s long-term development.
Society’s messages that new motherhood should be a happy time can
create barriers for getting help. A new mother may be reluctant to
recognize that she needs help with depression or seek treatment because
she fears admitting (even to herself) how she is feeling (or not
feeling) about her baby.
- psychotherapy such as interpersonal and cognitive-behavioural therapy (CBT)
- supportive counselling
- increased social support from friends and family and more emotional support from partners
- electro-convulsive therapy
- maternal relaxation or massage
- hormone therapy
- bright light therapy.
Using antidepressants while breastfeeding
Breastfeeding has significant health benefits for the infant and is
psychologically important to many mothers. Mothers who take
antidepressant medication and who wish to breastfeed may worry about the
possible effects of the medication on the baby. Research is
inconclusive, but we know that small amounts of the medications do pass
into breast milk. Mothers are sometimes advised to wait eight or nine
hours after taking antidepressants before breastfeeding.
Will PPD come back again?
Experiencing an episode of depression at any time in life increases
the likelihood of experiencing further episodes. Research suggests that
the minimum risk of experiencing a non–childbirth-related episode of
illness is 25 per cent. The risk of having another postpartum episode
may be as high as 40 per cent, with approximately 24 per cent of all
recurrences occurring within the first two weeks postpartum.
Where can I find help, treatment, and support for postpartum depression?
Treatment at CAMH
Help for Families from CAMH
Ontario Mental Health Helpline (open 24/7 for treatment anywhere in Ontario)
If you are concerned about PPD, there are people who can help you or direct you to other supports, including:
- family doctors
- public health nurses
- hospital programs
- programs for new mothers in the community.
Where can I find more resources related to postpartum depression?
Postpartum Depression Clinical Overview (PDF)