Baby Blues (Post-Partum Depression)

Baby blues, also known as post-partum depression and maternity blues, is a type of depression that affects some women after giving birth to an infant. It is a very common but self-limited condition that begins shortly after childbirth and can present with a variety of symptoms such as mood swings, irritability, sadness, changes in sleeping and eating patterns, low energy, anxiety, and tearfulness.

Mothers may experience negative mood symptoms mixed with intense periods of joy. Up to 85% of new mothers are affected by postpartum blues, with symptoms starting within a few days after childbirth and lasting up to two weeks in duration.  Typically, the condition develops within 4 to 6 weeks after giving birth, but it can sometimes take several months to appear.

It is not known why PPD occurs. However, depression is not a sign that you do not love your new arrival, as some mothers fear. It is a psychological disorder that can be effectively treated with the help of support groups, counseling, and sometimes medication. Anyone with symptoms should see their doctor immediately.

This type of depression does not only affect mothers. One study found that around 10 percent of new fathers experience postpartum or prenatal depression. The highest rates can be found 3 to 6 months after childbirth.

If symptoms are severe enough to affect daily functioning or last longer than two weeks, the individual should be evaluated for related postpartum psychiatric conditions, such as postpartum depression and postpartum anxiety. It is unclear whether the condition can be prevented, however education and reassurance are important to help alleviate patient distress.

Symptoms

Postpartum depression can affect parents in several different ways. Below are some common signs and symptoms:

  • a feeling of being overwhelmed and trapped, or that it is impossible to cope
  • a low mood that lasts for longer than a week
  • a sensation of being rejected
  • crying a lot
  • feeling guilty
  • frequent irritability
  • headaches, stomach aches, blurred vision
  • lack of appetite
  • loss of libido
  • panic attacks
  • persistent fatigue
  • concentration problems
  • reduced motivation
  • sleeping problems
  • the parent lacks interest in themselves
  • a feeling of inadequacy
  • an unexplained lack of interest in the new baby
  • a lack of desire to meet up or stay in touch with friends

Some people with postpartum depression may have had thoughts about harming their child. They may also think about committing suicide or self-harming. Neither parents nor the infant are harmed in most cases, but having these thoughts can be frightening and distressing.

Causes

PPD is likely to be the result of multiple factors. However, its exact causes are still not known.

Depression is usually caused by emotional, stressful events, a biological change triggering an imbalance of brain chemicals, or both.

Psychosocial causes

Pregnancy and postpartum are significant life events that increase a woman’s vulnerability for postpartum blues. Even with a planned pregnancy, it is normal to have feelings of doubt or regret, and it takes time to adjust to having a newborn. Feelings commonly reported by new parents and lifestyle changes that may contribute to developing early postpartum mood symptoms include;

  • Fatigue after labor and delivery
  • Caring for a newborn that requires 24/7 attention
  • Sleep deprivation
  • Lack of support from family and friends
  • Marital or relationship strain
  • Changes in home and work routines
  • Financial stress
  • Unrealistic expectations of self
  • Societal or cultural pressure to “bounce back” quickly after pregnancy and childbirth
  • Overwhelmed and questioning ability to care for baby
  • Anger, loss, or guilt, especially for parents of premature or sick infants

Risk factors

Most risk factors studied have not clearly and consistently demonstrated an association with postpartum blues. These include sociodemographic factors, such as age and marital status, obstetric factors, such as delivery complications or low birth weight.

Factors most consistently shown to be predictive of postpartum blues are personal and family history of depression.This is of particular interest given of the bidirectional relationship between postpartum blues and postpartum depression: a history of postpartum depression appears to be a risk factor for developing postpartum blues, and postpartum blues confers a higher risk of developing subsequent postpartum depression.

The following factors may contribute to PPD:

  • the physical changes of pregnancy
  • excessive worry about the baby and the responsibilities of being a parent
  • a complicated or difficult labor and childbirth
  • lack of family support
  • worries about relationships
  • financial difficulties
  • loneliness, not having close friends and family around
  • a history of mental health problems
  • the health consequences of childbirth, including urinary incontinenceanemiablood pressure changes, and alterations in metabolism.
  • hormonal changes, due to a sudden and severe drop in estrogen and progesterone levels following birth
  • changes to the sleep cycle

Difficulties with breast-feeding might also be linked to PPD. New mothers who experience breast-feeding difficulties in the 2 weeks following the birth of the infant have a higher risk of PPD 2 months later, according to a study carried out at the University of North Carolina at Chapel Hill.

People with a family history of depression have a higher risk of developing it themselves. However, nobody knows why this occurs.

A previous diagnosis of bipolar disorder might also increase the risk of developing PPD when compared to other people with a new infant.

Diagnosis

A doctor may aim to rule out baby blues by asking the person with suspect PPD to complete a depression-screening questionnaire.

The doctor will often ask whether they have felt low mood, depression, or hopelessness during the past month. They will also query whether the new parent still takes pleasure in activities that would usually make them happy.

The doctor may also ask if the patient has:

  • sleeping problems
  • problems making decisions and concentrating
  • self-confidence problems
  • changes in appetite
  • anxiety
  • fatigue, listlessness, or reluctance to be involved in any physical activity
  • feelings of guilt
  • become self-critical
  • suicidal thoughts

An individual who answers “yes” to three of the questions above probably has mild depression. A person with mild PPD is still able to continue with everyday activities. More “yes” answers suggest a more severe depression.

If the mother answers “yes” to the question of harming themselves or the baby, it is automatically diagnosed as severe PPD.

Some mothers with no partner or close relatives to help out might not want to answer these questions openly because they fear they will be diagnosed with postpartum depression and will have their baby taken away from them.

This is most unlikely to happen. An infant is only taken away in extreme situations. Even in very severe cases where the individual has to be hospitalized in a mental health clinic, the infant will usually accompany them. If a new parent has severe depression, they will face great difficulty functioning at all will not be able to function at all and will need extensive help from a dedicated mental health team.

Prevention

Screening

There are no specific screening recommendations for postpartum blues. Nonetheless, a variety of professional organizations recommend routine screening for depression and/or assessment of emotional well-being during pregnancy and postpartum. Universal screening provides an opportunity to identify women with sub-clinical psychiatric conditions during this period and those at higher risk of developing more severe symptoms. Specific recommendations are listed below:

  • American College of Obstetrics and Gynecology (ACOG): In 2018, ACOG recommended universal screening for depression and anxiety using a validated tool at least once during pregnancy or postpartum, in addition to a full assessment of mood and well-being at the postpartum visit. This is in addition to existing recommendations for annual depression screening in all women.
  • American Academy of Pediatrics (AAP): In 2017, the AAP recommended universal screening of mothers for postpartum depression at the 1-, 2-, 4-, and 6-month well child visits.
  • United States Preventative Services Task Force (USPSTF): In 2016, the USPSTF recommended depression screening in the general adult population, including pregnant and postpartum women. Their recommendations did not include guidelines for frequency of screening.

Primary Prevention

Given the mixed evidence regarding causes of postpartum blues, it is unclear whether prevention strategies would be effective in decreasing the risk of developing this condition. However, educating women during pregnancy about postpartum blues may help to prepare them for these symptoms that are often unexpected and concerning in the setting of excitement and anticipation of a new baby. Mothers who develop postpartum blues often have significant shame or guilt for feelings of anxiety or depression during a time is expected to be joyful. It is important to reassure new parents that low mood symptoms after childbirth are common and transient. Obstetric providers may recommend that patients and their families prepare ahead of time to ensure the mother will have adequate support and rest after the delivery. Additionally, they should provide education and resources to family and friends about red flags of more severe perinatal psychiatric conditions that may develop, such as postpartum depression and postpartum psychosis.

Treatment

Recent parents who feel that they are showing PPD symptoms should get in touch with their doctor. Although recovery may sometimes take several months, and in some cases even longer, it is treatable.

The most important step on the road to treating and recovering from PPD is to acknowledge the problem. Family, partners, and the support of close friends can have a major impact on a faster recovery.

It is better for the person with PPD to express how she feels to people she can trust, rather than repressing emotions. There is a risk of partners or other loved ones feeling shut out, which can lead to relationship difficulties that add to the PPD.

Self-help groups are beneficial. Not only do they provide access to useful guidance, but also access to other parents with similar problems, concerns, and symptoms. This may reduce the feeling of isolation.

Medications

The doctor may prescribe an antidepressant for people with severe PPD. These help to balance the chemicals in the brain that affect mood.

Antidepressants may help with irritability, hopelessness, a feeling of not being able to cope, concentration, and sleeplessness. These medications can help with coping also bonding with the baby but can take a few weeks to become effective.

The downside is that antidepressant chemicals can be passed on to infants through breast milk, and there is little indication of the long-term risks. According to some small studies, tricyclic antidepressants, such as imipramine and nortriptyline, are most likely the safest to take while breast-feeding a baby.

TCAs are not suitable for people with a history of heart diseaseepilepsy, or severe depression with frequent suicidal thoughts.

Those who cannot take TCAs may be prescribed a selective serotonin reuptake inhibitor (SSRI), such as paroxetine or sertraline. The amount of paroxetine or sertraline that eventually gets into breast milk is minimal.

A mother with PPD should discuss feeding options with her doctor so that selecting the right treatment, which may include an antidepressant, is safe for both her and the child.

Tranquilizers may be prescribed in cases of postnatal psychosis, where the mother may have hallucinations, suicidal thoughts, and irrational behavior. However, in such cases, the medications should be used for a short time. Side effects include:

  • loss of balance
  • memory loss
  • lightheadedness
  • drowsiness
  • confusion

Psychological therapies

Share on PinterestCognitive behavioral therapy is one treatment option for PPD.

Studies have found that cognitive behavioral therapy (CBT) can be successful in moderate cases of PPD.

Cognitive therapy is also effective for some people. This type of therapy is based on the principle that the thoughts can trigger depression. The individual is taught how to better manage the relationship between her thoughts and state of mind. The aim is to alter the thought patterns so that they become more positive.

For those with severe depression, where motivation is low, talking therapies alone are less effective. Most studies agree that the best results come from a combination of psychotherapy and medication.

Electroconvulsive therapy

If the symptoms are so severe that they do not respond to other treatment, they might benefit from electroconvulsive therapy (ECT). However, this only suggested when all other options, such as medication have not been successfully.

ECT is applied under general anesthetic and with muscle relaxants. ECT is usually very effective in cases of very severe depression. The benefits, however, may be short-lived.

Side effects include headaches and memory loss that is usually, but not always, short term.

Treating severe postpartum depression

A person with severe PPD may be referred to a team of specialists, including psychiatrists, psychologists, occupational therapists, and specialized nurses. If the doctors feel that the patient is at risk of harming herself or her child, she may be hospitalized in a mental health clinic.

In some cases, the partner or a family member may care for the infant while the person with PPD is being treated.

Lifestyle tips

The more a doctor knows during or even before a pregnancy about the medical and family history, the higher the chances are of preventing PPD.

The following changes may help:

  • Follow a well-balanced, healthy diet.
  • Eat frequently to maintain blood sugar levels.
  • Get at least 7 to 8 hours good-quality sleep each night.
  • Make lists and be organized to reduce stress.
  • Be open in talking to close friends, partners, and family members about feelings and concerns.

Contact local self-help groups.

Statistics

Researchers from Northwestern Medicine reported in JAMA Psychiatry that postpartum depression affects approximately 1 in every 7 new mothers.

In their study, involving over 10,000 mothers, they also found that close to 22 percent of them had been depressed when they were followed up 12 months after giving birth.

The team also discovered that:

  • More than 19 percent of the women who had been screened for depression had considered hurting themselves.
  • A large proportion of mothers who had been diagnosed with postpartum depression were previously diagnosed with another type of depression or anxiety disorder.

A Canadian study found that postpartum depression is much more common in urban areas. They found a 10 percent risk of postpartum depression among women living in urban areas compared with a 6 percent risk for those in rural areas.

Medically reviewed by Obinna Victor Eze on Jenuary 27, 2020 — Written by Adam Felman

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