What is Postpartum Depression?

UPDATED: JULY 2033

Happiness always follows after the birth of your baby, right?

Nope, not always. 

Postpartum depression (PPD) is a condition that between 7-20% women experience after delivery. Nowadays more light is being shed on PPD because it's a serious public health issue that affects women, children, and families. Even though the defined postpartum period is between 2-6 weeks after birth, postpartum depression can happen anytime between 2 weeks to 1 year after birth. 

About 7% of women experience a major depressive episode within the first 3 months, but if you factor minor depressive episodes, about 20% of women experience those within the first 3 months. 

Within the 2 week to 1 year time period, women may experience major depressive episodes. And other common symptoms mainly experienced in PDD (when compared to major depressive disorder) are psychomotor agitation (ex. anxiety or nervous excitement) and lethargy. You may also notice exaggerated changes in mood and pre-occupation with your baby's well-being. Anxiety, ruminative thoughts and panic may also happen too. 

PPD is a little different than postpartum blues and postpartum psychosis:  

• Postpartum blues: mild dysphoria occurring in the first week after delivery

• Postpartum psychosis: a condition with a rapid onset associated with hallucinations or bizarre delusions, mood impairment swings, disorganized behaviour, and cognitive dominant symptoms, including extreme sadness and loss of interest or pleasure in things previously enjoyed. Usually occurs in conjunction with bipolar disorder. 

Risk Factors of Postpartum Depression

• Depression during pregnancy

• Anxiety during pregnancy

• Experiencing stressful life events during pregnancy or the early postpartum period

• Traumatic birth experience

• Preterm birth

• Low levels of social support

• Previous history of depression

• Breastfeeding problems

• Multiparity

Symptoms of Postpartum Depression

• Depressed mood or severe mood swings

• Excessive crying

• Difficulty bonding with your baby

• Withdrawing from your family and friends

• Loss of appetite or eating much more than usual

• Inability to sleep (insomnia) or sleeping too much

• Overwhelming fatigue or loss of energy

• Reduced interest and pleasure in activities you used to enjoy

• Intense irritability and anger

• Fear that you're not a good mother

• Feelings of worthlessness, shame, guilt or inadequacy

• Diminished ability to think clearly, concentrate or make decisions

• Severe anxiety and panic attacks

• Thoughts of harming yourself or your baby

• Recurrent thoughts of death or suicide

Criteria for a Major Depressive Episode

At least five of the following nine symptoms in the same 2-week period:

• Depressed mood

• Loss of interest or pleasure

• Change in weight or appetite

• Insomnia or hypersomnia

• Psychomotor retardation or agitation

• Loss of energy or fatigue

• Feeling worthlessness or guilt

• Impaired concentration or indecisiveness

• Recurrent thoughts of death and/or suicidal ideation or attempt 

And also have to meet this criteria:

• These symptoms cause significant distress or impairment

• The episode is not attributable to substance abuse or a medical condition

• The episode is not better explained by a psychotic disorder

• The patient has never experienced a manic or hypomanic episode

Next Steps

May moms are reluctant to seek help because they're unable to recognize their own mental health symptoms and accessing care can be difficult. An easy screening tool that will help you determine is PPD is affecting you is the Edinburgh Postnatal Depression Scale. This scale is used by most health practitioners like myself. 

If not treated properly, PPD can affect your overall functioning. While untreated PPD may cause health and developmental problems in your baby - and even affect the whole family. Treatment does not always have to be simply holistic. It may involve medications, and that's perfectly okay. The important thing is that you're getting the support that you need and deserve. 

If you prefer to approach PPD from a holistic lens, be sure to check out postpartum depression and Naturopathic Medicine.

References

Horibe M, Hane Y, Abe J et al. Contraceptives as possible risk factors for postpartum depression: A retrospective study of the food and drug administration adverse event reporting system, 2004-2015. Nurs Open. 2018;5(2):131-138. doi:10.1002/nop2.121.

Polmanteer, R., Keefe, R. and Brownstein-Evans, C. (2018). Trauma-informed care with women diagnosed with postpartum depression: a conceptual framework. Social Work in Health Care, pp.1-16.

Schiller, C., Meltzer-Brody, S. and Rubinow, D. (2014). The role of reproductive hormones in postpartum depression. CNS Spectrums, 20(01), pp.48-59.