This topic is about major depression triggered by childbirth. It is different from the "baby blues," which many women have in the first couple of weeks after childbirth. For more information, see Baby Blues.
depression is a serious illness that can occur in the first few months after
childbirth. It also can happen after
miscarriage and stillbirth.
depression can make you feel very sad, hopeless, and worthless. You may have
trouble caring for and bonding with your baby.
depression is not the "baby blues," which usually go away within a
couple of weeks. The symptoms of postpartum depression can last for
In rare cases, a woman may have a severe form of
postpartum psychosis. This is
an emergency, because it can quickly get worse and put her or others in
It's very important to get treatment for depression. The
sooner you get treated, the sooner you'll feel better and enjoy your
depression seems to be brought on by the changes in
hormone levels that occur after pregnancy. Any woman
can get postpartum depression in the months after childbirth, miscarriage, or
You have a greater chance of getting postpartum
You are more likely to get postpartum psychosis if you or
someone in your family has
bipolar disorder (also known as
A woman who has postpartum
These symptoms can occur in the first day or two after
the birth. Or they can follow the symptoms of the baby blues after a couple of
If you think
you may have postpartum depression, take a short quiz to check your symptoms:
A woman who has
postpartum psychosis may feel cut off from her baby. She may see and hear
things that aren't there. Any woman who has postpartum depression can have
fleeting thoughts of suicide or of harming her baby. But a woman with
postpartum psychosis may feel like she has to act on these thoughts.
If you think you can't keep from hurting yourself, your baby, or someone
else, see your doctor right away or call 911 for emergency medical care. For
other resources, call:
doctor will do a physical exam and ask about your symptoms.
sure to tell your doctor about any feelings of baby blues at your first checkup
after the baby is born. Your doctor will want to follow up with you to see how
you are feeling.
Postpartum depression is
treated with counseling and antidepressant medicines. Women with milder
depression may be able to get better with counseling alone. But many women need
both. Moms can still breast-feed their babies while taking certain antidepressants.
To help yourself get better, make sure you eat well,
get some exercise every day, and get as much sleep as possible. Get support
from family and friends if you can.
Try not to feel bad about
yourself for having this illness. It doesn't mean you're a bad mother. Many
women have postpartum depression. It may take time, but you can get better with
Learning about postpartum depression:
Health Tools help you make wise health decisions or take action to improve your health.
Postpartum depression seems to be
triggered by the sudden
hormone changes that happen after childbirth, miscarriage, or stillbirth. This is more likely in women who have certain risk factors, including previous depression. For more information, see What Increases Your Risk.
The two most common symptoms of depression are:
An especially serious symptom of depression is thinking about death and
suicide. Some women with postpartum depression have fleeting, frightening thoughts of harming their babies.
Nearly every day, you may also:
If you have
at least five of the above symptoms for 2 weeks or longer, and one of the
symptoms is either sadness or loss of interest, you may have depression and may
Even if you have fewer symptoms, you may still
be depressed and may benefit from treatment. No matter how many symptoms you
have, it's important to see your doctor. The sooner you get treatment, the
better your chance for a quick and full recovery.
If you think you may
have depression, take a short quiz to check your symptoms:
This severe condition is most likely to affect women who have
bipolar disorder or a history of
postpartum psychosis. Symptoms, which usually start
during the first 3 weeks (as soon as 1 to 2 days) after childbirth,
Postpartum psychosis is considered an emergency requiring
immediate medical treatment. If you have any psychotic symptoms,
seek emergency help right away. Until you tell your
doctor and get treatment, you are at high risk of suddenly harming yourself or
Symptoms of postpartum depression start in the weeks to months after childbirth, miscarriage, or stillbirth.
cases, symptoms peak after slowly building for 3 or 4 months.
Postpartum depression makes it
hard for you to function well. This includes caring for and bonding with your baby.
In rare cases, dangerous
postpartum psychosis symptoms can
occur within the first few postpartum weeks, as soon as a few days
Early treatment is important for you, your
baby, and the rest of your family. The sooner you start, the more quickly you
will recover. And there's less chance that your depression will affect your baby. Babies of
depressed mothers might be less attached to their mothers and might lag behind
developmentally in behavior and mental ability.
For more information about who is more likely to have postpartum depression, see What Increases Your Risk.
A risk factor is anything that increases your chances of having a certain problem. Risk factors for postpartum depression include:
Risk factors for postpartum
Call 911, the national suicide hotline at 1-800-273-TALK (1-800-273-8255), the National Child Abuse Hotline at 1-800-4-A-CHILD (1-800-422-4453), or other emergency services right away if:
Call a doctor right away if:
Seek care soon if:
pregnancy health professional may be the first person to note and
diagnose postpartum depression. This is one of many reasons why it's important to have a medical
check 3 to 6 weeks after childbirth.
Diagnosis and treatment of postpartum
depression can be provided by a:
Counseling can be provided by a:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
For part of your postpartum checkup, your doctor typically asks you about your moods and emotions.
doctor may check your
thyroid-stimulating hormone (TSH) levels to make sure
thyroid problem isn't causing any depression symptoms.
If you have had
postpartum depression, or
postpartum psychosis before, are now pregnant and have
depression, or have
bipolar disorder, ask your doctor and family members
to watch you closely. Some experts suggest that high-risk women have their
first postnatal checkup 3 or 4 weeks after childbirth, rather than the usual 6
Talk to your doctor about your symptoms, and together you can decide what
type of treatment is right for you.
Treatment choices include:
Women with moderate to severe postpartum depression are advised to
combine counseling with antidepressant medicine. Women with mild depression are likely to
benefit from counseling alone.
You may also benefit from:
Antidepressants are typically used for 6
months or longer, first to treat postpartum depression and then to prevent a
relapse of symptoms.
To prevent a relapse, your doctor may recommend that you
take medicine for up to a year before considering tapering off of it. Women who have had several bouts of depression may need to take medicine for a long time.
Keeping your body and mind strong and healthy will help reduce the effects of hormone changes and stress that come with childbirth.
Women whose risk is higher for the reasons listed below may want to take extra steps to prevent postpartum depression.
Postpartum depression is a medical condition. It's not a sign of weakness. Be honest
with yourself and those who care about you. Tell them about your struggle. You,
your doctor, and your friends and family can team up to treat your
There's a lot you can do for yourself at home to cope with postpartum depression, from getting regular exercise to joining a support group.
Antidepressants are commonly used, usually in combination
with counseling and support.
You may start to feel
better within 1 to 3 weeks of taking antidepressant medicine. But it can take
as many as 6 to 8 weeks to see more improvement. If you have questions or
concerns about your medicines, or if you don't notice any improvement by 3
weeks, talk to your doctor.
Antidepressants are typically
used for at least 6 months, first to treat postpartum depression and then to
prevent a relapse of symptoms. To prevent a relapse, your doctor may recommend
that you take medicine for up to a year before you think about stopping it.
Women who have had several bouts of depression may need to take medicine for a long time.
Treating your depression is very important for your baby.
Breast-feeding is good for your baby's health. And it's good for your
baby's bond with you. At best, you will be able to treat your depression
and breast-feed your baby. But if you decide to choose
between taking medicine and breast-feeding, take the medicine.
Poor family and social support
and high stress raise the risk of
postpartum depression. For this reason, every
woman with a new baby needs plenty of support from family and friends. Any
special care you get will help you get through the challenges of the postpartum
prevent and treat depression during pregnancy and after childbirth. To improve treatment success, both parents should try to take part.
Your doctor may recommend a licensed counselor who
specializes in treating postpartum depression. To effectively treat
depression, it's important that you and your counselor have a comfortable
In rare cases,
electroconvulsive therapy is used to treat
severe forms of depression. It works well as short-term treatment.
American Congress of Obstetricians and Gynecologists
(ACOG) is a nonprofit organization of professionals who provide health care for
women, including teens. The ACOG Resource Center publishes manuals and patient
education materials. The Web publications section of the site has patient
education pamphlets on many women's health topics, including reproductive
health, breast-feeding, violence, and quitting smoking.
The American Pregnancy Association is a national health
organization committed to promoting reproductive and pregnancy wellness through
education, research, advocacy, and community awareness. You can call a
toll-free helpline or use the Web site to request patient education materials.
Mental Health America (formerly known as the National
Mental Health Association) is a nonprofit agency devoted to helping people of
all ages live mentally healthier lives. Its website has information about
mental health conditions. It also addresses issues such as grief, stress,
bullying, and more. It includes a confidential depression screening test for
anyone who would like to take it. The short test may help you decide whether
your symptoms are related to depression.
The Office on Women's Health is a service of the U.S. Department of Health and Human Services. It provides women's health information to a variety of
audiences, including consumers, health professionals, and researchers.
Postpartum Support International offers information and support not
only to women who are coping with postpartum depression and anxiety after
childbirth but also to their families. The Web site also includes the Mills
Depression and Anxiety Symptom-Feeling Checklist for evaluating your
Other Works ConsultedAbajo FJ, Garcia-Rodriguez LA (2008). Risk of upper gastrointestinal tract bleeding associated with selective serotonin reuptake inhibitors and venlafaxine therapy. Archives of General Psychiatry, 65(7): 795–803.American College of Obstetricians and Gynecologists (2008, reaffirmed 2009). Use of psychiatric medications during pregnancy and lactation. ACOG Practice Bulletin No. 92. Obstetrics and Gynecology, 111(4): 1001–1020.American College of Obstetricians and Gynecologists (2010). Screening for depression during and after pregnancy. ACOG Committee Opinion No. 453. Washington, DC: American College of Obstetricians and Gynecologists.Cipriani A, et al. (2011). Depression in adults (drug and other physical treatments), search date June 2009. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.Craig M, Howard L (2009). Postnatal depression, search date May 2008. Online version of Clinical Evidence: http://www.clinicalevidence.com.O'Hara MW, Segre LS (2008). Psychologic disorders of pregnancy and the postpartum period. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 504–514. Philadelphia: Lippincott Williams and Wilkins.Spinelli MG (2009). Postpartum psychosis: Detection of risk and management. American Journal of Psychiatry, 166(4): 405–408.Yonkers KA (2009). Management of depression and psychoses during pregnancy and the puerperium. In RK Creasy et al., eds., Creasy and Resnik's Maternal Fetal Medicine, 6th ed., pp. 1113–1122. Philadelphia: Saunders.
March 8, 2012
Patrice Burgess, MD - Family Medicine & Lisa S. Weinstock, MD - Psychiatry
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