What is Postpartum Depression?

While pregnancy and the postpartum period are often seen as a joyful and special time for many, they can also bring about challenges that might increase the risk of mental health concerns. During the postpartum period, caregivers take on many new responsibilities like caring for the baby, creating a safe environment, and communicating with their little one. It’s also a time to learn new roles and navigate any challenges that might come up.

Postpartum is also a period where birthing parents may experience emotional challenges more frequently during the postpartum period. These experiences generally fall into three categories: postpartum blues, postpartum depression, and postpartum psychosis. Postpartum blues refers to temporary and relatively mild emotional changes, such as tearfulness, irritability, and mood swings, that commonly occur shortly after childbirth. Postpartum depression involves more persistent and intense depressive symptoms that may affect a birthing parent’s daily functioning and ability to care for themselves or their baby. Postpartum psychosis is a rare but severe condition involving symptoms such as confusion, delusions, hallucinations, or significant behavioral changes and requires immediate medical attention.

Although its exact causes are not fully understood, postpartum depression is believed to result from a combination of factors. Hormonal changes following childbirth may affect mood and emotional regulation, while psychosocial factors such as limited social support, relationship difficulties, financial stress, sleep deprivation, and the challenges of adjusting to a new role may further increase the risk. Postpartum depression not only affects the birthing parent but also their interactions with their baby and the entire family, and it requires timely recognition and specialized support. In this therapy sketch, we will review take a closer look at postpartum depression.

What is postpartum depression?

The development of mood disorders during pregnancy and the postpartum period was first proposed by Victor Luis Marce in 1858. The postpartum period is a challenging time marked not only by physiological changes in the birthing parent but also by the transition to parenthood and the assumption of new roles and responsibilities.

Mood disorders that arise during the postpartum period are classified according to the severity, characteristics, treatments, and prognoses of their symptoms; they are grouped into three main categories: postpartum blues, postpartum depression, and postpartum psychosis.

Postpartum Blues

Postpartum blues is one of the most common postpartum problems, affecting a significant proportion, %50–80 percent, of new mothers. Postpartum blues typically emerge between the 3rd and 5th days after childbirth. Birthing parents experiencing postpartum blues generally exhibit symptoms such as crying, sleep disturbances, anxiety, irritability, rapid mood swings, difficulty concentrating, and feelings of loss and grief. While researchers have explored many hormonal and sociodemographic factors related to its causes, the findings have been quite varied. Medication is not required for postpartum blues, and symptoms gradually subside and typically resolve within two weeks. However, if symptoms do not improve within the expected timeframe, care should be taken regarding the risk of progression to depression (Gitlin & Pasnau, 1989; Landy et al., 1989; Robinson & Stewart, 1986).

Postpartum Psychosis

Postpartum psychosis is the most severe of the mental health issues that can arise during the postpartum period. It typically begins within the first two to three weeks following childbirth, and symptoms can persist for two to three months. Initially, symptoms may include severe fatigue, insomnia, an inability to rest, frequent crying, and rapid mood swings. As symptoms progress, suspiciousness, confusion, difficulty adjusting to one’s surroundings or the passage of time, disorganized thoughts and behavior, and a feeling of detachment from oneself or one’s surroundings may emerge. An unusual elevation in mood or intense restlessness and unhappiness may also be observed (Gülseren, 1999; Parry, 1995).

Some people may make statements that do not seem logical, experience persistent, difficult-to-control thoughts about the baby’s health, or develop strong beliefs that do not align with reality. Research indicates that delusions are observed in approximately half of those experiencing postpartum psychosis, while hallucinations are observed in about one-quarter. Postpartum psychosis can also manifest as depressive symptoms, delusions, hallucinations, and thoughts of harming oneself or the baby. Because there is a risk that these thoughts may turn into actions, symptoms must be evaluated carefully and without delay (Thome, 2000; Wisner et al., 2002).

It is important to note that postpartum psychosis is not a condition caused by parenting skills. However, it affects the safety and wellbeing of caregivers and the baby, and it requires careful and timely psychiatric intervention. If symptoms appear, the person should not be left alone, and emergency medical services should be contacted as soon as possible.

Postpartum Depression

Postpartum depression is a form of depression that occurs after childbirth and can affect a birthing parent’s emotions, thoughts, daily functioning, and relationship with their baby. Although its symptoms may resemble those of depression seen in other periods of life, it develops within the unique physical, psychological, and social conditions of the postpartum period. For this reason, it should not be viewed merely as depression experienced after childbirth, but rather evaluated within the broader context (Dilbaz & Enez, 2007; Gülseren, 1999; Karamustafalıoğlu & Tomruk, 2000).

When does it start?

Postpartum depression most often emerges in the first few weeks after childbirth. While symptoms may become apparent in the second or third week for some people, they may develop more gradually and be harder to notice in others. Therefore, the fact that depression does not begin immediately after childbirth does not mean that the difficulties experienced are unrelated to the postpartum period. Symptoms may sometimes become noticeable several months after childbirth and can persist for a long time if left untreated. A gradual onset can lead to postpartum depression being overlooked (Bashiri & Spielvogel, 1999; Georgiopoulos et al., 1999; Gülseren, 1999). Rather than experiencing a sudden, intense feeling of despair, a person may begin to feel increasingly listless, lonely, anxious, or inadequate over time (Gülseren, 1999; Parry, 1995).

What is the difference between postpartum fatigue and depression?

Fatigue, disrupted sleep patterns, changes in appetite, anxiety, and spending less time on personal needs are quite common after childbirth. Some of these experiences may be a natural part of the postpartum adjustment process. Therefore, trying to understand postpartum depression solely through the lens of insomnia or physical fatigue can be misleading (O’Hara et al., 1984).

What matters is how long the symptoms last, how intense they are, and how they affect a person’s life. Exhaustion that does not subside despite rest, a loss of interest in activities that were once enjoyable, intense feelings of guilt, worthlessness, or hopelessness, difficulty organizing one’s thoughts, and an inability to fulfill daily responsibilities are symptoms that warrant closer evaluation for depression. Emotional difficulties that last beyond the first two weeks after childbirth or that are becoming increasingly severe may indicate a need for professional evaluation (Hopkins et al., 1989; Karamustafalıoğlu & Tomruk, 2000).

What does postpartum depression feel like?

Postpartum depression does not manifest the same way in everyone. While sadness and frequent crying may be more prominent in some people, intense anxiety, anger, restlessness, or a complete lack of emotion may be the primary symptoms in others. For this reason, postpartum depression is not always recognizable from the outside as simply looking sad. A person may continue to appear functional to those around them while struggling intensely on the inside (Dilbaz & Enez, 2007; Karamustafalıoğlu & Tomruk, 2000). Symptoms that may be observed in postpartum depression include the following:

Persistent or frequent feelings of sadness and crying
Loss of interest in activities that were previously enjoyable
Intense fatigue and lack of energy
Inability to sleep even when given the opportunity to rest, or sleeping more than usual
A noticeable decrease or increase in appetite
Feeling worthless, inadequate, or like a failure
Constant preoccupation with the thought, “I’m not a good caregiver”
Intense and uncontrollable worries about the baby’s health and safety
Symptoms of panic or a constant feeling that something bad is going to happen
Difficulty concentrating, remembering things, or making decisions
Slowed thinking and movements, or, conversely, intense restlessness
Anger and impatience toward your partner, baby, or those around you
Difficulty forming an emotional bond with your baby
Feeling guilty about wanting time for yourself
Hopelessness about the future
Thoughts about ending your life or self-harm (American Psychiatric Association, 1994)

Experiencing some of these symptoms from time to time does not necessarily mean you have postpartum depression. However, if the symptoms have persisted for a long time, are becoming increasingly intense, or are affecting your ability to care for yourself, your baby, and your daily life, it is important to seek professional help.

Stigma around postpartum mental health challenges

Experiences such as postpartum depression are not a reflection of a caregiver’s parenting capacity or conscious choices. These changes can emerge from a combination of genetic, hormonal, and psychosocial factors and can significantly affect a birthing caregiver’s well-being. Yet the postpartum period is still a time when birthing parents and families may encounter significant stigma and myths, which can create additional barriers to seeking and receiving care.

For example, because of increased expectations from one’s family and community, caregivers may experience greater shame and guilt about the challenges and changes they are going through. They may worry that these experiences will cause others to question their parenting abilities. Similarly, a caregiver may become self-critical about changes in their mood and thoughts, judging their own parenting skills, even though these experiences are not necessarily connected.

Some caregivers may also feel dismissed or overlooked by their healthcare providers when sharing their postpartum challenges. This can deepen feelings of helplessness and add to the stress of an already vulnerable transition into caregiving.

Understanding that we as caregivers and our communities may be experiencing stigma and that this stigma can create barriers to care is an important step toward reducing shame and connecting with support.

Care and support options for postpartum depression

For birthing parents experiencing postpartum depression, the care options available may depend on their particular experiences, including the severity and frequency of their symptoms and how these symptoms are affecting their daily lives. Care may include psychiatric and medication support, psychotherapy, support groups, or a combination of these approaches.

For example, medical options may include antidepressants to help caregivers manage symptoms related to changes in their mood. It is important, however, for caregivers to consult with their healthcare providers about their medication options so they can find what works best for them. For example, if a birthing parent is breastfeeding, their healthcare provider can help them understand which medications may be the best options for them.

Therapy is also recommended to support caregivers who are experiencing postpartum depression. Therapy can help a caregiver make sense of their experience and process and integrate their emotions. It can help them identify negative or self-critical thoughts, learn emotional regulation skills that can support them through changes in mood, reduce rumination and feelings of overwhelm, and develop new coping skills to navigate new experiences, manage important changes, and re-engage in meaningful activities.

In addition to individual therapy for the birthing parent, the family can also participate in couples or family therapy to extend support to the whole family. This can help support the birthing caregiver while also attending to the needs and relationships of the family as a whole, offering a more systemic form of care.

In addition, many caregivers experiencing postpartum depression may also benefit from connecting with a support group. Both peer-based and more structured groups can be helpful. Connecting with others can help caregivers feel less isolated, recognize that they are not alone in their experiences, share coping strategies, and develop a sense of community. Support groups can also provide a safe space to talk about challenges and reduce some of the stigma or guilt that may accompany postpartum depression.

Medication, therapy, and support groups do not need to replace one another. Depending on their individual needs and preferences, caregivers may benefit from a combination of these approaches, allowing for more holistic support.

Experiencing birth and navigating changes in family dynamics can be both rewarding and challenging for new caregivers. At the same time, birthing caregivers may experience increased vulnerability to mental health challenges, including postpartum depression, due to a combination of factors such as hormonal changes and increased distress within their psychosocial environment. Most importantly, experiences such as postpartum depression are not a reflection of a caregiver’s parenting capacity or conscious choices. With compassionate, thoughtful care, options such as medication, therapy, and support groups can provide meaningful support to birthing caregivers and their families during this important transition.

Takeaways

While birth and the transition to parenthood can be a rewarding time, postpartum period can bring increased vulnerability to mental health challenges for the birthing parent, including postpartum blues, postpartum depression and postpartum psychosis.
Postpartum blues involves temporary and relatively mild emotional changes that commonly occur shortly after childbirth and typically resolve within two weeks.
Postpartum psychosis is a rare but severe condition that can affect the safety and wellbeing of the caregiver and baby and requires careful, timely psychiatric intervention.
Postpartum depression can emerge gradually in the first few weeks or months after childbirth and can affect emotions, daily functioning, and relationships with the baby. Symptoms may include sadness, anxiety, anger, restlessness, guilt, hopelessness, or difficulty forming an emotional bond with the baby
Medication, therapy, and support groups can work together to provide holistic support to birthing caregiver and their family, depending on the caregiver’s individual needs and preferences.
Postpartum depression is not a reflection of a caregiver’s parenting capacity or conscious choices, and compassionate, thoughtful care can provide meaningful support to birthing caregivers and their families.

References:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). American Psychiatric Association.
Bashiri, N., & Spielvogel, A. M. (1999). Postpartum depression: A cross-cultural perspective. Primary Care Update for OB/GYNS, 6(3), 82–87.
Dilbaz, N., & Enez, A. (2007). Women and psychiatry: Postpartum mood disorders. Türkiye Klinikleri Journal of Internal Medical Sciences, 3(47), 32–40.
Georgiopoulos, A. M., Bryan, T. L., Yawn, B. P., Houston, M. S., Rummans, T. A., & Therneau, T. M. (1999). Population-based screening for postpartum depression. Obstetrics & Gynecology, 93(5), 653–657.
Gitlin, M. J., & Pasnau, R. O. (1989). Psychiatric syndromes linked to reproductive function in women: A review of current knowledge. American Journal of Psychiatry, 146(11), 1413–1422.
Gülseren, L. (1999). Postpartum depression: A review. Türk Psikiyatri Dergisi, 10(1), 58–67.
Hopkins, J., Campbell, S. B., & Marcus, M. (1989). Postpartum depression and postpartum adaptation: Overlapping constructs? Journal of Affective Disorders, 17(3), 251–254.
Karamustafalıoğlu, N., & Tomruk, N. (2000). Postpartum blue and depression. Mood Disorders Series, 1(2), 64–71.
Landy, S., Montgomery, J., & Walsh, S. (1989). Postpartum depression: A clinical view. Maternal-Child Nursing Journal, 18(1), 1–29.
O’Hara, M. W., Neunaber, D. J., & Zekoski, E. M. (1984). Prospective study of postpartum depression: Prevalence, course, and predictive factors. Journal of Abnormal Psychology, 93(2), 158–171.
Parry, B. L. (1995). Postpartum psychiatric syndromes. In H. I. Kaplan & B. J. Sadock (Eds.), Comprehensive textbook of psychiatry (6th ed., pp. 1059–1066). Williams & Wilkins.
Robinson, G. E., & Stewart, D. E. (1986). Postpartum psychiatric disorders. Canadian Medical Association Journal, 134(1), 31–37.
Thome, M. (2000). Predictors of postpartum depressive symptoms in Icelandic women. Archives of Women’s Mental Health, 3(1), 7–14.
Wisner, K. L., Parry, B. L., & Piontek, C. M. (2002). Clinical practice: Postpartum depression. The New England Journal of Medicine, 347(3), 194–199.
Marakoğlu, K., Özdemir, S., & Çivi, S. (2009). Postpartum depresyon. Türkiye Klinikleri Journal of Medical Sciences, 29(1), 206–214.

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