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Postpartum Depression

Reviewed by Psychology Today Staff

The birth of a baby usually brings excitement, bliss, and joy. But that joy is tempered for the nearly 60 percent of new mothers who also suffer from postpartum depression (PPD). The symptoms include anxiety, depression, irritability, confusion, and crying spells, as well as problems with sleep and appetite. PPD can be mild or severe. When symptoms last just 24 to 72 hours, they can be considered a temporary case of “baby blues,” but when they endure as long as two weeks, new mothers and their partners should take it seriously and seek professional help.

Symptoms and Causes of Postpartum Depression

Many women who appeared to function with impressive calm and efficiency prior to the birth of their child may find themselves baffled and disoriented by the onset of postpartum depression. Some research suggests that PPD sufferers were always more susceptible to anxiety than others, and the stressor of their baby’s arrival activated their innate susceptibility. But for new mothers, social isolation and a weak support network have also been shown to increase the likelihood of developing anxiety after childbirth.

What are the common symptoms of postpartum depression?

Common postpartum symptoms include disorienting feelings of anxiety, irritability, lethargy, or confusion that often lead to frequent crying, sleep and appetite concerns, and in extreme cases, thoughts of self-harm and infanticide. In about half of all cases, symptoms actually begin during pregnancy; in many others, they may not manifest for weeks after delivery, and some experts suggest that doctors should consider postpartum depression as a diagnosis anywhere from six months before birth until a year after.

What are the symptoms of more extreme cases of postpartum depression?

In extreme cases of postpartum depression, sufferers may experience drastic symptoms including hopelessness, panic, shame, guilt, suicidal thoughts, and even thoughts of infanticide enduring for weeks or months. Severe cases of PPD interfere with a new mother's ability to bond with her baby.

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Preventing, Recognizing, and Treating Postpartum

Given the exhaustion of becoming a parent and the demands of the role, it’s not uncommon for new mothers and fathers sometimes to cry. But new mothers suffering from postpartum depression may cry all day, and feel unable to function. They may want to sleep all the time—or, in some cases, find it impossible to sleep at all. When a new parent experiences these symptoms, or rage, thoughts of self-harm, or a fear or aversion to their baby, they should seek treatment, or, if they cannot muster the energy, a loved one should step up to help them.

How do doctors treat postpartum depression?

Postpartum depression is typically treated with a combination of approaches including talk therapy, antidepressants, hormonal therapy, and support group attendance. A promising new medication recently approved for use by the U.S. Food and Drug Administration, known as brexanalone, can alleviate symptoms in a matter of days with benefits that can last a month, although it must be administered in a hospital setting.

What should new mothers do to preserve their mental health?

Make sure not to let their self-care lapse. Clinicians advise new moms to maintain healthy sleep, exercise, and eating routines, to take advantage of support from their social networks, and to find ways to make time for themselves. Resisting the urge to criticize themselves for being tired or unsure of themselves is also important.

Postpartum Psychosis

The scary, disorienting condition known as postpartum psychosis is rarer than postpartum depression, occurring in one to two out of every 1,000 deliveries. It also differs in its rapid and severe onset, and more concerning symptoms. Women experiencing postpartum psychosis are severely impaired, suffering from obsessive thoughts, paranoia, delusions, and hallucinations—sometimes with command hallucinations to kill the infant or delusions that the infant is possessed—and are at risk for suicide and/or infanticide. Symptoms of postpartum psychosis usually manifest within the first four weeks after delivery but can occur anytime within the first 90 days.

How do women manage postpartum psychosis?

An insidious symptom of psychosis is that the woman suffering from it may not fully realize that she is in trouble, or that her thoughts could lead to potentially lethal action. She may wonder if her thoughts are abnormal or if the things she sees and hears are real, but those concerns may not stop her from going through the motions of her day—caring for her baby, working, visiting with others. And the longer those thoughts are present without being addressed, the more entrenched they can become.

Why is postpartum psychosis hard to detect?

Doctors, hospital personnel, and even family members often fail to detect postpartum psychosis not just because the condition is rare, but because women experiencing it may not overtly show symptoms. A key difference between PPD and postpartum psychosis is that the disturbing thoughts that are a symptom of both cause great anxiety and distress to mothers with PPD, but may not overtly trouble those experiencing psychosis; a mother expressing concern about her thoughts, therefore, is more likely dealing with PPD and may be easier to diagnose, while a woman with the more dangerous condition may go undiagnosed.

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