Diagnosing and Treating Postpartum Depression
Although many new mothers, and even new fathers, experience a period of exhaustion, anxiety, or sadness after a child is born, most new parents feel these symptoms lift after about two weeks. However, some parents develop a condition called postpartum depression: a type of clinical depression that most often develops about three weeks after childbirth. Women are more likely to experience this condition than men, but any parent can develop it. It does not have to occur after the birth of the first child, as many parents experience postpartum depression after their second or third child.
What Is Postpartum Depression and What Causes It?
Postpartum depression has many potential root causes. Some of these include:
- Existing depression: Women and men who already have experienced depression at some point in their lives are more likely to develop postpartum depression after having a baby.
- History of abuse: New parents who have experienced verbal, emotional, physical, or sexual abuse as children, or in adult relationships, are more likely to have depression or post-traumatic stress disorder. This increases the risk of developing postpartum depression when they have a new baby.
- Substance abuse: Existing substance abuse or a history of substance abuse increases the risk of mood disorders due to brain changes. This increases the risk of body changes, like pregnancy, and lifestyle changes, like a new baby, triggering depression or anxiety.
- Stress: New parents who experience stress because of the new baby are more likely to develop postpartum depression. Stress on new parents includes not wanting to have children, being unprepared for children, lack of help from partners or family, financial or emotional instability, and other environmental triggers.
- Hormonal fluctuations: Hormones like estrogen and progesterone fluctuate a lot over the course of a pregnancy. After childbirth, these hormones drop suddenly after rising steadily for the past nine months. This sudden fall in hormone levels can affect serotonin and dopamine levels in the brain, which may lead to postpartum depression.
- Having multiple children: Having twins, triples, or even more children from the same pregnancy increases the risk of postpartum depression.
A parent who develops postpartum depression symptoms of postpartum depression like refusing to care for the child, fear about being around the child, talking negatively about the child, and expressing concern about harming the child.
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Signs of Postpartum Depression
Initial symptoms of postpartum depression may include the proverbial “baby blues” – feelings of sadness, anxiety, guilt, or exhaustion that begin a few days after childbirth and that may last up to two weeks. If these symptoms do not go away on their own or get worse, this is an indication of postpartum depression.
Early symptoms of the baby blues include:
- Mood swings
- Feeling overwhelmed
- Having trouble concentrating
- Difficulty falling or staying asleep
- Changes to appetite
Postpartum depression can begin at any time after childbirth, up to six months afterward. Symptoms that may continue or get worse include:
- Severe, uncontrollable mood swings
- Intense irritability and anger
- Depressed mood that does not lift
- Excessive crying
- Inability to bond with the baby
- Fear of being a bad parent
- Feeling worthless, ashamed, guilty, or inadequate
- Withdrawing from friends and family
- Changes to appetite (eating a lot or eating very little), leading to weight fluctuation
- Fatigue or exhaustion
- Anhedonia: an inability to feel pleasure, especially in previously enjoyable activities
- Cognitive changes or trouble paying attention
- Difficulty making decisions
- Panic attacks
- Thoughts of self-harm
- Thoughts about harming the baby
- Recurring and uncontrollable thoughts of suicide or death
The experience of postpartum depression may clear up after several months, especially if the new parent has no previous history of depression. However, the experience can be disturbing, making it difficult to create a new routine with a new child in the family. It can also hurt relationships and the person’s feelings of self-worth. It is important to get help for postpartum depression and discuss the baby blues with a doctor if the feelings are intense.
It is also helpful to know that postpartum depression in both mothers and fathers is much more common than many people assume, even in people who are excited to be parents. This means that the medical community is working harder to understand postpartum depression, associated risks like substance abuse, and how to treat the condition.
Postpartum Depression Is a Common Condition
The Centers for Disease Control and Prevention (CDC) reports that as many as one in nine women will develop postpartum depression. The Office of Women’s Health reports that 13 percent of new mothers develop this condition. However, some reports suggest that as many as one in five – or 20 percent – of women develop postpartum depression or another mental health problem like bipolar disorder or postpartum psychosis.
The CDC added to their study on new mothers and depression that about 4 percent of new fathers develop postpartum depression, and 20 percent experienced at least one episode of depression by their child’s 12th birthday. Fathers who develop postpartum depression are likely to have a female partner who is also experiencing postpartum depression.
Between 600,000 and 900,000 women develop postpartum depression every year, but only about 15 percent receive the treatment they need to overcome the condition, avoid co-occurring disorders like substance abuse, and integrate their family into their lives.
Co-Occurring Postpartum Depression and Substance Abuse
Depression and substance abuse are highly correlated, and several studies between 1999 and 2012 revealed that women with postpartum depression were very likely to abuse alcohol or illicit drugs. A survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that 14.9 percent of women between the ages of 15 and 44 reported binge alcohol use during their postpartum period, and 8.5 percent of that group reported illicit drug use.
A study on alcohol consumption among women with postpartum depression found that 1.5-8.4 percent of these women developed some form of problem drinking. While this was lower than the average among women who were neither pregnant nor postpartum, it reflects a potentially troubling form of self-medication among women experiencing mental health disorders. Breastfeeding complicates any amount of drinking after childbirth. Additionally, women who developed problem drinking were more likely to suffer a longer period of postpartum depression, as found in six-month follow-ups.
A different study examined illicit drug use in the past 30 days among postpartum new mothers. Marijuana consumption was about 4.6 percent; cocaine, including crack, was around 0.6 percent; prescribed psychotherapeutic drugs were abused at a rate of 2.6 percent; and polydrug abuse, or consuming more than one intoxicating substance at a time, was 3.9 percent.
Substance abuse increased the risk of postpartum depression, according to some studies. In a study of 385 women, 19.7 percent of those who abused cocaine before having a baby developed postpartum depression symptoms.
Getting Help for Postpartum Depression
As with other forms of clinical depression, postpartum depression has two facets for treatment: medication and therapy. Working with a therapist for both individual and family therapy, to help both partners, is the first step in treating this condition. This is, in part, because evidence-based treatment like Cognitive Behavioral Therapy helps to change behaviors and one’s understanding of the root causes of mental health problems. It is also an important step for women who are concerned that antidepressants may pass through breastmilk and affect their child; while studies show that this is very rare and highly unlikely, therapy should be considered the main focus of postpartum depression treatment.
Antidepressant medication is an important component for treating severe depression, including postpartum depression. Currently, selective serotonin re-uptake inhibitors (SSRIs) are considered the best type of antidepressants available with a prescription from a psychiatrist; however, other classes of antidepressants, including serotonin-norepinephrine re-uptake inhibitors (SNRIs), may be available. Tricyclic antidepressants and MAO Inhibitors are older classes of antidepressants that are very strong and rarely prescribed unless other medications do not work.
The combination of medication and talk therapy has been shown to successfully treat 90 percent of women who pursue help. Complementary treatments can help, such as attending support groups for new parents with postpartum depression. Natural remedies, including some herbal supplements, added vitamins and minerals, exercise, massage, and meditation, may help to ease some symptoms, as long as a doctor is consulted before pursuing these treatments.
Parents who struggle with substance abuse and postpartum depression should detox with the help of a medical professional, receive assessment of their postpartum depression, and enter a rehabilitation program that understands this mood disorder. Such a program should be equipped to treat both the substance abuse condition and postpartum depression simultaneously.
New parents who receive social support and screening for potential postpartum depression are more likely to experience positive outcomes. Crisis hotlines, reaching out to friends or family, or even calling 911 if obsessive thoughts of harm, to oneself or one’s child, occur can prevent devastating outcomes and get new parents the introduction to treatment they need. Friends and family should reach out if they are concerned that a new mother or father in their lives is struggling with postpartum depression, anxiety, or substance abuse.
People struggling with substance abuse who may become pregnant or want to become pregnant should ideally get treatment for the condition before beginning a new family. If a woman is abusing substances and becomes pregnant, professional assistance is imperative to ensure the health of mom and baby.