Feeling sad or anxious after baby? It could just be the "baby blues," but 10 to 20 percent of new moms experience postpartum depression. Learn about the signs of postpartum depression and how to treat it.

By Ronnie Lichtman and Allison Winn Scotch
lenetstan/shutterstock

After giving birth, many women experience "baby blues" marked by mood swings, feelings of ambivalence toward motherhood, mild depression, and bouts of unexplainable crying. These blues, which last one or two weeks, may result from hormonal changes or feelings of isolation. Lack of sleep certainly plays a role, too.

For as many as 10-20 percent of new mothers, though, baby blues turns into clinical postpartum depression, or PPD. Read on to learn about postpartum depression symptoms and treatment options.

Postpartum Depression Symptoms

The signs of postpartum depression are different for everyone, and no two mothers experience exactly the same thing.  If you recognize any three of the following symptoms, you may have PPD and should consult a physician. You may need counseling, antidepressant medication, or both. 

  • Persistent sad, anxious, or "empty" mood
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, helplessness
  • Loss of interest or pleasure in hobbies and activities that you once enjoyed, including sex
  • Decreased energy, fatigue, being "slowed down"
  • Difficulty concentrating, remembering, making decisions
  • Insomnia, early-morning awakening, or oversleeping
  • Loss of weight and/or appetite, or overeating and weight gain
  • Thoughts of death or suicide; suicide attempts
  • Restlessness, irritability
  • Persistent physical symptoms that don't respond to treatment, such as headaches, digestive disorders, and chronic pain

So when does postpartum depression start? It’s usually triggered within days or weeks of delivery, but PPD symptoms can appear up to one year later. That’s why it’s important to stay in tune with your body and emotions in the postpartum phase

How Long Does Postpartum Depression Last?

The baby blues can last from a few days to a few weeks and include symptoms like crying spells, anxiety, inability to sleep, and quick fluctuations in mood. On the other hand, postpartum depression lingers for much longer, and it’s generally more intense. Joel Evans, M.D., coauthor of The Whole Pregnancy Handbook (Gotham), explains that if you experienced depression during your pregnancy or have suffered from PPD after previous pregnancies, you may be at increased risk for postpartum depression.

Postpartum Depression Treatment

Unfortunately, at a time when you feel the rockiest, you might have to take the initiative to get help. “Often, doctors don’t know the right questions to ask, and women aren’t telling their doctor how bad they really feel,” says therapist Karen Kleiman, coauthor of Dropping the Baby and Other Scary Thoughts.  

If you think you might have postpartum depression, schedule an appointment right away. It could be with your family physician, midwife, obstetrician, or therapist. You can also look for a reproductive psychiatrist, a doctor who specializes in mood or psychiatric conditions related to reproductive cycles. If your health-care provider doesn’t take your concerns seriously, see someone else.

Treatment for postpartum depression may consist of antidepressant and/or anti-anxiety medication, talk therapy, support groups, or other behavioral methods like cognitive behavioral therapy. Note that most medications are safe if you’re breastfeeding.

If you are diagnosed with postpartum depression (or suspect you have it), the following tips may help:  

  • Set realistic goals, and assume a reasonable amount of responsibility—let your family and friends help you.
  • Break large tasks into small ones, set priorities, and do what you can, as you can.
  • Participate in activities that may make you feel better.
  • Exercise regularly—even if it's just going for a walk. Studies have shown that mild, regular exercise can regulate mood.
  • Expect your mood to improve gradually, not immediately. Remember, people rarely "snap out of" a depression. Feeling better takes time.

Above all else, know that you’re not alone. Finding friends who empathize is crucial. To search for online and local support groups and health professionals experienced with postpartum issues, contact Postpartum Support International (postpartum.net). “Hearing that your condition has a name and you are not crazy can be a tremendous relief,” says Tamar Gur, M.D., Ph.D., professor of psychiatry at The Ohio State University Wexner Medical Center, in Columbus. “I tell women that this is a common condition that’s very treatable.”

A Postpartum Depression Medication

In early 2019, the U.S. Food and Drug Administration (FDA) approved a postpartum depression medication called brexanolone (marketed by manufacturer Sage Therapeutics as Zulresso). As the first FDA-approved medication that aims to treat PPD, it’s an intravenous infusion given continuously over 60 hours. Clinical trials show that it starts working within hours, and these results held up over the month. 

Many experts and women hope that Zulresso could provide the relief they need to combat postpartum depression symptoms, despite side effects of sleepiness, flushing, dry mouth, excessive sedation, and more. The cost for Zulresso is estimated at $34,000 before insurance. Learn more about Zulresso here.

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