Postpartum Depression: Signs, Statistics, and Treatment Options

After giving birth, many women experience "baby blues" characterized by mood swings and mild depression. 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.

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The baby blues are 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.

Postpartum depression, on the other hand, lingers for much longer. It tends to be more intense, with feelings like persistent sadness, helplessness, guilt, and fatigue. Women may need treatment to alleviate symptoms of PPD.

According to the National Institute of Mental Health (NIMH), up to 80 percent of new moms experience the baby blues. Around 10-20 percent go on to have postpartum depression. 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.

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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 might 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. 

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.  

• RELATED: Male Postpartum Depressions Exists, Too

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.”

• RELATED: Postpartum Anxiety: The Other Baby Blues We Need to Talk About

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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